Fact: Seven New Zealanders are diagnosed with melanoma each day, 80 per cent of new cancers are skin cancer and 480 Kiwis lose their lives to this silent killer. Top Auckland-based reconstructive and cosmetic surgeon, Dr Tristan de Chalain warns, "If you have moles on your skin, get them checked it's better to be reassured than regretful."
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As a member of a generation of women who grew up having fun in the sun in the '80s, sporting a tan was my ultimate beach accessory. Fast forward to 2020, and the scars from years of sunshine are the moles I see in the mirror. I asked Dr Tristan de Chalain, to shed light on detecting melanoma from an unsuspicious mole. With summer on its way, we felt the need to share the facts and some great advice on how to stay safe under our harsh New Zealand sun.
“I believe it’s vital to have a yearly top-to-toe skin check. Early detection can mean the difference between life and death. ”
Dr Tristan de Chalain
What is a mole?
Moles, or naevi (singular naevus), are growths on the skin that may vary in colour from very, pale flesh tones to very dark brown or black. They may be isolated or clumped in groups. They are benign (i.e. non-cancerous) growths, which may be located anywhere on the skin. Most appear in early childhood and during the first two to three decades of life. Moles are subject to change; they may enlarge or disappear; some may grow a hair or two, and a tiny proportion may undergo malignant degeneration and become cancerous.
What causes moles on the body?
Clusters of melanin-producing cells called melanocytes cause them, and it's unknown what causes these clusters to form, but most European and Asian adults will have some ten to 40 moles during their adult life. Moles may darken with sun exposure and pregnancy. Men and women will usually have equal numbers of moles.
Who are the most at risk of getting moles and does skin colour factor?
Men and women appear to be equally affected. Most moles occur between childhood and early middle age. While sun exposure can cause a mole to darken, it won't provoke moles' development. When it comes to skin colouring, fair-skinned people have more visible moles, but pigmented skins can also exhibit moles.
Images Dr Tristan de Chalain
Above: melanoma A asymmetry and simple mole. Above: Both normal skin moles.
Are all moles capable of becoming melanoma?
Congenital moles (moles present at birth) may have a slightly higher risk of conversion to melanoma, and around 1 in 100 people would have a congenital naevus. Similarly, dysplastic naevi (moles which look different from other moles) are usually larger and have a more poorly defined and irregular border. These moles have a greater likelihood of converting to a malignancy.
What are the signs that a mole needs removal?
The great majority of moles never present a problem. However, a small proportion is at risk of undergoing malignant degeneration. If a mole is large, 5mm ( the size of an eraser on top of a pencil), or you have moles in sun-exposed areas or any moles that have been subject to repeated trauma. There are red flags or signs of cancer conversion; this is what to look out for when self-examining.
So what should you look for when self-checking your body?
Firstly, it's essential to check your moles regularly; this includes moles in hard to see areas such as between the toes and on the back. Use a mirror or enlist the aid of your partner, but do check regularly. Pay particular attention to those exposed to sunlight. Moles that don't change are unimportant, but moles that show changes in shape, size, colour or sensation, deserve an expert's examination. I recommend an annual top-to-toe skin check or a mole map session; your dermatologist or plastic surgeon will be happy to help.
When buying a sunscreen what is the best SPF protection?
Wear a daily moisturiser fortified with at least an SPF 15. Activities in the sun like sports, gardening, beach-going, demand a good sunblock, practice sun avoidance between 11 am and 3 pm, and use protective gear like hats and long-sleeved shirts. Mineral powder provides adequate sun protection, and many makeup brands incorporate an SPF in the formula. As with most things, the key is commonsense; some protection is better than none, especially for men who generally hate anything with that goopy-feel on their skin. The act of actually using the product far outweighs any theoretical benefits of one product over another. In other words, shop around for a product you like to wear, and then use it.
Images from Dr Tristan Chalain
Above: Small and large Dysplastic Naevus. Above: Melanoma C colour, malignant melanoma.
What are the myths around sunscreen you want people to understand?
The biggest one is that using a high SPF means you won't burn. SPF means 'sun protection factor' which loosely translated suggests using a product with an SPF of 15 will allow you 15 times the sunshine dose before exhibiting the same degree of damage that would have occurred if you don't use any sunscreen. In other words, the UV radiation in the sun is still doing you harm, but at a slower rate. My advice is to use sunscreen liberally and often, and don't hesitate to reapply. Slip, slop, slap is still great advice.
What do you want to share from your experience treating melanoma?
Melanoma is called the "silent killer" for a reason. It's often completely free of symptoms, unlike the non-pigmented skin cancers, such as squamous cell cancers (SCC) and basal cell cancers (BCC). Be alert for changes in moles on your body and those of friends, loved ones, and those who have a low threshold for getting an expert opinion. My motto: Rather be reassured than regretful. My policy is to remove any mole that looks at all suspicious, and I have, in this way, caught several unexpected melanomas. Sensible adults should have mammograms, pap smears, and prostate exams on an annual basis; likewise, I believe it's vital to have a yearly top-to-toe skin check. Early detection can mean the difference between life and death.
