The ABCDE Signs of a ”Changing Mole”

Assurance Skin, Laser & Aesthetics | 2 Apr 2015

 One should be concerned if a mole starts to change in size, shape or color, especially if it occurs rapidly.

A mole is a small spot of darkened pigment on the skin. Most moles are circular or oval and are usually not very large.

For cosmetic reasons, smaller moles can be removed by laser surgery or cautery.  Bigger moles are best removed by surgical excision. Only excisional surgery will be employed when an abnormal looking mole is suspicious of being cancerous. Such moles will need to be examined histologically to exclude malignant melanoma. Do consult a doctor or dermatologist to have a proper clinical evaluation if you intend to have your moles removed.

Moles cannot be prevented. Some are congenital at birth and others are acquired later in life. Most acquired moles are considered to be benign growths. They typically start formation during early childhood. It has been suggested that they form in response to sun exposure. However, genetic factor is clearly involved in the formation of moles.

Skin Cancers: The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. 

1. Basal cell carcinoma(BCC)

Pigmented BCC on nose, often mistaken as mole
BCC is very common and makes up 80-85% of all skin cancers. BCC usually develops on the face, nose, and around the mouth of fair-skinned individuals. It may just be a red patch or shiny bump or an open sore that does not heal. In Asians, it often presents as a pigmented bump, giving the misleading impression that it is a mole. This type of cancer can be cured easily if treated early with surgery.

2. Squamous cell carcinoma (SCC)

Forehead SCC

SCC makes up 10% of all skin cancers and usually appears as a scaly patch or raised, warty growth. It also has a high cure rate when found and treated early with surgery. In rare cases, if not treated, it can be deadly.

3. Melanoma

Invasive Pigmented melanoma on left thigh

Melanoma makes up only 5% of all skin cancers. However it is the most dangerous form of skin cancer and is the leading cause of death from skin diseases. It usually looks like a dark brown or black mole-like patch with irregular edges. This type of skin cancer can occur anywhere on the body and when found early, can be cured with surgery. If ignored, it spreads throughout the body and can be fatal.

Risk factors of Melonoma include:

  1. fair complexion
  2. excessive childhood sun exposure and blistering childhood sunburns
  3. increased number of atypical looking moles
  4. family history of melanoma and
  5. presence of a changing mole on the skin.

One thing worthy of note is that more than 50% of melanomas are believed to arise from the skin without a preexisting pigmented lesion.

Early detection of melanoma is the best hope of reducing mortality and achieving a cure. Emphasizing to high-risk patients about the need of regular total body self or dermatological examination is very important.

ABCDE signs of  a ”changing mole”

The warning signs of early melanoma follow the ABCDE criteria for a changing mole:

  • Asymmetry
  • Border notching
  • Colour changes
  • Diameter >6 mm
  • Enlarging rapidly

A “changing mole” is the most common symptom of melanoma. More than 80% of patients with melanoma have observed such warning signs at the time of diagnosis. Symptoms, such as bleeding, itching, ulceration, and pain in a pigmented lesion, also warrant evaluation.

If you have a family history of melanoma or other risk factors for melanoma, it is important for you to schedule regular check ups with a dermatologist who is trained to identify skin cancers for early detection of changing moles.

Treatment for Skin Cancer

The first line treatment of skin cancer is always surgical excision and it is better to treat early than late.

A skin biopsy with laboratory analysis is sometimes necessary to confirm the clinical suspicion.  Thereafter, your dermatologist will plan the surgical excision to completely remove the skin cancer. A wide excision surgery may sometimes be necessary depending on the type of skin cancers you have.

Further blood test and imaging studies may have to be done to detect if the cancer has spread to other parts of body. Chemotherapy or radiation therapy may sometimes be necessary as a follow up treatment.


Assurance Skin, Laser & Aesthetics
Mount Elizabeth Novena Specialist Centre 
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Singapore 329563
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