SKIN CARE
When to Book a Mole Check or Skin Lesion Assessment
Changes worth checking, what the appointment should clarify, and when referral may be the safer next step.
Most moles are benign. Most skin lesions are harmless. But not all changes should be ignored, and the difficulty for patients is knowing which changes are worth checking and which can safely be observed. A mole or lesion that has changed in size, shape, colour, border, texture or sensation — or one that is bleeding, crusting, itching or behaving differently from others on the body — deserves a proper clinical assessment rather than continued monitoring at home.
The purpose of a mole or lesion check is clinical clarity: is this benign, does it need monitoring, should it be treated, or should it be referred for a specialist opinion?
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The ABCDE guide to mole changes
The ABCDE criteria are a practical framework used to assess whether a mole may need further investigation. A — Asymmetry: one half of the mole does not match the other. B — Border: the edges are irregular, ragged, or poorly defined. C — Colour: the mole has more than one shade (brown, black, red, white, or blue). D — Diameter: the mole is larger than 6mm, though smaller lesions can still be significant if they are changing. E — Evolving: the mole has changed in size, shape, colour, or behaviour over weeks or months. Any one of these features can justify an assessment. Multiple features increase the clinical urgency.
What happens at a mole check appointment
Your GP will examine the mole or lesion directly, assess its features against the criteria above, and consider the clinical context — your skin type, sun exposure history, family history of skin cancer, and whether you have multiple atypical moles. The examination helps determine whether the lesion looks clearly benign (common moles, seborrhoeic keratoses, dermatofibromas), whether it looks uncertain and warrants monitoring or photography for comparison, or whether it has features that warrant urgent or routine referral to dermatology for further assessment or excision biopsy.
Early detection
Why waiting can be the wrong decision
Melanoma is the most serious form of skin cancer, but when caught early, outcomes are significantly better. The challenge is that early melanoma can look unremarkable — it may resemble a normal mole with subtle changes. Patients often delay assessment because they assume a mole is fine, because it does not hurt, or because they feel embarrassed about booking for something that might turn out to be nothing. In dermatology, “probably nothing” is still worth checking.
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Beyond moles
Other lesions worth assessing
Not every skin lesion assessment is about melanoma. Patients also present with skin tags, seborrhoeic keratoses, cysts, lipomas, warts, and other benign growths that are cosmetically bothersome or physically irritating. Some of these can be treated with cryotherapy or simple removal at the practice. Others may need dermatology referral for excision. The assessment clarifies what the lesion is and what, if anything, should be done about it.
Common questions
What should prompt me to book a mole check rather than wait and watch?
Changes in size, shape, colour, border irregularity, asymmetry, new bleeding, itching or pain in an existing mole warrant review. A new lesion that appears different from your other moles, or a mole that looks different from it used to, is also a reason to book. If something feels worrying, it is reasonable to have it looked at rather than wait.
Does the GP remove moles, or refer for specialist assessment?
The GP’s role at a mole-check appointment is assessment — examining the lesion, considering the wider skin picture, and deciding whether it can be reassured, monitored, or referred to a dermatologist for further evaluation or removal. Some benign lesions can be removed in-clinic; anything uncertain is referred for specialist review rather than removed at Basuto.
Can a mole check give me a definitive answer about whether a lesion is cancerous?
Not on its own. The appointment identifies whether a lesion has features that warrant specialist assessment. A definitive diagnosis requires dermatology review and, where needed, a biopsy to examine the tissue. The GP’s role is to identify when that further step is needed, not to provide the final diagnosis in-clinic.
FURTHER READING