High mole-arity
March 29, 2012 9:26 AM   Subscribe

How do people with lots of moles monitor them for signs of cancer?

I have a lot of moles. My left forearm alone, elbow to wrist, has 33 moles. My face has a baker's dozen that I can see in the mirror. I would conservatively estimate that I have, in total, over 200 moles on my body.

Lately this has been bothering me. It doesn't help that I periodically get asked if I am worried about skin cancer. In one case, a dude told me that a mole on my face looked bigger and that the commenter's relative died from skin cancer so shouldn't I get that removed? I went to a company outing and apparently my back looks like a "million pieces of fly shit" that might all be cancer from sun (thanks, Malaysian lady!*). A coworker told me he was glad he wasn't me because with this many moles I probably already have skin cancer.

My initial response is basically fuck you very much for your concern and commentary on my harmless skin marks, but it's starting to get me wondering. How am I supposed to monitor these things? I briefly toyed with the idea of a mole spreadsheet, tracking various attributes, taking pictures, but then I realized just how crazy that sounded. Right now I am kind of noting the ones that I can see and that seem worth watching but with so many of the things I am starting to wonder if it's even worth bothering. A doctor told me "you'll know if one of them gives you trouble" but that sounds a little stupid.

The appearance of the moles doesn't bother me. I grew up with them and they are part of who I am. I would let the whole thing slide if it wasn't for the cancer angle that everyone and their dog seems to want to comment about. It bothers me that they might be a health concern that I am currently not monitoring because of the magnitude of the task. Therefore my questions are, in order: should I be concerned about being, um, moley? If so, how do I decide what to monitor or should I actually make an effort to monitor them all?

*Apparently this is a common idiom in Malaysia, that moles are places where a fly shit on you. At least, that's what came out of her mouth when everyone at the lakeside BBQ suddenly turned and gave her the silent stare when she came up with that particular gem.
posted by Sternmeyer to Health & Fitness (27 answers total) 14 users marked this as a favorite
Best answer: You go to a dermatologist. I have a friend at high risk for skin cancer, and she does, in fact, have measurements, notes, and pictures of all her moles that her dermatologist takes yearly, and then compares to her skin the next year.
posted by brainmouse at 9:29 AM on March 29, 2012 [2 favorites]

You see a dermatologist who can assess the moles you have in their current state and tell you what to be on the look out for.

Mostly, if a mole changes in anyway --- color, size, a hair grows out of it where there was no hair before --- or you develop a new one, you want to get checked out.

And, I can't say this enough, ALWAYS WEAR SUNSCREEN IN THE SUN!
posted by zizzle at 9:29 AM on March 29, 2012 [1 favorite]

Kaiser around here takes pictures of you each time you come in and a computer compares them to see if there are any changes. (This is in addition to your MD looking for any suspicious changes.)
posted by small_ruminant at 9:30 AM on March 29, 2012

My dermatologist said that I should get my husband to monitor them, too, as he might notice changes that I don't, particularly those in areas I can't see (back, etc).
posted by jenny76 at 9:30 AM on March 29, 2012

Yeah, I've gone to dermatologists who take pictures for record-keeping. And then I proceed to move, again, leaving all of those records and my dermatologist behind. I've done this twice now. So, additional recommendation: remember to get a copy of your file if you relocate, even if contacting the dermatologist's office sounds like a low priority moving item.
posted by deludingmyself at 9:34 AM on March 29, 2012

If I were you, I'd start taking photos of them maybe twice a year. The reason I say this is because the growth of a cancerous mole can be so slow that you're positive it hasn't changed at all. I had a very slow-growing mole on my face for almost 20 years. Every year I'd go in and ask the dermatologist about it, and he'd say it was fine. Finally it got too weird-looking and I went to a new dermatologist who took one look at it and said "that looks like a BCC, let's biopsy it." And sure enough that's what it was. I was sure it had always looked like that, but then checking pictures of a younger me, it was much, much smaller.
posted by HotToddy at 9:35 AM on March 29, 2012 [1 favorite]

I don't have that many moles, and whenever I go to the dermatologist, I get a "mole check." I also keep an eye on them.

I have a few friends who have many, many moles (like you), and all of them have had some removed for signs of precancerous growth. If you have a lot of moles, go see a dermatologist ASAP.
posted by ablazingsaddle at 9:36 AM on March 29, 2012

Nthing the advice of consulting a dermatologist. I also have many moles. I go once a year for a good going over. My dr uses a nifty cube shaped thing that I guess is a magnifier to see if there are any changes. I've had two weirdo moles removed so far -- both benign, thankfully. On her order I wear SPF 30 on my face and all exposed skin. If you don't like the greasy feel of some sunscreens, I recommend Kiehl's Creme de Corps with SPF30 sunscreen.
posted by dorkydancer at 9:41 AM on March 29, 2012 [1 favorite]

Best answer: You go to a dermatologist and have them looked at, and you follow the dermatologist's advice. I think some of the concern is overblown; melanoma is a serious cancer, yes, but in most cases if you have a doctor checking you reasonably often (once a year or even every six month if your dermatologist recommends it should be more than enough) it's caught while surgery can cure it. (And many of the cases where it's not curable don't end up being "obvious" cases anyway, but rather nodular melanomas that even experienced dermatologists often miss.) If you have a significant other that can check your back, that also helps.

I have a lot of moles, too, but I have a doctor look at them every so often, and I have my significant other check them every month or so.

And not that you asked, but all three people that have made comments to you are way out of line.
posted by infinitywaltz at 9:48 AM on March 29, 2012

As long as they are nice and round, are smaller than a pencil eraser, are uniform in color (no splotches of darker or lighter bits), and stay flat then I don't worry.

When any of those things change I have my doctor check it out. If she says go to a dermatologist then I'd go. So far anything I've been concerned about my doctor has given an okay.

I avoid the sun like a vampire.

My husband checks the areas I can't see.

I have a family history of skin cancer, so I tend to be pretty vigilant.
posted by TooFewShoes at 9:51 AM on March 29, 2012

Go to the dermatologist. With a high number of moles, this is something you should be doing once a year, probably. You should monitor them for changes at home, too, and be aware of the mole warning signs, which are typically remembered by the acronym ABCDE (asymmetrical, border, color, diameter, elevation). However, with a large number of moles, the ugly duckling method is also useful--keep a special eye on any moles that look different from your others.

I have no family history of skin cancer, but a shit-ton of moles is a common thing in my family, and my sister and I both get checked regularly. The dermatologist will usually want to remove one or two, too, during these checks. It's not a big deal, just something to be vigilant about.

And yes, those people are out of line. However, since I've been so trained to look for weird moles, I often notice suspicious-looking moles on others. The people telling you that you might want to get them checked out might be on to something, and you shouldn't ignore them out of defensiveness.

A doctor told me "you'll know if one of them gives you trouble" but that sounds a little stupid.

You should find a new doctor.
posted by PhoBWanKenobi at 10:01 AM on March 29, 2012

My wife and I both have lots of moles. She keeps a close eye on them for any sudden growth, color changes, etc. and gets them checked every few months by a dermatologist.

I use lots of sunscreen and cross my fingers. WHO WILL WIN?
posted by M.C. Lo-Carb! at 10:02 AM on March 29, 2012 [2 favorites]

A dermatologist examines your skin carefully. They've seen thousands of patients. They're usually pretty good at spotting areas of concern. If they are very concerned about a spot, they'll take a biopsy. In borderline cases, they'll photograph and measure the area, and at your next visit, compare it against the record; if there are any changes, they'll take a biopsy etc. Sometimes, they can take a biopsy that's a bit larger/deeper, and really it's just a way of removing an iffy patch so that nothing develops in the future.

If you are white, especially if you are male, and especially if you have light color hair, blue or green eyes, are a "ginger", have very light skin, burn easily in the sun (rather than tan), are of Irish descent, have been sunburnt as a child or teenager, have a family history of skin cancer, you should go to a dermatologist for a full skin examination once a year. When the dermatologist examines you, they will determine how often they need to see you - perhaps as often as every six or even three months in extreme cases.

Have your significant other (if you do) examine areas you cannot see (back).

Be watchful, especially in the area of head and neck (where 80% of all skin cancers occur), for moles that change in any way. Remember ABCD for a mole - Asymmetry (the mole is not round) Border (not clean cut) Color (a distinct area that's light/dark or different color in the mole, especially one half of the mole) Dimension (larger than about 3mm or so). If the mole starts bleeding, or itching, that can be of concern.

Wear sunscreen. Always. Or cover with clothing that does not allow UV to penetrate. Be aware that UV rays bounce - off of concrete, f.ex., so merely having, say, your face not in direct sunlight is no guarantee that you're not getting UV radiation.

50% of deadly melanomas do not develop from moles, but from areas clear of moles - for example, you can get melanoma in the under your nails in the nail bed.
posted by VikingSword at 10:04 AM on March 29, 2012

Chiming in to say that I am pale and have lots of moles and I visit a dermatologist for a mole check every year or two, and my husband and I look at them every so often for changes. (You know, like everyone else has already said.) I have a bonus complication of being heavily tattooed, so my mole checks take a little longer since my derm has to look closely at the ones surrounded by ink, but that's about it. I also religiously wear sunscreen any time I am outside. Skin cancer runs in my family, so I was told to do this from a very young age.

Thanks for posting this - you reminded me that I'm due for a mole check!
posted by bedhead at 10:18 AM on March 29, 2012

Best answer: It bothers me that they might be a health concern that I am currently not monitoring because of the magnitude of the task. Therefore my questions are, in order: should I be concerned about being, um, moley? If so, how do I decide what to monitor or should I actually make an effort to monitor them all?

I think that in order not to spend your life in a state of vague anxiety you outsource this entire concern to a dermatologist you see at the rate at which s/he suggests, every six months, once a year, whatever, and place the management of this problem in their capable hands.

And to people's rude questions, a brief smile and 'Thanks, no worries, I'm just moley' and quick subject change.
posted by A Terrible Llama at 10:21 AM on March 29, 2012

I have over 100 moles and I keep an eye on them for potential skin cancer changes. I do think that a spreadsheet tracking the location and attributes of the moles is overkill, but that might be because I know myself well enough to know that I'd spend a whole afternoon putting that together then never open it again.

However, taking digital pictures of yourself nude is actually easy, quick, and provides a nice way to go back and check "hey has this mole that's now catching my eye always been there, and looked like that?" You want to actually take a series of pictures that are each close-up enough to see what the moles look like, but far enough away that's it clear where on your body they are.

My experience with needing a mole biopsy that did end up to be non-benign was that I indeed noticed that something wasn't right. It wasn't an immediate "oh my gosh, that mole has CHANGED" moment, though--it just kept catching my eye and I puzzled for a few weeks over whether that mole had always been on my cheek. I finally went back to check a photo from a year before (lucky it was on my face, so pics were available) and it was only after seeing the picture that I realized it had changed from a very light brown to jet-black.

If you have more than 100 moles you are at an elevated risk for melanoma, but that risk is still pretty low. For me, taking digital pictures once a year and going to the dermatologist somewhere around once a year (sometimes more like once every two) feels like a pretty easy way to manage that risk in a smart way that is sustainable.
posted by iminurmefi at 10:23 AM on March 29, 2012

Those people are jerks! But I do back up the idea of having your partner check you out on the regular, too. Or if you don't have one, get a mole buddy!

When I was in my twenties, I was looking at my boyfriend's leg and said "Huh, that mole looks just like the ones they show in the skin cancer pamphlets." Luckily he was a total hypochondriac, because he got it checked immediately, the biopsy came back positive and then he had a bigger chunk of leg removed. As others have said, melanoma is a serious thing, but for him, the whole thing was over, literally in a week.
posted by looli at 10:26 AM on March 29, 2012

I have lots of moles and have had ten removed over the last 13 years after visual inspections or biopsies pegged them as likely precancerous.

I go to a dermatologist every six months for a full-body check, and ask him to err on the side of caution. The removal is not a demanding process if you catch the things early, and I'd much rather have a few extra scars on me than risk melanoma. This is not unusual for fair-skinned mole-prone people.

The other thing I do, which my dermatologist tells me is unusual, is to have photo references of my healthy skin that the doctor can compare me against during a checkup. My mother hired a medical photographer when I was 16, right after my first round of removals, to take a binder full of pictures of me from every possible angle, and I bring that binder with me to each checkup. This gives you and your doctor a definite way to tell if a mole is new or has changed shape, size or color, instead of relying on you to have a perfect memory for all 100+ blemishes on your body. This seems extreme if you're still at the "this might be something to check out" stage, but if the doctor tells you that this is something to be concerned about, I would definitely recommend having pictures done.
posted by Holy Zarquon's Singing Fish at 10:35 AM on March 29, 2012

It's a pain in the neck to monitor all your own moles if you have that many; but that's the JOB of a good dermatologist. I go once a year for a mole check. Peace of mind, and it may well save your life (I actually know two people who died of melanoma. I also know several people who had it, but are fine...because they had those weird moles checked.) People with as many moles as you have ARE at a higher risk for melanoma, so it's smart to be on top of it.

A doctor told me "you'll know if one of them gives you trouble" but that sounds a little stupid.

This IS stupid. You will know if one of them gets REALLY WEIRD but you want to catch them when they're only just a wee bit weird.
posted by Countess Sandwich at 10:37 AM on March 29, 2012

Response by poster: Thanks for the replies. I've had some challenges regarding medical care for moles so the dermatologist suggestion is not as easy as I would like.

I live in an underserved area for MDs and have no family doctor. This means that my medical care is obtained at the local health clinic, with no real continuity of care. Basically I get to see whatever doctor in in the office at the time. When I do go see a doctor and ask about moles, they happily take a look and declare them fine.

I have asked to get a referral to a dermatologist but every doctor has so far refused because they do not feel I need the care of a dermatologist. The one time I pushed, the doctor looked back in my file and said I "seemed a little bit hypo" about moles, seeing as I had been looked at several times with no problems or diagnosis. This pisses me right off because by the time something gets nasty enough that they will refer me, I suspect it will be pretty far along. I am glad to hear that my situation isn't outlandish and that this is exactly what a dermatologist does.

My plan going forward is to really push for a referral so I can get on top of this. Hopefully I can get in to see a doctor willing to do that for me.
posted by Sternmeyer at 10:46 AM on March 29, 2012 [1 favorite]

Sternmeyer, that sounds like a difficult situation! Yikes!

Definitely continue to push for a a referral, but if you are paying for your medical care out of pocket/without insurance, you probably don't need a referral. If you have insurance, you may also be able to get away with seeing a dermatologist without a referral as well. It depends on your plan, your provider, etc.

Good luck!
posted by ablazingsaddle at 11:16 AM on March 29, 2012

Regardless of whether or not you can see a dermatologist (good luck!), I am in favor of the DIY Take Pictures and enlisting a friend methods. I don't have many, but I am super fair, and have a family history; I also have a couple of really oddly-shaped ones that have always been oddly-shaped but that need to be monitored constantly. The pictures help though this is reminding me that I need a new appointment stat.... I think it's really a shame your doctors have not been supportive of you, as it could be a serious issue. I would never have cared about mine except that every doctor that I've seen does a little double-take and makes sure I've shown them to a specialist, etc. and there have been no changes.
posted by jetlagaddict at 11:47 AM on March 29, 2012

You're me! I'm super moley too, with family history of melanoma and a few bad spots lopped off me. I've also had periods of no/crap insurance, and ppo/HMO.

If you need a referral, try using some alarming key words to your referring doc: moles that are changing, itchy, scabbing, suddenly darker/stretching out, or oozing are Bad News. Tell your referring doc you have moles with these traits; point them out if you have any that look weird. I hate having to fib to get the proper care, but I did this to get my annual skin check throug an HMO once. Waiting until a spot looks weird enough for a non-specialist to notice is a game I chose to avoid. Good luck!
posted by BigJen at 12:48 PM on March 29, 2012 [1 favorite]

If you're having trouble getting doctors to take you seriously, one approach that has worked very well for me and family members of mine in the past is to get them to document their non-concern in writing. For example, if they tell you you don't need a dermatologist referral, ask them to write that down on their professional letterhead and sign & date it for you. In my experience, this has resulted in getting the referral or test the patient wants 100% of the time. It's like "OK, if you're willing to gamble with my life, you need to also be willing to gamble with your license."

On the flip side, if they truly believe there is no reason for further investigation, there shouldn't be a problem with them saying so in writing.
posted by KathrynT at 2:45 PM on March 29, 2012 [3 favorites]

In New Zealand and Australia there is a technology called "molemap", which as I understand it just images your moles all over your body, and then can compare later images to the earlier one to catch changes. (Obviously skin cancer is a big concern down here.) Googling I see this indication that it may have reached the USA a few years ago. If and when you do get to see a dermatologist, it might be worth asking around whether he/she knows anywhere near you that provides this service. Or maybe you'll be able to find something about it through googling.
posted by lollusc at 4:37 PM on March 29, 2012

*Apparently this is a common idiom in Malaysia, that moles are places where a fly shit on you.

To be fair, the same word for shit (tahi) is also the proper word for ear wax and the stuff in your eye in the morning, so don't take it too hard!
posted by BinGregory at 7:50 PM on March 29, 2012

Since the dermatologist isn't really a great option for you, I suggest taking pictures as others have mentioned. You will become more familiar the more you study them.

It's terrifying, honestly. I have tons of moles too (and am super pasty white) and have had 3 go rounds with skin cancer (basil cell carcinoma) in 3 years. Only one of them was a mole, and it was on my back. It started turning color from dark brown to a more pale brown.

I have had other moles removed that weren't cancerous - just bothered me or were too big or too dark (or both) and those spots are now hideous. I should have just stuck with the moles there.
posted by getawaysticks at 7:18 AM on March 30, 2012

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