Mole and Pigmented Lesion Monitoring

Monitoring moles and pigmented lesions means regular examination of the skin by a dermatologist, to follow the appearance of moles over time and to spot any change early. It combines a clinical examination of the whole skin with dermatoscopy and a comparison of the findings from one check-up to the next.

The main aim is the early detection of melanoma and other skin cancers, at stages when treatment is usually simpler. At Detalii Med in Baia Mare, monitoring is carried out by Dr Alina Perța, senior consultant dermatologist, and Dr Greta Jurj, specialist dermatologist.

Regular monitoring is recommended especially for people with a higher risk of skin cancer:

• people with many moles, for example more than 50;
• people with atypical moles, irregular in shape or with several colours;
• people with large moles present from birth;
• people with fair skin, freckles, red or blond hair, who burn easily in the sun;
• people who have had repeated sunburn, especially in childhood, or who have often used sunbeds;
• people with a personal or family history of melanoma;
• people with reduced immunity, for example as a result of immunosuppressive treatment.

Monitoring makes it possible to notice subtle changes in a mole that might go unnoticed at a single examination. Comparison over time helps the doctor identify lesions that are changing and recommend their removal at the right moment, while avoiding unnecessary excision of stable moles.

Monitoring does not prevent skin cancer and cannot rule out the risk completely. A melanoma can also appear on skin without moles or between two check-ups. For this reason, monthly self-examination and sun protection remain important. When a lesion is suspicious, the diagnosis can only be established by removing it and examining it histopathologically.

At the first visit, the doctor discusses risk factors with the patient: skin type, sun exposure, past sunburn, sunbed use and personal and family history. The patient can point out any moles that have worried them or that they have seen changing.

Based on this information and the examination, the doctor decides whether monitoring is needed and at what interval. The patient also receives an explanation of the warning signs, often summarised by the ABCDE rule: asymmetry, irregular borders, uneven colour, a diameter larger than about 6 mm and evolution, meaning any change over time.

The examination usually covers the entire skin surface, including the scalp, between the fingers and toes, the soles of the feet and less visible areas. The patient is asked to undress to their underwear, with their privacy respected. The doctor looks at the moles with the naked eye and at those of interest with the dermatoscope.

Lesions that need monitoring are noted and documented so that they can be compared at the next check-up. At the end, the patient is told the status of the important lesions:

• lesions that look benign and need no special action;
• lesions to be reviewed after a shorter interval, usually a few months;
• lesions for which removal and histopathological examination are recommended.

Removal of a mole can be scheduled separately, after the consultation.

Monitoring requires no recovery, and the patient can resume their activities straight away. Between check-ups, the patient's role is important: self-examination of the skin about once a month is recommended, in front of a mirror, with the help of a hand mirror or a family member for the back and scalp.

Sun protection is part of prevention: avoiding exposure during peak hours, protective clothing, a hat, high-factor sunscreen and giving up sunbeds.

Skin examination and dermatoscopy do not usually involve any risk or discomfort. The limits of monitoring lie in the fact that no examination method is completely accurate and that some lesions can change quickly between check-ups.

If a lesion is removed, the procedure has its own risks, such as bleeding, infection or a scar, which are discussed separately beforehand. The patient should come back earlier than the scheduled date if they notice a new mole, a change in shape, colour or size, or a lesion that bleeds or does not heal.

The result of each examination is discussed at the end of the visit. The first full assessment usually takes longer than later check-ups, especially for people with many moles.

The monitoring interval is set individually. For many people at increased risk, a yearly check-up is recommended, while lesions under observation may be reviewed after a few months. Monitoring is a long-term process: its benefit comes from regularity and from comparing findings over time.

Regular mole monitoring is a simple and useful form of prevention for people at risk of skin cancer. It combines regular medical examination with self-examination and sun protection. Any change in a mole should be shown to a dermatologist, and suspicious lesions are removed and examined histopathologically.