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Do moles continue changing in adults?

QIt is often said moles stop changing in young adults, but in my experience they don't. The contraceptive pill and pregnancy change them, but they still seem to evolve beyond that. It causes many adults to attend. What is the truth?

A Moles do change in adults. In children they are usually flat, brown and small. With age they often enlarge (although less frequently beyond 5mm) and in some sites they also become raised.

These raised moles are benign, end-stage 'old' moles, but they cause concern to patients. The skin-coloured papules around the mouths of older people that have hairs coming out of them are examples.

The trouble is that other changes are indeed worrying ­ the challenge is to teach the public to recognise them.

The key changes are in shape, diameter and colour. Early melanomas usually look like harmless moles which become progressively irregular in shape and develop colour changes. A benign mole is usually brown and fairly symmetrical. An evolving melanoma may have a ragged edge and have additional colours such as black or red.

The imperative is to excise melanomas early when they are curable, and research suggests most delays in treatment are caused by the patient not presenting immediately. If anything, patients should be encouraged to self-examine and seek advice if their moles change.

It is often said moles change in pregnancy, but there is no data to support this view. There is some evidence that when melanoma presents in pregnancy the tumours may be thicker. This myth that moles are 'allowed' to change in pregnancy may encourage late presentation.

Pregnant women should therefore be encouraged to seek advice if their mole changes.

Dr Julia Newton-Bishop is consultant in dermatology,

St James University Hospital,

Leeds

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