It is wise to have a skin check whenever you notice concerning spots. While some skin cancer lesions appear suddenly, others grow slowly over time. For example, the crusty, pre-cancerous lesions associated with sunspots can take years to develop. Other forms of skin cancer, like melanoma, can appear very suddenly, while at other times, the lesions can vanish and reappear.

If you have a family history of skin cancer, suntan or use tanning beds, you are at increased risk.

In general, you should start getting screened for skin cancer in your 20s or 30s. However, if you are in the sun a lot, have a family history of skin cancer, or have moles, you should be checked sooner.

It is recommended that all adults check their own skin every three months. It’s important to completely examine your skin from the top of your scalp to the soles of your feet. You will need the help of a partner or friend to check areas you cannot see, like the back of your ears.

As part of a complete early detection strategy, we recommend that you see a dermatologist once a year, or more often if you are at a higher risk of skin cancer, for a full-body, professional skin exam.

You will be asked to take off all of your clothes and put on a medical exam gown. Our doctor will ask if you have any moles or any lesions that concern you. They will then look at every inch of your body — from your face, chest, arms, back, and legs to less-visible places like your scalp, behind your ears, between your toes, and the soles of your feet.

The actual check of your skin can take from 5 up to 30 minutes depending on your skin type and the number of moles and spots to be looked at. This includes some time for the doctor to ask you questions about your general health and family history. Make sure you tell the doctor about any spots or moles you have which are changing, sore, abnormal or new.

If any concern skin lesion, for a precise diagnosis you may be advised to have a skin biopsy. Our doctors will discuss with you regarding the suitable procedure for your condition.

Shave biopsy:  A use of a tool similar to a razor to remove a small section of the top layers of skin (epidermis and a portion of the dermis).

Punch biopsy: A use of a circular tool to remove a small core of skin, including deeper layers (epidermis, dermis and superficial fat).

Excisional biopsy: A use of a small knife (scalpel) to remove an entire lump or an area of abnormal skin, including a portion of normal skin down to or through the fatty layer of skin.

Depending on the location of the skin biopsy, you may be asked to undress and change into a clean gown. Our doctor will then clean the area of the skin and mark to outline the biopsy area.

You then receive an anaesthetic injection to numb the biopsy site. The numbing medication can cause a burning sensation in the skin for a few seconds. Afterward, you should not feel any pain or discomfort during the skin biopsy. To make sure the anaesthetic is working before the procedure begins, the doctor or nurse will prick your skin with a needle and ask you if you feel any sensation.

A skin biopsy typically takes about 15 minutes total, including the preparation time, dressing the wound and instructions for at-home care.

Our doctor may instruct you to keep the bandage over the biopsy site until the next day. Continue wound care as instructed until the stitches are removed or, if you don’t have stitches, until the skin is healed.

Our doctor will arrange an appointment for stitches removal and to discuss the results. Healing of the wound can take several weeks but is usually complete within two months. Wounds on the legs and feet tend to heal slower than those on other areas of the body.

Any biopsy will probably leave at least a small scar. Different methods can result in different scars, so if this is a concern, ask the doctor about possible scarring before the biopsy is done.

Please inform our doctor if you are taking any medication (particularly aspirin, clopidogrel, dabigatran and warfarin, which could make you bleed more), or if you have any allergies, medical conditions, or a pacemaker or implanted defibrillator. Remember, to tell the doctor about any over-the-counter supplements or herbal remedies as a number of these can also lead to abnormal bleeding.

Our doctor will explain to you why the skin lesion needs excision and the procedure involved. You may have to sign a consent form to indicate that you understand and agree to the surgical procedure.

The area to be removed is marked with a surgical marker. A local anaesthetic injection will rapidly numb the area of skin involved and keep it numb during the procedure. The numbing medication can cause a burning sensation in the skin for a few seconds. The dermatologist will then cut around and under the lesion with a scalpel and sharp scissors along with an appropriate margin of normal surrounding tissue.

There may be some bleeding in the area from where the lesion has been removed during the surgery. To stop bleeding the doctor may coagulate the blood vessels with a cautery. This can make a hissing sound and a burning smell but will not be felt.

The edges of the wound will then be sewn together to make a thin suture line. This type of wound closure is called primary closure. There may be two layers of sutures (stitches) ­ a layer underneath that is absorbable and a layer of sutures on the surface which will need to be removed in 4-14 days. Occasionally special skin glue is used to join the edges together, instead of sutures.

A dressing may be applied, and instructions will be given on how to care for your wound and when to get the stitches out.

The time the procedure may take varies, but it is likely to be between 30 and 90 minutes.

The lesion needs to be analysed for the precise diagnosis it will be placed in formalin ready to go to the pathology laboratory. Here, a pathologist will process and examine the specimen under the microscope and provide your doctor with a report a few days later.

Your wound may be tender 1–2 hours after the excision when the local anaesthetic wears off.

Leave the dressing in place for 48 hours or as advised by your dermatologist. Avoid strenuous exertion and stretching of the area until the stitches are removed and for some time afterwards.

If there is any bleeding, press on the wound firmly with a clean folded towel without removing the existing dressing or looking at it for 20 minutes. If it is still bleeding after this time, seek medical attention.

Keep the wound dry for 48 hours. You can then gently wash and dry the wound. A small amount of pinkness and tenderness to touch around the wound edges is normal but, if the wound becomes increasingly red or painful, consult your dermatologist promptly — it could be infected and need a course of antibiotics.

The scar will initially be red and raised but usually reduces in colour and size over several months.

Most wounds take 1 to 3 weeks to heal. If a large area of skin was removed, you may have a skin graft. In that case, healing may take longer. Some soreness around the site of the wound is normal.

Mole mapping may be recommended for people who have a higher risk of melanoma, including those with: moles present at birth that can turn into skin cancer, an atypical mole called a dysplastic nevus, a mole that is larger than a nickel, which may have an irregular shape or an uneven colour. Mole mapping can also be offered for those who have a family history of skin cancer and a large number of moles especially if more than 50.

Mole mapping can help identify skin cancers early and, in some cases, reduces the need for biopsies.

Mole mapping, also known as Automated Total Body Mapping (ATBM), involves a specialized computer taking photos of your entire body and then combining these photos into a complete image of your body. This baseline image is then compared to your whole-body photograph during your follow-up visit (usually the next year).

Prior to any surgical or non-surgical procedure being carried out, here at The London Cosmetic Clinic, we will request that you attend a no obligation consultation, skin analysis and medical history check, so that we can advise on the best course of action safely and effectively.