Skin concern
Moles & Skin Lesions
Most marks on adult skin are benign, and most of them look alike to the naked eye. What a lesion turns out to be decides whether it is left alone, monitored, removed or sent to a specialist, so identifying it comes before any decision about treating it.
Understanding the cause
What's happening in your skin
Most adult skin marks are benign
Skin tags, seborrhoeic keratoses, cherry angiomas and ordinary moles account for most of what people bring in. They behave differently from one another and look much the same without magnification.
Skin tags are soft outgrowths that catch on collars, seatbelts and jewellery. Seborrhoeic keratoses are the waxy, stuck-on brown patches that start arriving from the forties onward and are routinely mistaken for moles. Cherry angiomas are small red vascular spots. Ordinary moles are clusters of pigment cells, most of them acquired through childhood and early adulthood. None of these is a problem in itself. The reason a new mark still warrants a look is that a mark you have noticed is a mark you cannot name, and naming it is the whole of the first appointment.
The naked eye is the wrong instrument
In a randomised trial in primary care, adding a dermoscope moved sensitivity from 54.1% to 79.2%, while specificity held at 71.3% and 71.8%.
A dermoscope combines magnification with polarised light, so pigment networks, vessel patterns and border architecture sitting below the surface become visible. Those structures are what separate one brown mark from another, and they are largely invisible without the instrument. The second pair of numbers matters as much as the first. Specificity is the share of harmless lesions correctly left alone, and an examination that flags everything pays for its sensitivity in unnecessary referrals, waiting and worry.
What it is decides what happens next
Nothing that looks suspicious is removed here as a cosmetic procedure. Assessment comes first on every lesion, and that order is not negotiable.
Three routes follow an assessment. A benign lesion that catches, bleeds or bothers you can be removed, by cryotherapy for suitable surface lesions or by doctor-led shave removal, cautery or minor excision where that suits the lesion better. A lesion causing no trouble can be imaged and monitored, with specific guidance on what would count as a change. A lesion that needs a specialist opinion is sent for one, and we say so rather than treating it.
