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Mole Mapping/Surveillance

Checked: 30-05-2025 by Rob Adams Next Review: 01-06-2027

Overview

A routine mole mapping service or mole surveillance service is not available in BNSSG.

Please see the advice from the Primary Care Dermatology Society on atypical (dysplastic) melanocytic naevi.

Patients with multiple benign looking naevi or only a few atypical naevi which have not changed (and no FH of melanoma) can be managed in primary care with advice about self-examination, 3 monthly reviews in surgery and/or self-photographing of moles.

David de Berker (consultant dermatologist at UHBW) has the following advice:

'We do get patients with all kinds of scenarios, multiple benign normal moles, multiple atypical moles, one atypical mole among lots of normal moles and so on. Mole mapping is usually only undertaken if there are several risk factors or one over riding factor like lots of atypical moles. However, we would usually be seeing such a patient on the basis of suspicion concerning a particular mole and the context would then drive the next step.

Having lots of average looking moles is not a reason for referral.'

Red Flags

See the following guide from Clinical Knowledge Summaries:

Skin cancers - recognition and referral | CKS | NICE (2)

If there is any suspicion that a mole is malignant, then the best route to an opinion is via the Skin - USC (2WW) pathway.

What to do before referral

Patients who have multiple moles but who do not have a mole that is suspected to be malignant can usually be managed in primary care.

PCDS (1) recommends the following general advice:

Patients need to be taught on appropriate UV protection and the self-examination of moles and informed to look for new lesions and change in existing lesions - approximately 20% of all melanomas arise from pre-existing naevi, with the remaining majority arising de novo.
Patients should take photographs of their moles and store the images on their mobile phone or computer - the patient and partner / relative should perform regular skin examinations to look for change.

Atypical Mole Syndrome (AMS) and Familial Atypical Mole and Melanoma syndrome (FAMMM)

Referral for dermatology review should be considered in the following scenarios (1):

if a patient has atypical mole syndrome (AMS) with a very large numbers of moles (at least 50, of which at least 2 are atypical)
if a patient has familial atypical mole and melanoma syndrome (FAMM) – AMS plus FH of melanoma in one or more 1^st and 2^nd degree relatives.

If there is still any uncertainty about the need for a dermatology opinion then please consider using Advice & Guidance. (there is an option for secondary care to convert to a referral if the box on eRS is ticked).

Referral

Routine referrals for mole surveillance are usually not indicated and may be returned with advice to consider alternative pathways.

If there are concerning moles then an urgent suspected cancer referral should be considered.

Alternatively, Dermatology Advice and Guidance can be helpful if there is still uncertainty. Referrers can use the conversion to referral option which allows the dermatologist to arrange an appointment if this is necessary.

Referrals for benign skin lesions are otherwise subject to the Benign Skin Lesion Policy - Prior Approval.

Resources

References

(1) Atypical (dysplastic) melanocytic naevus (pcds.org.uk)

(2) Skin cancers - recognition and referral | CKS | NICE

Self examination - advice for patients

Moles - NHS - advice leaflet from the NHS on moles.
Melanocytic naevi (pigemented moles) -British Association of Dermatologists
PCDS video - self-examination of moles - 7 minute video for patients on recognising concerning moles.

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