The ABCDE rule, what a changing mole means, and how to take a photograph a doctor can actually assess.
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Skin cancer is the most common cancer in the UK, and the great majority of cases are highly treatable. Most are basal cell or squamous cell carcinomas — slow-growing, rarely life-threatening, and curable when dealt with.
Melanoma is the one that matters most. It is far less common but behaves differently: it can spread, and the difference between early and late is substantial. Caught early it is usually cured by a straightforward excision.
Skin assesses reasonably well remotely, provided the photographs are taken properly. That is a real advantage of a service like this, and it is one of the few areas where we can add something rather than simply pointing you elsewhere.
What we cannot do is diagnose. A skin cancer diagnosis is made by removing the lesion and examining it under a microscope. A photograph decides how urgently you need seeing — not what it is.
Of these, E matters most. A mole that is changing deserves attention regardless of how it scores on the others.
The ugly duckling sign. Most people's moles look broadly like each other. A mole that stands out as different from all your others is worth showing to a doctor, even if it does not tick an ABCDE box.
Soles of the feet, between the toes, under the nails, the scalp, behind the ears and the back. Melanoma occurs in places that never see the sun, and these sites are diagnosed later because nobody checks them.
A new dark streak under a fingernail or toenail that is not from an injury needs assessing.
Skin cancer is less common in people with darker skin, but it is diagnosed later and outcomes are worse.
Acral melanoma — on the palms, soles and under the nails — is proportionally more common in people with darker skin, and those are precisely the sites nobody thinks to check. This deserves stating plainly, because the message that skin cancer is a fair-skinned problem causes real harm.
Decades of outdoor work is a genuine risk factor — farming, construction, groundwork, roofing. It is cumulative, and it is rarely thought of as an exposure at all.
Assessment starts with examination, usually with a dermatoscope — a magnifying device with a light that shows structures invisible to the naked eye and considerably improves accuracy.
The diagnosis itself is made by removing the lesion and examining it under a microscope. There is no blood test and no scan that substitutes for this.
For melanoma, the thickness matters more than almost anything else — it drives what happens next and the outlook. That is measured on the removed specimen, which is why complete excision rather than a shave sample is important.
A good photograph lets a doctor decide how urgently you need to be seen. That is genuinely useful and can save weeks.
It cannot make a diagnosis, and any service implying otherwise is overselling. Some melanomas look unremarkable in a photograph, and some alarming-looking lesions turn out to be entirely benign.
Mole-checking apps are not a substitute for assessment. They miss melanomas, and a reassuring app result has led people to delay.
Skin is the area where remote assessment works best, and where we can do something rather than simply redirect you.
Send photographs in advance and a GP will review them properly — deciding whether this needs urgent referral, routine referral, or nothing at all.
We cannot diagnose skin cancer, and we cannot remove anything. Diagnosis needs excision and microscopy.
Nor can we use a dermatoscope through a photograph, which is a real limitation — it is the tool that most improves accuracy.
Where the appearance is concerning, you need an urgent dermatology referral — free on the NHS, and generally within two weeks.
A private GP usually cannot make that referral directly. We write to your NHS GP the same day with the images and the assessment, which is what gets it moving.
Ask specifically for an urgent suspected skin cancer referral. It is free and it is usually quick.
Melanoma treated early is usually cured by a single excision. The whole reason for acting on a changing mole is that the difference between early and late is so large.
Moles you have had for years that have not changed, and skin tags, which are harmless. Neither needs an urgent appointment — though anything you are unsure about is worth photographing and asking about.
There is no safe way to use a sunbed, and "building a base tan" is not a real thing. Melanoma risk rises with use and rises more when use starts young.
A tan is not a sign of health — it is a sign of skin damage that has already happened.
Every couple of months, in good light, with a mirror or a partner for your back. Include your scalp, the soles of your feet, between your toes and under your nails.
Photographing anything you are watching, with a ruler, is genuinely useful — comparison over months is more informative than memory.
Vitamin D matters, but you do not need to burn for it. Short exposures are enough, and a cheap daily supplement through the winter does the rest.
This is an NHS pathway and the NHS does it well. Suspected skin cancer goes down the urgent two-week-wait referral route — fast, free, and seen by dermatologists with dermoscopy and the ability to biopsy. Nothing a private online GP offers improves on that.
What we can genuinely do is look at a photograph today and write the referral the same day. That matters, because the alternative is often a three-week wait for an appointment to have the conversation at all — and in melanoma, weeks count.
The honest limitation of assessing a mole by photograph is real and worth stating. Dermoscopy — magnified, polarised examination — detects features invisible to the naked eye and to a phone camera. A reassuring photograph is not the same as a reassuring dermoscopic examination, and where there is any doubt we refer rather than reassure.
Private dermatology mole checks are widely marketed. They can be worthwhile for someone with many atypical moles or a strong family history, but routine whole-body mole screening in low-risk people is not recommended — it generates anxiety and unnecessary excisions without evidence of benefit.
What costs nothing and prevents more skin cancer than any check: sun protection, avoiding sunburn, and never using sunbeds — which are a Group 1 carcinogen.
NICE NG12, Suspected cancer: recognition and referral, is the governing guideline. It defines urgent referral for suspected melanoma using the weighted 7-point checklist — change in size, shape or colour scoring two each; diameter 7mm or more, inflammation, oozing and change in sensation scoring one — with referral at a score of three or above, or for any lesion suspicious of melanoma.
NG12 also sets out referral criteria for squamous cell carcinoma and non-urgent referral pathways for basal cell carcinoma.
NICE NG14, Melanoma: assessment and management, covers diagnosis, staging and follow-up, and recommends dermoscopy by a trained clinician for assessing pigmented lesions — the basis for the limitation stated above.
The UK National Screening Committee does not recommend population screening for skin cancer, which underpins the position on routine mole checks.
IARC classifies ultraviolet-emitting tanning devices as Group 1 carcinogens, and the Sunbeds (Regulation) Act 2010 prohibits their use by under-18s.
No — and any service claiming otherwise is overselling.
What a photograph does is decide how urgently you need to be seen, which is genuinely useful and can save weeks. The diagnosis is made by removing the lesion and examining it under a microscope.
Good natural light, in focus, no flash, no filters. Take one close-up filling the frame and one from further back showing the location, and include something for scale.
Filters and editing alter exactly the colours that matter, so send the originals.
Change. A mole that is changing in size, shape, colour or sensation matters more than any other feature.
And the ugly duckling sign — a mole that looks different from all your others is worth showing someone even if it does not tick an ABCDE box.
Your risk is lower, but it is not zero — and outcomes are worse because diagnosis comes later.
Acral melanoma, on the palms, soles and under the nails, is proportionally more common in people with darker skin. Those sites are worth checking specifically, because almost nobody does.
Not good enough to rely on. They miss melanomas, and a reassuring result has led people to delay getting seen.
Use them as a prompt if you like, never as an answer.
If you have a specific lesion that is changing — go to your NHS GP. It is free and it leads to an urgent dermatology referral within two weeks.
Where private mole mapping can make sense is if you have very many moles, a family history of melanoma, or a previous skin cancer, and want systematic surveillance.
What it should not be is a substitute for acting on a changing mole today.
Not entirely. Most people apply well under the tested amount and reapply too rarely.
Shade, clothing and a hat do more, and they do not wear off. Sunscreen works best as the layer for what those miss.
Worth getting checked. A sore that does not heal within four weeks, or that heals and returns, is one of the commonest presentations of basal cell carcinoma.
These are slow-growing and highly treatable, but they do not resolve on their own and they get harder to treat the longer they are left.
Yes — cumulative occupational sun exposure is a genuine risk factor, and it is rarely thought of as an exposure at all.
It makes regular self-checking worthwhile, particularly on the face, ears, neck, forearms and the back of the hands.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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