You’re Probably Not Checking Your Moles Enough
Feature illustration by Maria Jia Ling Pitt; inserts by Ana Tellez

Wearing sunscreen is one of those things, like updating our operating systems, that we all know we’re supposed to do but usually only half-do, half of the time, not sweating it until it bites us in the ass. It’s a problem. The older and wiser women in my life are constantly telling me to protect my skin. I nod and nod, yes yes absolutely, and then quickly return to whatever small crisis is occupying my time. The lesson has a 30-second lifespan. But my “silly me” mentality is not going to look cute in ten years, when my moles come out of the woodwork, all asymmetrical and ominous.


Or, it’s a little bit about wrinkles. But only in the sense that wrinkles — which form first and most prominently on our faces and hands, where the sun shines — are proof that the sun has a drastic effect on skin. In ways visible and invisible. Denying it is like denying vegetables are worth eating. We’re only hurting ourselves. We’ll be wearing our skin suits forever, until they sag and droop around our sorry-ass bones. It’s not like hair! How we treat it now matters in the long run.

If you’ve been as willfully ignorant as I have (and are aware in only the vaguest terms that moles shouldn’t change shape or something), join me in going back to the basics: what the fuck is a mole, why do they matter more in the summer, how we should be taking care of ourselves, etc.

I spoke with two dermatologists, Dr. Amy Wechsler and Dr. Melinda Longaker, for summer skin tips and general life guidance. Read on if you love yourself.

Melanin: Between the top and second layer of our skin, we have skin cells called melanocytes. These are the cells that produce melanin, a.k.a. pigment. The more powerful and active they are, the darker your skin will be. Melanocytes produce melanin through a process called melanogenesis. UV radiation from the sun boosts this process, causing the skin to create more melanin to protect itself. This is why some skin darkens in the sun.

Freckles: Scientifically known as ephelides, freckles are a product of increased melanin production in response to sun exposure. If your melanocytes are spread out evenly, you tan. If they’re bunched up, unevenly, you freckle. Freckles are flat, round, light brown-ish and frequently come and go (just as tans do). They are small — from one to five millimeters in diameter, or somewhere between the dull point of your elementary-school pencil and the eraser. Freckles are harmless.

Liver spots: Technically called lentigines, liver spots (sometimes called sun spots) look like big freckles. They’re the result of increased melanocyte production (the pigment-producing cells, not the pigment itself) — but only in the top layer of the skin, which is why they are usually harmless. They can be up to 10 millimeters wide (a.k.a. one centimeter). Liver spots are the result of exposure to the sun over a long period of time. Like decades.

Moles: Moles are raised spots that mostly develop in the first 20 years of life, and then continue to change over time. They are typically smaller than lentigines but bigger than freckles. Moles are clusters of melanocyte cells, sort of like liver spots, but deeper-rooted and in tighter quarters, making them more dangerous. Most people have between 10 and 40 moles, but only 10% of the population experience “atypical” moles, and only .0001 of those will be cancerous.

Melanoma: Melanoma is the most dangerous type of skin cancer, and it occurs when melanocytes start producing at out-of-control rates. Moles are vulnerable to cancer because they’re already clusters of melanocytes. The out-of-control production happens when the DNA in these cells changes somehow (many scientists believe sun exposure expedites this process, but more research needs to be done). About 25% of melanoma cases develop from existing moles, the rest appear as new spots. The longer these spots go undetected, the deeper they go in the skin and the more dangerous they become. The survival rate in the U.S. is 98% if they’re caught early, 17% if they’ve already spread.

(Here’s an un-fun fact: People who used tanning beds before age 30 are 75% more likely to develop melanoma.)

Dr. Longaker stresses the importance of performing regular full-body mole checks, particularly in the beginning of the summer so you have a basis for monitoring change.

Step 1. Strip completely naked in front of a full-length mirror. Dr. Longaker suggests grabbing a hand mirror, too, so you can see 100% of your back. Be thorough, she says: “Check between your toes and on your scalp. Check behind your ears, too. Everywhere.”

Step 2. The main thing you’re looking for is anything that seems new, looks different or exhibits any of the below features (ABCDE):

Asymmetry: Moles, whatever odd shape they may be, should be symmetrical, says Dr. Wechsler.

Borders: Moles can have weird borders, but if they are changing, getting weirder or becoming asymmetrical, that’s a red flag.

Colors: Watch for changing colors. If you see multiple colors or worse, black, that’s cause for concern, warns Dr. Wechsler.

Diameter: Moles that are greater than six millimeters in diameter are much more likely to be cancerous than smaller ones. That’s about the size of a pencil eraser.

Elevated: Dr. Longaker says elevation is only a problem if the spot used to be flat, or if it seems more elevated that it was before. It’s also a problem if it’s scabbing, dry and not healing.

Again, the key thing to note is change. And the only way to track change is to check your skin regularly.

Step 3. Go to the derm if you see something questionable. Both Dr. Longaker and Dr. Wechsler couldn’t stress this enough: You know your body. If something makes you pause, get it checked out right away, regardless of “the rules.” If you’re worried about it, that’s probably because it changed, even if you can’t remember what it looked like before. Simple as that.

You’ve heard this a million times, but sunscreen is incredibly important. When our skin is exposed to the sun, our melanocytes will produce more melanin — this is especially true for the palest among us — which damages DNA and breaks down collagen causing wrinkles, yes, but which also puts as at risk for over-melanin or melanocyte production.

Get new sunscreen. Dr. Longaker says be wary of using last year’s sunscreen. Mayo Clinic says they’re designed to last up to three years, but she recommends buying a new bottle just in case.

Make sure the SPF is high enough. Both Dr. Longaker and Dr. Wechsler recommend a broad-spectrum SPF of 30 or higher (ideally 50).

Use a lot of it. And reapply. Most people are not using enough sunscreen, and don’t realize they aren’t getting the advertised SPF as a result. Dr. Longaker says we need a tablespoon to cover our faces and a full Dixie cup to cover our bodies. She recommends Neutrogena, Anthelios or Elta. (As she told us last summer: find a sunscreen you really love, so you don’t dread reapplying often.) And don’t forget sunscreen for your lips!

Cover your skin whenever possible. Both derms reference rash guards and the importance of covering up if you’ll be out in the water for long periods of time. Dr. Longaker also recommends using an umbrella on the beach and wearing a wide-brim hat, as baseball caps don’t offer as much coverage as people think.

Protecting our skin from the sun is kind of a pain, but we need to stop thinking of wearing sunscreen as something we should do, like going for a run, and start thinking of it as something we have to do, like washing our face and brushing out teeth. There’s no time like the summer to get started.

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