Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Self-examination is the only form of skin surveillance that happens every month rather than every year, and it catches things an annual appointment cannot — because a lesion that appears in March does not wait for November. What it is not is a clinical assessment. The useful framing is that self-examination decides when to be seen, not whether something is dangerous. Those are different jobs, and confusing them is where both false reassurance and unnecessary alarm come from.
A Method That Actually Works
The commonest failure in self-examination is not missing a lesion. It is inconsistency — checking in different light, at different times, in a different order — which makes comparison against last month impossible. Method matters more than thoroughness.
- Same conditions each time. The same room, the same light, roughly the same time of day. Daylight is better than a bathroom bulb.
- Same order each time. Face and scalp, neck, chest and abdomen, each arm including underarms, hands including between fingers and under nails, back and buttocks with a hand mirror, each leg, then feet including soles and between the toes.
- Once a month. Frequent enough to notice change, infrequent enough that change has time to occur. Weekly checking makes small changes harder to see, not easier.
- Compare, do not judge. The question is “is this different from last month?” rather than “does this look like cancer?”. The first is answerable at home; the second is not.
The areas most often skipped are the ones where melanoma is diagnosed latest — scalp, behind the ears, back, buttock crease, soles and between the toes. Practical technique for those is in checking the places you cannot see.
What You Are Looking For
Two frameworks, and the second is more useful than the first.
ABCDE — Asymmetry, Border irregularity, Colour variation within one lesion, Diameter over about 6mm, and Evolving. The last letter carries most of the weight: a lesion that is changing matters more than one that has always looked slightly unusual.
The ugly duckling — more useful in practice, because it requires no measurement. Most people’s moles follow a family resemblance. The lesion worth examining is the one that does not belong among the others. Applied properly this is a better home test than ABCDE, and it is developed in the ugly duckling sign.
Alongside those, four findings warrant an appointment on their own:
- A lesion that bleeds or crusts without having been caught or knocked
- A lesion that itches persistently or has changed in sensation
- A new pigmented lesion appearing in adulthood, particularly after 40
- A dark streak in a nail that was not there before
What the Tools Are Worth
| Tool | Genuinely useful for | Limitation |
|---|---|---|
| Full-length mirror plus hand mirror | Back, buttocks, posterior thighs, scalp margin | Awkward and easy to rush; a second person is more reliable |
| Phone photographs with a ruler in frame | Tracking one specific lesion over months | Only comparable if lighting and distance are consistent |
| A body map diagram | Recording where lesions are so you check the same ones | Records position, not appearance |
| Another person | Scalp and back — the two areas self-examination reliably fails | Requires asking, which people avoid |
| Consumer dermatoscope attachments | Little at home | The instrument reveals structures; interpreting them is a trained skill, and images without training generate anxiety rather than information |
| Mole-check apps | Prompting someone to seek advice | No dermoscopy, no standardised conditions, no clinician — and a reassuring score on an unexamined lesion is worse than no score |
The photograph method is the one worth doing properly, because it is the only home technique that produces genuinely comparable evidence. Consistent distance, consistent lighting, a measurement reference in frame, repeated monthly — set out in how to photograph a mole for a clinician.
Where Self-Examination Genuinely Fails
Being clear about this is what makes the rest of it useful.
- It cannot see beneath the surface
- The features that distinguish a melanoma from a benign lesion — pigment network, vessel architecture, blue-white structures — sit below the stratum corneum and require dermoscopy to visualise. No amount of looking replaces that.
- Memory is not a baseline
- People are markedly poor at recalling how a lesion looked a year ago. This is not carelessness; it is how visual memory works, and it is the specific gap that photographic surveillance exists to fill.
- Some sites are effectively unexaminable alone
- The scalp under hair, the mid-back, and the soles. Melanoma at these sites is characteristically found later and thicker for exactly this reason.
- Reassurance is the dangerous output
- Finding nothing is only meaningful if you looked at everything, in adequate light, including the places you would rather not ask someone to look at.
How the Two Fit Together
Annual surveillance and monthly self-examination cover different failure modes, and neither substitutes for the other.
| Self-examination | Clinical surveillance | |
|---|---|---|
| Frequency | Monthly | Usually annual |
| Catches | Something new or changed since last month | Slow change invisible month to month |
| Sees | The surface | Sub-surface structure, via dermoscopy |
| Compares against | Memory, or your own photographs | Standardised images from previous visits |
| Main weakness | Hard-to-see sites; no depth information | Twelve-month gaps — a fast lesion can arise between visits |
The gap in clinical surveillance is precisely the gap self-examination fills. Nodular melanoma can develop and progress within an annual interval, often on skin that had no mole before — which is why noticing something yourself in month four matters. See melanoma on clear skin and clinical mole surveillance.
When to Stop Watching and Book
The rule that avoids both extremes: watch a lesion that is stable; book one that has changed. Monitoring something that is actively changing is the failure mode that costs, and it is far commoner than over-reacting.
Book without waiting for the next scheduled check if a lesion is growing, has developed a second colour, has an outline that is no longer regular, bleeds or crusts without injury, itches persistently, or simply does not look like your other moles. Details in when to see a doctor about a mole.
| Item | Price |
|---|---|
| Initial consultation | £100 |
| Mole mapping — complete package | £300 |
| Mole removal | £350 |
| Histological analysis | £180 |
Appointments at 101 Harley Street: mole mapping or contact the clinic.
Frequently Asked Questions
- How often should I check my own skin?
- Monthly. Frequent enough to notice change, infrequent enough for change to have occurred. Checking weekly makes small differences harder to detect rather than easier, because there is less for them to stand out against.
- Does the order really matter?
- Yes, more than thoroughness does. A consistent sequence in consistent light is what makes this month comparable with last month. An exhaustive but disorganised check produces no usable comparison.
- Is ABCDE the best method?
- It is a useful checklist, but the ugly duckling approach is more practical at home: identify the lesion that looks unlike your others. It requires no measurement and maps better onto how melanoma actually presents within one person’s skin.
- Are phone photographs worth taking?
- Yes, if taken properly — consistent distance and lighting, with a ruler or coin in frame for scale, repeated monthly. Casual photographs in varying conditions are not comparable and can mislead in both directions.
- Should I use a mole-check app?
- As a prompt to seek advice, they do no harm. As a source of reassurance they are actively risky: no dermoscopy, no standardised conditions, no clinical history and no accountability. A low-risk score on an unexamined lesion supplies a reason not to attend, which is the wrong output.
- Can I buy a dermatoscope for home use?
- You can, but it is unlikely to help. The instrument reveals structures; interpreting them is a trained skill built on seeing many thousands of lesions. Without that training the images typically generate anxiety rather than information.
- How do I check my own back?
- A full-length mirror with a hand mirror held behind, working in sections rather than attempting the whole area at once. It is considerably more reliable with another person, or with photographs taken by someone else and compared over time.
- Does self-examination replace professional checks?
- No, and the reverse is also true. Self-examination catches what appears between appointments; clinical surveillance catches slow change and sees beneath the surface. Each covers the other’s blind spot.
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