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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Total-body photography answers one question that dermoscopy cannot: is there something here that was not here last year? Dermoscopy examines a lesion you have already decided to look at. Whole-body imaging finds the lesion nobody was looking at — and since a substantial proportion of melanomas arise on skin that had no mole, that distinction does real work. What makes it function is not the camera but the standardisation: same positions, same distances, same lighting, every time.
The Job It Does
A mole map produces two image sets that answer different questions, and the division of labour is worth understanding because it explains why both are necessary.
| Total-body photography | Dermoscopic imaging | |
|---|---|---|
| Question | Has anything appeared, disappeared or grown? | What is the internal structure of this lesion? |
| Coverage | The whole visible skin surface | Selected lesions only |
| Magnification | None beyond ordinary photography | High, with surface reflection removed |
| Finds | New lesions; changes in size or distribution | Structural features invisible to the naked eye |
| Blind to | Sub-surface structure | Anything that was not selected for imaging |
The second blind spot is the important one. Dermoscopy is only applied to lesions someone chose to examine, which means it cannot by itself detect a lesion that no one noticed. Whole-body imaging is the mechanism that catches what selection missed. The complementary technique is covered in digital dermoscopy explained.
Why Standardisation Is the Whole Technique
Photographs are easy. Photographs that can be compared twelve months apart are not, and every element of the capture protocol exists to serve comparison.
- Fixed positions
- The sequence works through a defined set of poses covering the whole surface, with overlap between views so nothing falls between frames. Repeating the same poses next year is what allows the two sets to be laid over one another.
- Fixed distance and framing
- If the camera is closer this year, every lesion appears larger. Consistent distance is what makes a genuine size change distinguishable from an artefact of framing.
- Controlled lighting
- Colour is a diagnostic variable. Under different lighting the same lesion photographs as a different colour, so illumination is standardised rather than ambient.
- Consistent patient preparation
- Nail varnish removed, no fake tan, no heavy moisturiser. Fake tan in particular alters the apparent colour of every lesion beneath it and makes an entire set non-comparable — which is why rescheduling is better than mapping over it.
Where any of these vary, the comparison software reports differences that are artefacts rather than findings, and the clinical review spends its time discounting noise instead of examining signal.
What Happens at the Second Visit
At baseline, whole-body photography records. From the second visit onwards it compares, and this is where its value is realised.
The software aligns this year’s images against last year’s and flags differences: lesions present now that were absent before, lesions that have enlarged, and changes in the overall distribution. Those flags are then assessed clinically — the software identifies where to look, and a consultant plastic surgeon determines what it means. That division is set out in how the FotoFinder system works.
A new lesion is not in itself alarming. Adults acquire benign lesions throughout life — seborrhoeic keratoses in particular become steadily more common with age. What matters is that a new lesion is identified and assessed rather than absorbed unnoticed into a crowded back. Distinguishing the common benign newcomers from the ones that matter is the subject of a new mole in adulthood.
What It Does Not Cover
Total-body photography is a description of the visible skin surface in a set of standard poses. Four categories sit outside it, and all four are examined directly by the consultant rather than photographically:
- Scalp beneath hair — parted and examined, not imaged through.
- Nail beds — which is why varnish removal matters; a pigmented streak in a nail is a finding that cannot be assessed through polish.
- Areas covered by underwear, examined directly.
- Mucosal surfaces and between the toes, which no standard pose captures.
These are also the sites where melanoma is characteristically diagnosed later and thicker. The imaging does not replace the examination; it runs alongside it.
One further limitation is temporal rather than anatomical. Annual imaging compares two points twelve months apart, and a lesion that arises and progresses within that window can pass between them — the specific behaviour of nodular melanoma, discussed in melanoma on clear skin. Monthly self-examination is what covers that gap: checking your own skin.
Who Gains Most From It
The value of whole-body imaging scales with how much there is to keep track of. It earns its place for people with many moles, atypical moles, fair skin, a family or personal history of skin cancer, significant sun exposure or immunosuppression — the reasoning is in who is at high risk of melanoma.
For someone with a handful of stable lesions and no risk factors, a documented baseline is a reasonable choice rather than a clinical necessity, and it should be presented that way.
| Item | Price |
|---|---|
| Mole mapping — complete package | £300 |
| Initial consultation | £100 |
| Mole removal | £350 |
| Histological analysis | £180 |
Total-body photography is part of the mole mapping package rather than a separate charge. Appointments at 101 Harley Street: mole mapping or contact the clinic.
Frequently Asked Questions
- What is total-body photography?
- A standardised set of photographs covering the whole visible skin surface, captured in fixed poses, at fixed distances and under controlled lighting so that the same sequence can be repeated and compared at a later visit. It detects lesions that are new or have changed rather than examining any one lesion in depth.
- How is it different from dermoscopy?
- They answer different questions. Whole-body photography asks whether anything has appeared or changed across the entire surface. Dermoscopy examines the internal structure of a particular lesion at high magnification. Photography finds; dermoscopy assesses.
- How many photographs are taken?
- A defined sequence of poses covering the whole surface with overlap between views, so that no area falls between frames. The exact number depends on the protocol and on how many individual lesions also require dermoscopic capture.
- Why does fake tan matter so much?
- Because colour is diagnostic information. Fake tan alters the apparent colour of every lesion beneath it, which makes the whole set non-comparable against previous and future visits. Rescheduling is preferable to mapping over it.
- Is a new lesion at follow-up a bad sign?
- Usually not. Adults acquire benign lesions throughout life, and seborrhoeic keratoses in particular become steadily more common with age. The point of detecting a new lesion is that it gets assessed rather than absorbed unnoticed.
- Does it cover my whole body?
- It covers the visible skin surface in standard poses. The scalp beneath hair, nail beds, areas under underwear, mucosal surfaces and between the toes are examined directly by the consultant instead — and those are precisely the sites where melanoma tends to be found late.
- Is there any radiation or risk?
- None. It is photography using visible light. Nothing is injected, nothing penetrates the skin, and there is no cumulative exposure of any kind.
- Is it useful on a first visit?
- It creates the reference set, which is what every subsequent comparison depends on. Its detection function — identifying what is new — requires a previous set to compare against, so it begins working properly at the second visit.
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