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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Dermoscopic Imaging Selection: Precision in Melanoma Detection
Dermoscopic imaging selection is a critical process for early melanoma detection, focusing detailed analysis on suspicious skin lesions. This article explains how consultant plastic surgeons utilize established criteria like the ABCDE rule and the ‘ugly duckling’ sign to identify moles requiring close-up digital dermoscopy. It details the role of advanced technology, such as FotoFinder dermoscopy, in capturing high-resolution images for precise skin lesion analysis and tracking changes over time. Understanding this selection methodology optimizes clinical resources and enhances the accuracy of pigmented lesion assessment, crucial for timely intervention.
London Skin Clinic, led by GMC-registered consultant plastic surgeons, provides expert clinical mole screening and advanced dermatological surgery. Our approach integrates consultant experience with FotoFinder digital dermoscopy for comprehensive mole surveillance and early melanoma detection, ensuring precise skin lesion analysis and patient safety.
To explore your options, contact us to schedule your consultation. You can also reach us via: Schedule a Harley Street Mole Check
What is Dermoscopic Imaging & Why is Mole Selection Crucial?
Dermoscopic imaging is a non-invasive diagnostic technique using a dermatoscope—a high-powered, illuminated magnifier—to examine skin lesions. It allows a clinician to see structures beneath the skin’s surface invisible to the naked eye. Selection is crucial because imaging every mole on an individual with many nevi is impractical and clinically unnecessary. This focuses detailed analysis on lesions with a higher probability of being atypical or malignant, optimising the efficiency and accuracy of melanoma detection.
Understanding Digital Dermoscopy for Skin Lesion Analysis
Digital dermoscopy captures high-resolution images of moles that can be stored, magnified, and compared over time, offering an advantage over naked-eye examination or traditional handheld dermoscopy. It enables the tracking of subtle changes in a mole’s structure, size, or colour—often the earliest signs of skin cancer. This creates a permanent, objective visual record for ongoing surveillance.
How Do Consultants Select Moles for Close-Up Dermoscopy?
The selection of moles for detailed imaging is guided by clinical principles and consultant experience. The approach combines visual pattern recognition with a patient’s individual risk profile.
Applying the ABCDE Rule and ‘Ugly Duckling’ Sign
The initial visual assessment uses two tools. The ABCDE rule is a mnemonic for features of concern:
- Asymmetry: One half of the mole does not match the other.
- Border: The edges are irregular, scalloped, or poorly defined.
- Colour: The colour is not uniform and may include shades of brown, black, tan, red, or blue.
- Diameter: The mole is larger than 6mm (the size of a pencil eraser), although melanomas can be smaller.
- Evolving: The mole has changed in size, shape, colour, or elevation, or new symptoms like itching or bleeding have developed.
The ‘ugly duckling’ sign observes that benign moles on an individual tend to resemble one another. A mole that looks distinctly different—the “ugly duckling”—is flagged for closer inspection. This comparative approach is effective for identifying suspicious lesions during a full-body skin examination, a key part of what to expect during your mole mapping appointment.
Considering Patient History and Risk Factors
A consultant plastic surgeon reviews your personal and family medical history. Key risk factors include a personal or family history of melanoma, a high number of moles, significant sun exposure or blistering sunburns, and fair skin that burns easily. A patient’s report of a new or changing mole will lead to that lesion being selected for close-up imaging.
The Role of Advanced Technology: FotoFinder® Digital Dermoscopy
At London Skin Clinic, clinical expertise is augmented by the FotoFinder® system. It is used for total body photography and high-magnification digital dermoscopy, enhancing the precision of initial assessment and long-term monitoring.
Leveraging AI-Powered Analysis for Enhanced Detection
The FotoFinder® system uses an AI-driven algorithm to assist the consultant during skin lesion analysis. After a mole is imaged, the software provides a score based on its analysis of patterns, colours, and structures associated with malignancy. This provides a second opinion, highlighting subtle features less obvious to the human eye. The AI score is not a diagnosis; it is a tool supporting the final judgement of the GMC-registered consultant plastic surgeon. This combination of human expertise and AI technology in mole surveillance improves the accuracy of melanoma detection.
Why Not Every Mole Receives a Close-Up Image
Full-body photography captures an overview of all moles, but close-up dermoscopic imaging is selective. This approach focuses on efficiency and clinical relevance, ensuring suspicious lesions receive the most scrutiny. The table below outlines the criteria for this selection.
Our Consultant-Led Protocol for Suspicious Mole Assessment
The protocol for suspicious mole assessment at our Harley Street clinic is structured and led by GMC-registered consultant plastic surgeons. This ensures patients receive expert diagnostic and clinical judgement from initial examination to final recommendation.
The Expert Eye: Why Consultant Plastic Surgeons Lead the Process
Consultant plastic surgeons have an extensive background in skin oncology and reconstructive surgery. Their training involves years of diagnosing and surgically managing skin cancers, giving them an understanding of a lesion’s three-dimensional structure and its potential for malignancy. This experience allows them to interpret dermoscopy patterns accurately. Their clinical judgement is central to the diagnostic process, guiding technology use and ensuring decisions are based on a full patient assessment. This expertise is vital for effective annual skin cancer screening.
What Makes a Mole Look Suspicious to Our Specialists?
Beyond the ABCDE criteria, our specialists look for specific dermoscopic patterns, including an atypical pigment network, blue-white veils, irregular dots or globules, and abnormal vascular patterns. A mole that is actively growing, firm, or has a crusty surface will also be flagged. These clinical signs, combined with the patient’s risk profile, inform the decision on the need for a biopsy. Dermoscopy significantly improves diagnostic accuracy compared to naked-eye examination alone.
The Patient Experience: What to Expect During Mole Selection
Is Dermoscopic Imaging Painful or Invasive?
Dermoscopic imaging is non-invasive and painless. The dermatoscope, a handheld device, is placed on the skin. It uses a light source and lens to view the mole; there are no needles, incisions, or discomfort. Capturing an image takes a few seconds.
Understanding Your Results and Next Steps
After the examination, the consultant plastic surgeon will discuss the findings, show you the dermoscopic images, and explain if any moles require further action. Potential next steps include:
- Routine Surveillance: The mole is benign and requires no immediate action. It will be monitored at your next screening.
- Short-Term Monitoring: The mole has unusual features but does not warrant immediate removal. A follow-up appointment in 3-6 months may be recommended to check for changes.
- Biopsy or Excision: The mole displays features suspicious for atypical nevus or, less commonly, melanoma. The consultant will recommend its removal for laboratory analysis (histopathology).
Prioritizing Your Skin Health: Early Detection is Key
A structured, expert-led approach to mole surveillance is the most effective strategy for early skin cancer detection. Selecting which moles to image in detail directs clinical attention where it is most needed, increasing the likelihood of identifying malignant changes at the most treatable stage.
Why Choose London Skin Clinic for Your Mole Surveillance
London Skin Clinic’s mole surveillance is led by GMC-registered consultant plastic surgeons with extensive experience in skin cancer diagnosis. We use the FotoFinder® digital dermoscopy system to provide a baseline for monitoring, and our in-person, consultant-led care ensures a high standard of clinical assessment. For more information on moles and their assessment, consult trusted health resources.
Conclusion
Dermoscopic imaging selection is a cornerstone of skin cancer surveillance. Combining clinical criteria like the ABCDE rule and the ‘ugly duckling’ sign with FotoFinder® technology and the diagnostic acumen of a consultant plastic surgeon effectively identifies and monitors high-risk lesions. This targeted approach is fundamental to early melanoma detection and positive patient outcomes. If you have concerns about a new or changing mole, a professional assessment is essential. To arrange an evaluation at our Harley Street clinic, contact us or Schedule a Harley Street Mole Check.
Frequently Asked Questions
What criteria guide the dermoscopic imaging selection at London Skin Clinic?
At our clinic, the dermoscopic imaging selection is a consultant-led process based on established clinical criteria. Our plastic surgeons primarily use the ‘ugly duckling’ sign (a mole that looks different from others), the ABCDE rule for melanoma, and a patient’s personal and family history to identify lesions requiring close-up analysis with our FotoFinder® system.
Will every single mole on my body be chosen for close-up dermoscopic imaging?
Not necessarily, as it is inefficient and clinically unnecessary to image every mole. The process begins with total body photography to create a baseline map. Our consultant then meticulously reviews this map to identify any outlier or suspicious moles that warrant high-magnification dermoscopic analysis for a more detailed assessment.
What is the ‘ugly duckling’ sign and how does it influence dermoscopic imaging selection?
The ‘ugly duckling’ sign is a key factor in dermoscopic imaging selection; it refers to any mole that looks distinctly different from the other moles on your body. This difference in size, shape, or colour makes it an outlier, prompting our consultants to prioritise it for detailed examination to rule out any abnormalities.
How does the FotoFinder® system assist with dermoscopic imaging selection?
The FotoFinder® system’s advanced AI software supports our consultants by flagging moles with potentially suspicious features against a vast database of images. While this technology provides valuable data, the final decision for dermoscopic imaging selection is always made based on the expert clinical judgment of our GMC-registered consultant surgeon.
If a mole isn’t selected for close-up imaging, does that mean it’s completely safe?
Moles not selected for immediate close-up imaging are considered stable based on the initial clinical overview. They are still documented in your baseline body map and will be carefully monitored for any changes during subsequent annual skin checks. Any evolution in a mole’s appearance at a future appointment would make it a candidate for dermoscopic review.
How can I schedule an appointment for a mole check and potential dermoscopic imaging?
If you have concerns about a new or changing mole, the first step is a comprehensive clinical assessment with one of our consultant plastic surgeons. They will determine the need for detailed imaging during your consultation. You can schedule a Harley Street mole check through our website to secure an appointment.
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