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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Melanoma risk factors are usually presented as a list, which makes them look interchangeable. They are not. Some are fixed and set your baseline — skin type, mole count, family history, genetics. Others are behavioural and continue to accumulate. And one matters more than the rest combined: having already had a melanoma. Knowing which category you fall into determines something practical, which is how closely your skin should be watched and how often.
Risk Is Tiered, Not Additive
A list of ten risk factors implies that having four is worse than having two. In practice the factors carry very different weights, and a single strong one outranks several weak ones.
| Weight | Factor | Why it sits here |
|---|---|---|
| Strongest | Previous melanoma | Establishes both susceptibility and the fact that it has already happened once |
| Strong | Many moles, or atypical mole syndrome | More lesions means more opportunity, and atypical lesions are harder to assess individually |
| Strong | Family history in a first-degree relative | Reflects shared genetics and shared sun-exposure environment |
| Strong | Known genetic mutation such as CDKN2A | Uncommon, but decisive where present |
| Moderate | Fair skin that burns and does not tan | Less melanin, less protection — a fixed baseline factor |
| Moderate | History of blistering sunburn, particularly in childhood | Intermittent intense exposure matters more than cumulative dose for melanoma |
| Moderate | Immunosuppression, including post-transplant | Reduced immune surveillance of abnormal cells |
| Moderate | Tanning bed use, especially before 35 | The most avoidable factor on the list |
| Background | Increasing age | Incidence climbs steadily through adult life |
The practical consequence: a fair-skinned person with 90 moles and a mother who had melanoma sits in a different category from someone with fair skin alone, and the surveillance interval should reflect that rather than treating both as “at risk”.
What You Cannot Change
- Skin type
- Recorded formally as a Fitzpatrick type, from I (always burns, never tans) to VI. Melanoma occurs in every skin type — a point worth stating plainly, because the assumption that darker skin is exempt causes real delay in diagnosis, particularly for acral melanoma on the palms, soles and nail beds. Detail in Fitzpatrick skin types and risk.
- Mole count
- More than about 50 moles raises risk, and more than 100 raises it further. The mechanism is partly arithmetic and partly biological — a tendency to form many naevi reflects something about how melanocytes behave. See does having many moles raise risk.
- Family history
- A melanoma in a first-degree relative — parent, sibling or child — is a stronger signal than most people expect, and it matters more when the relative was young at diagnosis or had more than one primary melanoma. Two or more affected close relatives raises the question of an inherited predisposition.
- Genetics
- The best-characterised inherited factor is a CDKN2A mutation. It is uncommon and testing is not routine, but in families with clustered early melanoma it changes both surveillance intensity and who else in the family should be screened.
- Previous melanoma
- The strongest single factor. A person who has had one melanoma has a materially raised risk of a second primary, which is why post-melanoma surveillance is closer than screening for anyone else.
What You Can Still Influence
Two factors remain live, and both concern ultraviolet exposure — but not in the way most people assume.
The pattern of exposure matters more than the total. For melanoma, intermittent intense exposure — the fortnight abroad, the burnt weekend — carries more weight than steady cumulative exposure, which is more closely associated with basal and squamous cell carcinoma. This is why an office worker who burns twice a year is not obviously safer than someone who works outdoors.
Childhood burns count decades later. Blistering sunburn in childhood and adolescence is associated with adult melanoma risk. That cannot be undone, but it does change how closely an adult with that history should be watched — the argument developed in why sun exposure history matters at yearly checks.
Tanning beds are the one clean win. Sunbed use, particularly before the age of 35, raises melanoma risk, and it is entirely avoidable. It is the only item on the risk list that can be removed rather than managed.
What protection achieves is worth stating honestly: reducing future exposure lowers the accumulation of further risk. It does not reverse the risk already established, which is precisely why surveillance and prevention are separate activities rather than alternatives.
What Risk Category Actually Changes
Risk assessment is not an exercise in labelling. It determines three practical things.
- Whether surveillance is worth it at all. For someone with a handful of stable moles, no family history and no significant sun damage, annual photographic surveillance is a reasonable choice but not a clinical necessity. It should be offered as such rather than sold.
- How often. Twelve months is standard. Shorter intervals apply where risk is concentrated — a previous melanoma, or atypical mole syndrome under active monitoring. See how often mole mapping should be repeated.
- How the same lesion is treated. This is the least obvious and most important consequence. A mildly atypical lesion in a low-risk patient can reasonably be monitored; the same lesion in someone with a previous melanoma and a first-degree family history is more likely to be excised. The lesion has not changed — the threshold has.
What Applies Regardless of Category
Risk stratification describes populations. It does not predict individuals, and the majority of melanomas occur in people who would not have been classed as high risk. Two things therefore apply to everyone.
A changing lesion is assessed on its own merits. Low risk is not a reason to watch and wait. If one lesion is behaving differently from its neighbours — growing, changing colour, bleeding without injury — that is examined regardless of what the risk profile says. The features are set out in when to see a doctor about a mole.
Melanoma can appear on skin that had no mole. Roughly a substantial proportion of melanomas arise de novo rather than within a pre-existing naevus, which is why counting moles is not the same as watching skin — see melanoma on clear skin.
Having Your Risk Assessed
Risk assessment forms the first stage of a mole mapping appointment: medical history, family history, sun exposure, skin type and immunosuppression are recorded, and they determine both what the imaging concentrates on and the interval you are asked to return at.
| Item | Price |
|---|---|
| Mole mapping — complete package | £300 |
| Initial consultation | £100 |
| Mole removal | £350 |
| Histological analysis | £180 |
Appointments at 101 Harley Street: mole mapping or contact the clinic.
Frequently Asked Questions
- What is the biggest risk factor for melanoma?
- Having had a melanoma already. After that, a high mole count or atypical mole syndrome, a melanoma in a first-degree relative, and known genetic predisposition such as a CDKN2A mutation carry the most weight. Fair skin and sunburn history are meaningful but sit below those.
- How many moles is too many?
- Risk rises above roughly 50 and rises further above 100. The count is a marker rather than a mechanism — it reflects both more lesions to go wrong and something about how melanocytes behave in that individual.
- How much does family history matter?
- More than most people assume, particularly a first-degree relative diagnosed young or with more than one primary melanoma. Two or more affected close relatives raises the question of inherited predisposition and changes who else in the family should be screened.
- Can people with darker skin get melanoma?
- Yes. It is less common but frequently diagnosed later, partly because of the assumption that darker skin is exempt. Acral melanoma on the palms, soles and nail beds is a particular pattern to be aware of, and those sites deserve deliberate examination.
- Does using sunscreen now undo past sun damage?
- No. Protection prevents further accumulation of risk; it does not reverse what has already occurred. That is why surveillance and sun protection are complementary rather than alternatives.
- How much does tanning bed use matter?
- Enough to be worth stopping, particularly under 35. It is the only factor on the list that can be removed outright rather than managed, which makes it disproportionately worth acting on.
- If I am low risk, do I still need to check my skin?
- Yes. Most melanomas occur in people who were not classified as high risk, because the low-risk group is far larger. Risk category determines surveillance intensity; it never overrides a lesion that is changing.
- How often should a high-risk person be seen?
- Twelve months is the standard interval, shortened where risk is concentrated — a previous melanoma, or atypical mole syndrome under active monitoring. The interval is set individually at the consultation rather than by protocol.
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