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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The ABCDE rule is taught as five equal criteria. It is not: the letters carry very different weight, and the last one does most of the work. A lesion that has always looked slightly irregular is a much weaker signal than a lesion that looked ordinary last year and does not now. Understanding which features matter, and which common lesions imitate them, is the difference between checking usefully and checking anxiously.
ABCDE, Weighted Honestly
| Letter | What it describes | How much weight it carries |
|---|---|---|
| A — Asymmetry | One half unlike the other if a line is drawn through it | Moderate. Many benign moles are mildly asymmetric |
| B — Border | Irregular, notched, scalloped or blurred edge | Moderate, and stronger when the edge is fading out rather than merely uneven |
| C — Colour | More than one colour within a single lesion; black, red, white or blue areas | Strong. Colour variegation within one lesion is one of the more reliable features |
| D — Diameter | Larger than about 6mm | Weak on its own. Many benign moles exceed it; some early melanomas do not reach it |
| E — Evolving | Any change in size, shape, colour, elevation or sensation | Strongest. Change over time outweighs any static feature |
The practical consequence is that a stable, slightly irregular mole someone has had since adolescence is a very different proposition from a symmetrical, evenly coloured lesion that has grown noticeably in six months — even though the first ticks more letters. Duration and trajectory are not in the mnemonic, and they matter more than most of what is.
The Test That Works Better in Practice
The ugly duckling sign outperforms ABCDE for self-assessment, and it requires no measurement at all.
An individual’s moles tend to follow a family resemblance — broadly similar in colour, shape and size, because they arise from the same skin under the same influences. The lesion worth examining is the one that does not belong to that family. It may break no ABCDE criterion in isolation; what identifies it is that it is unlike its neighbours.
This works because it converts an absolute judgement into a comparative one, and comparison is what people are actually good at. The approach is developed in the ugly duckling sign.
What Early Melanoma Actually Looks Like
The images that circulate online are mostly advanced lesions, which is unhelpful: they are unmistakable, and they teach people to look for something they will not see at the stage that matters.
Early melanoma is frequently unremarkable. It is often flat rather than raised, may be only a few millimetres across, and can be a single shade of brown rather than the multicoloured lesion people expect. What tends to be present, and what is worth training the eye on, is:
- An edge that fades rather than stopping cleanly — pigment appearing to leak into surrounding skin
- Subtle colour variation: a slightly darker area within an otherwise even lesion
- Asymmetry of pattern rather than of outline — the two halves textured differently
- Change, which is the feature that does not photograph well and is the reason baseline imaging exists
Three presentations deserve specific mention because they defeat the usual rules:
- Nodular melanoma
- Raised, firm, often symmetrical and evenly coloured — and it may be red or skin-coloured rather than pigmented at all. It fails most ABCDE criteria while being the most aggressive subtype. The features that identify it are firmness, elevation and rapid growth, not irregularity.
- Amelanotic melanoma
- Little or no pigment. Frequently mistaken for a benign vascular lesion or a persistent inflamed spot. Anything that has failed to resolve over several weeks warrants examination regardless of colour.
- Acral melanoma
- On the palms, soles or under the nails. Occurs across all skin types and is more common proportionally in darker skin, where it is frequently diagnosed late because these sites are rarely examined. A new dark streak in a nail, particularly one that widens or involves the surrounding skin, needs assessing.
The Things That Look Like Melanoma and Are Not
Most lesions people bring in with genuine concern turn out to be one of four benign entities. Recognising them prevents unnecessary alarm, though none of these should be self-diagnosed.
| Lesion | Typical appearance | What distinguishes it |
|---|---|---|
| Seborrhoeic keratosis | Brown or black, waxy, appearing stuck onto the skin | Well-demarcated, often with a rough surface; dermoscopy shows characteristic milia-like cysts — the comparison in detail |
| Basal cell carcinoma | Pearly, sometimes with visible fine vessels; may ulcerate | A skin cancer, but not melanoma — slow-growing and locally destructive rather than metastasising — how they differ |
| Cherry angioma | Small, bright red, domed | Vascular rather than pigmented; blanches with pressure |
| Subungual haematoma | Dark mark under a nail after trauma | Grows out with the nail. A pigmented streak that does not move as the nail grows is a different matter |
Why Earlier Is Better
Melanoma is staged principally by Breslow thickness — how deep the tumour has grown into the skin, measured in millimetres. Thickness at diagnosis is the single most important determinant of what treatment is needed and of the eventual outcome.
This is why detection timing matters so directly. A thin, localised melanoma is generally treated by excision with an appropriate margin. A thicker one raises the question of spread and brings a considerably more involved pathway with it. The difference between those two situations is often a matter of months.
It is also why the choice of removal technique matters at the point of suspicion. A pigmented lesion that might be melanoma is excised whole rather than sampled or destroyed in place, because Breslow thickness cannot be measured from a fragment and cannot be measured at all from tissue that no longer exists. Methods that treat a lesion superficially remove the possibility of staging it.
We are currently confirming a UK-referenced survival figure with our consultant team and will add it here with a citation rather than quoting an unsourced percentage.
What to Do About a Lesion You Are Worried About
- Photograph it properly — consistent lighting and distance, with a ruler in frame. This is the one home measure that produces usable evidence: how to photograph a mole.
- Do not wait to see whether it settles if it is changing. Watching a stable lesion is reasonable; watching a changing one is the failure mode that costs.
- Have it examined with dermoscopy. The features that separate melanoma from its mimics sit beneath the surface and are not visible to the naked eye — what dermoscopy shows.
- If it is suspicious, it comes out whole. That is what preserves the ability to stage it.
| Item | Price |
|---|---|
| Initial consultation | £100 |
| Mole mapping — complete package | £300 |
| Mole removal | £350 |
| Each additional mole removed | £200 |
| Histological analysis | £180 |
Assessment is by a consultant plastic surgeon at 101 Harley Street: mole mapping, mole removal or contact the clinic. Where a lesion is already suspicious, the NHS route runs through a GP on the urgent suspected-cancer pathway — criteria in removal on the NHS.
Frequently Asked Questions
- What does ABCDE stand for?
- Asymmetry, Border irregularity, Colour variation within one lesion, Diameter over about 6mm, and Evolving. The letters are not equal in weight: Evolving is the strongest signal and Diameter the weakest, since many harmless moles exceed 6mm and some early melanomas do not reach it.
- What does early melanoma look like?
- Often unremarkable — flat, small, sometimes a single shade of brown. The features worth training the eye on are an edge that fades rather than stops, subtle variation in colour within the lesion, and above all change since it was last seen.
- Can melanoma be raised and evenly coloured?
- Yes. Nodular melanoma is typically raised, firm, symmetrical and evenly coloured, and may be red or skin-coloured rather than pigmented. It fails most ABCDE criteria while being the most aggressive subtype, which is why firmness and rapid growth are treated as findings in their own right.
- How quickly does melanoma change?
- Most melanomas change slowly enough that annual comparison detects them. Nodular melanoma is the exception and can develop and progress within months, which is why monthly self-examination remains necessary alongside annual surveillance.
- Can melanoma appear on skin with no mole?
- Yes, and a substantial proportion do arise on previously normal skin rather than within an existing mole. That is why counting moles is not the same as watching skin, and why a genuinely new pigmented lesion in adulthood deserves assessment.
- What about a dark line under a nail?
- A mark following an injury grows out with the nail and resolves. A pigmented streak that persists, widens, or extends onto the surrounding skin needs examining. This is one of the sites where melanoma is most often diagnosed late.
- Why does it matter how thick a melanoma is?
- Breslow thickness — the depth in millimetres — is the principal factor in staging and in determining what treatment is required. Because thickness cannot be measured from a fragment or from destroyed tissue, a suspicious pigmented lesion is removed whole rather than sampled or treated superficially.
- Should I have a worrying mole removed just to be safe?
- Sometimes that is exactly right, and sometimes comparison over a documented interval answers the question without an excision on a visible site. Which applies depends on the lesion’s features and your risk profile — that judgement is what the assessment is for.
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