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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Pigment cells carry oestrogen receptors, so moles genuinely do respond to hormonal change — darkening slightly, enlarging a little, and sometimes appearing where there was nothing before. Skin tags, cherry angiomas and facial pigmentation often arrive in the same window. All of that is common and usually harmless. The difficulty is one of timing rather than biology: perimenopause and menopause fall in the late forties and fifties, which is precisely when melanoma incidence begins to climb. A change explained by hormones and a change that needs examining can look identical from the outside, and the distinguishing features are specific.
What Actually Changes, and When
Skin does not change all at once at a single point. Three phases are worth separating, because what appears in each is different.
- Perimenopause — typically mid-forties onwards
- The phase of fluctuation rather than decline. Oestrogen swings rather than falls steadily, and this is when most people notice new lesions appearing: skin tags in friction sites, small red spots, and existing moles looking slightly darker. Searches for “new moles in perimenopause” peak here for a reason.
- Menopause — average around 51 in the UK
- Oestrogen settles at a low level. Melasma driven by hormonal fluctuation often improves, while sun-related pigmentation continues to accumulate. Skin becomes thinner and drier as collagen declines, which changes how lesions look and feel rather than creating new ones.
- After menopause
- Hormonal drivers largely stop. New pigmented lesions appearing at this stage are less likely to be hormonal and more likely to reflect cumulative sun exposure and age — which is exactly why a new or changing lesion here deserves more attention rather than less.
Four Different Things, Often Confused
“My moles are changing” frequently turns out to describe several distinct lesion types appearing together. They have different causes and different implications.
| What appears | What it is | Hormonal? | When to have it looked at |
|---|---|---|---|
| Existing moles darkening | Melanocytes responding to hormonal change | Yes | If one changes while the others do not |
| Brown patches on the face | Melasma — hormonally driven pigmentation, often symmetrical across cheeks and upper lip | Yes | If asymmetrical, or if a patch within it darkens unevenly |
| Flat brown marks on hands, chest, shoulders | Solar lentigines — cumulative sun damage, not hormones | No | If one becomes raised, irregular or multicoloured |
| Small red domed spots | Cherry angiomas — benign vascular lesions that become commoner with age | Age-related; hormonal link not established | If one bleeds repeatedly or changes shape |
| Soft skin-coloured tags in folds | Skin tags — friction plus hormonal and metabolic drivers | Yes, partly | If a crop appears over months — see below |
One of these carries information beyond the skin. A distinct crop of new skin tags, particularly around the neck, is associated with insulin resistance — a case-control study found diabetes rates above 50% in patients with more than 30 tags (Rasi et al., International Journal of Dermatology, 2007). Since metabolic risk also rises after menopause, a cluster appearing in this window is worth mentioning to a GP rather than filing under hormones. The evidence and what to ask for are set out in why skin tags suddenly appear.
The Pattern That Reassures
Hormonal change acts on the whole skin, not on one spot. That produces a recognisable signature:
- Several lesions change together, not one in isolation.
- Change is even — a mole darkens uniformly rather than developing a patch of different colour within it.
- Change is gradual, unfolding over months rather than weeks.
- Shape and border stay regular. Hormones alter pigment intensity; they do not make an outline ragged.
- Symmetry is preserved, including across the body — melasma typically appears on both cheeks rather than one.
The Pattern That Does Not
Every one of these describes a single lesion behaving differently from its neighbours.
- Asymmetry — one half unlike the other.
- Border irregular, notched or blurred.
- Colour uneven within the same lesion: two or more shades, or black, red or white areas.
- Diameter over about 6mm, or enlarging.
- Evolving — the letter that matters most. Any change in size, shape, colour, elevation or sensation.
- The ugly duckling — the lesion that looks unlike the rest of your moles. Most people’s moles follow a family resemblance; the outlier is the one to have examined.
- Bleeding, itching or crusting without having been caught or knocked.
“If a lesion is firm, pigmented, growing quickly, bleeding without being caught, or simply doesn’t look like its neighbours, I’d want it examined and possibly biopsied rather than just watched.”— Mr Onur Gilleard, Consultant Plastic Surgeon
The Timing Problem Nobody Mentions
This is the part of the subject that matters most and is almost always left out.
Menopause arrives, on average, at 51. Melanoma incidence rises steadily from the fifties onwards. The two overlap almost exactly — which means that at the precise age when a changing mole becomes more likely to matter, a plausible and reassuring explanation for change is also available.
The risk is not that hormones cause melanoma. It is that hormonal change supplies a reason not to look further. A mole that has genuinely altered gets filed under “the menopause” alongside the hot flushes and the sleep disruption, and the one lesion that was behaving differently from the others is absorbed into a general story about a difficult year.
The correction is straightforward and does not require alarm: hormonal change explains lesions changing together. It does not explain one lesion changing alone. Where a single mole is doing something the others are not, the hormonal explanation stops being available regardless of what else is happening.
In the largest published series of lesions removed as presumed benign skin tags, five of 1,335 proved malignant on histology (Eads et al., Archives of Dermatology, 1996) — a reminder that lesions assumed harmless occasionally are not, which is why examination precedes reassurance.
Pregnancy: The Same Mechanism, a Different Decade
The same oestrogen sensitivity produces mole darkening in pregnancy, typically in the second and third trimesters, alongside melasma and a rise in skin tags. The important difference is age rather than biology: in a woman in her early thirties the background probability of melanoma is considerably lower than in a woman of 55, so the same degree of hormonal change carries different weight.
What does not change is the rule. Even in pregnancy, one mole behaving unlike its neighbours warrants examination. Assessment is safe at any stage, and where removal is needed it can be performed under local anaesthetic.
Does HRT Affect Moles?
Hormone replacement therapy restores oestrogen levels, and it is biologically consistent that it could influence pigmentation in the same way that endogenous hormones do — some people notice melasma persisting or returning while taking it. What the evidence does not support is a clear effect of HRT on melanoma risk, and it should not be a reason to avoid treatment or to stop it because a mole has changed.
The practical approach is unchanged: a changing lesion is assessed on its own features, not on whether you happen to be taking HRT. If a lesion has altered since starting treatment, that is worth mentioning at the appointment, but it does not alter what the examination looks for.
What Is Worth Doing at This Stage of Life
- Establish a baseline. The single most useful thing at this age is a record of what your skin looks like now, so that future change can be compared rather than remembered. This is what mole mapping provides, and the value of it is greatest for people with many moles, fair skin, significant sun exposure or a family history.
- Check yourself monthly, in the same way each time. Good light, a full-length mirror and a hand mirror, working in sections. Guidance on the areas most often missed is in checking the places you cannot see.
- Photograph anything you are unsure about with a ruler beside it, in consistent lighting, and repeat monthly — how to photograph a mole properly.
- Do not wait to see whether it settles if a single lesion is changing while the others are not. That is the situation in which delay costs something.
Having a Mole Assessed
Assessment is by a consultant plastic surgeon on the GMC Specialist Register, using dermoscopy rather than naked-eye inspection. Where a lesion has features that warrant it, it is excised whole and sent for histological examination rather than treated in place — because a lesion destroyed by a superficial method cannot afterwards be examined.
| Item | Price |
|---|---|
| Initial consultation | £100 |
| Mole removal | £350 |
| Each additional mole | £200 |
| Histological analysis | £180 |
Assessment and removal usually take place at the same visit. To arrange one, see mole removal or contact the clinic. Where a lesion is suspicious rather than simply unwanted, the NHS route is a different pathway with different criteria — set out in skin lump removal on the NHS.
Frequently Asked Questions
- Is it normal for moles to change during menopause?
- Yes. Pigment cells carry oestrogen receptors, so moles can darken slightly or enlarge a little as hormone levels fluctuate. The change is typically gradual, even in colour, and affects several moles rather than one. A single mole changing while the others stay the same is a different situation and needs examining.
- Can you get new moles during perimenopause?
- New pigmented spots commonly appear in this window, though many of them are not moles: melasma on the face is hormonal, and flat brown marks on the hands and chest are usually sun-related lentigines. A genuinely new mole in your fifties is worth having looked at, because new pigmented lesions become less common with age rather than more.
- How do I tell a hormonal change from a worrying one?
- By whether the change is shared. Hormones act on the whole skin, so several lesions alter together, evenly and gradually. A worrying change is confined to one lesion, is uneven within it, or alters the outline rather than just the colour. The ugly duckling — the mole that looks unlike your others — is the single most useful thing to look for.
- Hormonal change, weight change and friction all contribute, and all three are common in this decade. A distinct crop appearing over months, particularly around the neck, is also associated with insulin resistance and is worth an HbA1c blood test with a GP. The tags themselves are harmless.
- Are the small red spots related to menopause?
- Those are usually cherry angiomas, benign vascular lesions that become more common with age. They are frequently noticed around this time, but a specific hormonal cause is not established. They only need attention if one bleeds repeatedly or changes shape.
- Does HRT make moles darker or riskier?
- Restoring oestrogen can influence pigmentation in the same way natural hormones do, and some people notice melasma persisting on treatment. Evidence does not show a clear effect on melanoma risk, and a changing mole is assessed on its own features rather than on whether HRT is being taken.
- Does menopause increase melanoma risk?
- Not directly. What happens is that menopause coincides with the decade in which melanoma incidence starts rising with age. The practical consequence is that a hormonal explanation is available at exactly the point where a changing mole most deserves examination — which is why one lesion changing alone should not be attributed to the menopause.
- When should I have a mole checked rather than watched?
- Whenever a single lesion is behaving differently from the rest: asymmetry, an irregular or blurred border, more than one colour within it, growth, or bleeding and itching without injury. Watching is reasonable for lesions that are changing together and evenly; it is not reasonable for the one that stands out.
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