Thursday 19th November 1992   Morning surgery 10:20

“How are you, Catherine?”
“I’m alright Dr Lewis. I’m just worried about another mole.”
Dr Lewis turned to us. “Catherine is one of those patients who has numerous moles: she’s got more than 50. It is thought to be an inherited tendency.”
“Dad’s got loads. I’ve got 137 at the moment, I think. It is hard to count them exactly. My Mum checks my back for me. She gets very flustered because there are so many.”
“It means that Catherine is at a slightly higher risk of skin cancer.”
“I don’t sunbathe and I always wear factor 50 even in Winter.” Catherine looked over at us. “Anyway, I’ve got this mole on my back. I think it’s a new one. It’s bigger and darker than the others.”
“Has it been sore or itchy?” Dr Lewis asked.
“No.
“Has it been bleeding?”
“No, I don’t think so.”
“We better have a look then.”
Catherine took off her shirt and turned round. There were moles all over her back. Most were small, light brown bumps. Some were flatter but similar in colour. A few had an orange tinge. The mole that Catherine was worried about was immediately obvious. It was much darker than the others and had a smooth, shiny surface.
Dilys got up to have for a closer inspection.
“What do you think, Dilys?”
“It’s quite flat.” She felt the mole with the tip of her finger as she spoke. “It feels smooth.”
“What about the colour?”
“Most of it looks black but this area is brown and, at the bottom, there is a reddish pink patch.”
“Good, so there are 3 colours?”
“Yes and it’s an unusual shape. It’s a bit lopsided.”
“Asymmetric, Dilys.”
“Yes, asymmetric and there is a dent or a notch on the side.”
“A notch is an important feature to look out for. Can you measure the mole?” Dr Lewis handed Dilys a tape measure.
“It’s 8 mm in length and 7 mm across.”
“So, we’ve got a new mole that looks quite different from Catherine’s other moles, what we sometimes call an ugly duckling. It is flat, 7 x 8 mm in size, asymmetric in shape with a notch and it contains 3 colours. Are you worried about it?”
“Yes, I am.” Dilys answered straight away.

Dr Lewis waited for Catherine to put her shirt back on and sit down.
“I am afraid this is quite a worrying mole, Catherine. It could be a skin cancer, a melanoma. It will need to be removed and tested.”
I thought it might be, Dr Lewis.”
“You should hear from the dermatologist very quickly.”
Catherine nodded and smiled. She wiped a tear from the corner of her eye and got up quickly to leave.

An ugly duckling.