Many Moles - Melanoma Risk

Dear Doctor,

I am a 25 year old white female with extremely fair skin never tan and many moles (around 50) mostly on the back of my legs and the front of my arms, but also a few on my chest and back. I am rarely in the sun and when I am I always wear sunscreen and a hat.  Although I definitely have been sunburned as a child, I never experienced a severe blistering sunburn.

I have had three moles removed and biopsied to date; thankfully none of them came back with bad results yet.  My brother (age 21, tans) had a possible melanoma that was removed-the dr said it was undetermined. I think two of my grandparents and an aunt may have had skin cancer but not sure if melanoma or other. So far my parents are clear.

My questions are about moles and risk of skin cancer. I understand that that having many moles is correlated with melanoma, but I am hoping you can further clarify the risks/statistics associated with this. I am very frightened about this sometimes to the point of feeling doomed because I feel like there is nothing I can do to prevent melanoma since it does not seem to be connected to sun exposure. More specifically:

1) Exactly how much higher risk am I for melanoma?  (I'm hoping for a number here)
2) Why shouldn't I just proactively remove every mole larger than eraser size from my body?  I understand new moles will develop but won't that make them easier to spot?
3a) I currently go to the dermatologist 2x a year for body checks.  Is there any research that indicates what impact frequent checks have on melanoma risk?  I'm curious if the research into mole/melanoma correlation controls for this factor.
3b) Would a body check every six months ensure that any potential skin cancers that develop will be caught early enough to be treated successfully?  
4) Is there anything else I can do to lower my risk?
5) Do you think I'm doomed to get melanoma?  I'm too embarrassed to ask my doctor this and I think she tries not to scare me.

Thank you for your time,

[Alan Rockoff, MD]

1) Exactly how much higher risk am I for melanoma?  (I'm hoping for a number here)

Maybe 2 3 times the average.

2) Why shouldn't I just proactively remove every mole larger than eraser size from my body?  I understand new moles will develop but won't that make them easier to spot?

Shown to be unnecessary.  The risk of any given mole turning cancerous is 1/200,000.  Having many moles is a risk for getting a melanoma that starts out looking like a mole but isn't, not for a mole turning into a melanoma.  Do not do this.

3a) I currently go to the dermatologist 2x a year for body checks.  Is there any research that indicates what impact frequent checks have on melanoma risk?  I'm curious if the research into mole/melanoma correlation controls for this factor.

Not known.  Still, you should do it, as you clearly plan to.

3b) Would a body check every six months ensure that any potential skin cancers that develop will be caught early enough to be treated successfully?  

Ensure is too strong a word, but it would certainly help.

4) Is there anything else I can do to lower my risk?

Minimize sun exposre and use sunscreen when you do go out in the sun.

5) Do you think I'm doomed to get melanoma?  I'm too embarrassed to ask my doctor this and I think she tries not to scare me.

Absolutely not.  You have a somewhat increased risk, but not nearly as much as someone whose father or mother had melanoma.  Your level of anxiety is far in excess of what it should be.  I recommend that you be more open with your dermatologist and that you consider getting help living with anxiety and risk.  Living is risky.  Your risk is far from the highest.

Dr. Rockoff