Diseases That Cause Many New Moles: When a Skin Check Isn't Enough

When dozens of new moles suddenly appear across the skin within weeks or months, it's rarely just a cosmetic concern. While most people develop new moles gradually throughout their lifetime, the rapid appearance of multiple moles can signal underlying systemic diseases that demand immediate medical attention. Understanding diseases that cause many new moles: when a skin check isn't enough could be the difference between early intervention and serious health complications.

The sudden eruption of numerous moles—medically termed eruptive nevi—often indicates that something deeper is happening within the body. These aren't the typical benign moles that develop slowly over years; they're warning signs that require comprehensive medical evaluation beyond a standard skin examination.

Key Takeaways

• Rapid mole development (multiple new moles appearing within weeks or months) often signals underlying systemic diseases rather than normal skin changes
• Paraneoplastic syndromes, immunodeficiency disorders, hormonal imbalances, and genetic conditions can all trigger sudden mole proliferation
• Standard skin checks alone may miss the underlying disease causing new moles—comprehensive medical evaluation including blood work and imaging is essential
• Early detection of the causative disease significantly improves treatment outcomes and can prevent serious complications
• Immediate dermatological consultation is warranted when experiencing sudden appearance of 5+ new moles within a short timeframe

Understanding Normal Mole Development vs. Abnormal Proliferation

What Are Normal Moles?

Normal moles, or melanocytic nevi, are clusters of pigment-producing cells called melanocytes. Most individuals develop between 10 and 40 moles throughout their lifetime, with the majority appearing during childhood and young adulthood [1]. These benign growths typically:

• Develop gradually over months to years
• Remain stable in size, shape, and color
• Measure less than 6mm in diameter
• Display uniform coloration (usually brown or tan)
• Have well-defined, regular borders

When Mole Development Becomes Concerning

The sudden appearance of numerous new moles deviates significantly from normal patterns. Warning signs include:

• ⚠️ Five or more new moles appearing within weeks or months
• 📈 Rapid growth of existing moles
• 🎨 Varying colors within individual moles or across multiple moles
• 📏 Irregular borders or asymmetrical shapes
• 💫 Clustering patterns in specific body regions
• 🔄 Continuous new mole formation without stabilization

Understanding different types of skin lesions helps distinguish concerning mole patterns from benign skin changes.

Diseases That Cause Many New Moles: When a Skin Check Isn't Enough—The Medical Conditions

Paraneoplastic Syndromes and Internal Malignancies

Paraneoplastic syndromes represent one of the most serious causes of sudden mole proliferation. These conditions occur when internal cancers trigger skin manifestations, including rapid mole development [2].

Sign of Leser-Trélat

This rare paraneoplastic syndrome manifests as the sudden eruption of multiple seborrheic keratoses (mole-like growths) associated with internal malignancy. Key characteristics include:

• Rapid appearance of dozens to hundreds of lesions
• Often accompanied by itching (pruritus)
• Associated cancers: gastrointestinal adenocarcinomas, lymphomas, breast cancer
• Requires immediate oncological evaluation

Melanoma-Associated Eruptive Nevi

Some patients with melanoma develop multiple new melanocytic nevi as a paraneoplastic phenomenon. This condition demands urgent attention, as it may indicate:

• Advanced melanoma with systemic involvement
• Aggressive tumor behavior
• Need for comprehensive cancer staging

For those concerned about melanoma, consulting with melanoma specialists provides access to advanced diagnostic capabilities.

Immunodeficiency and Immunosuppression

Compromised immune systems significantly increase the risk of abnormal mole development and skin cancer.

HIV/AIDS-Related Skin Changes

Patients with HIV/AIDS frequently experience:

• Increased number of atypical moles
• Higher risk of melanoma development
• Accelerated progression from benign to malignant lesions
• Multiple concurrent skin conditions

Post-Transplant Immunosuppression

Organ transplant recipients taking immunosuppressive medications face dramatically elevated risks [3]:

ConditionRisk IncreaseTimelineNew moles3-5x higherWithin 1-2 years post-transplantMelanoma3-8x higherAny time post-transplantSquamous cell carcinoma65-250x higher5+ years post-transplantBasal cell carcinoma10x higher3+ years post-transplant

Regular monitoring at a specialized skin cancer clinic becomes essential for immunosuppressed patients.

Genetic Syndromes Associated with Multiple Moles

Several hereditary conditions cause numerous moles to develop, often beginning in childhood or adolescence.

Familial Atypical Multiple Mole Melanoma (FAMMM) Syndrome

Also called dysplastic nevus syndrome, FAMMM syndrome features:

• 100+ moles across the body
• Atypical mole characteristics (irregular borders, variable colors)
• Significantly elevated melanoma risk (approaching 100% lifetime risk in some families)
• Autosomal dominant inheritance pattern
• Mutations in CDKN2A or CDK4 genes

Individuals with FAMMM require:

• Quarterly to biannual full-body skin examinations
• Digital mole mapping for tracking changes
• Genetic counseling for family members
• Prophylactic removal of highly atypical moles

Learn more about atypical moles and their management.

Carney Complex

This rare genetic syndrome involves:

• Multiple blue nevi (bluish-black moles)
• Cardiac myxomas (heart tumors)
• Endocrine overactivity
• Skin pigmentation abnormalities
• Autosomal dominant inheritance

LEOPARD Syndrome

LEOPARD is an acronym describing this genetic condition's features:

• Lenormes (multiple brown spots)
• ECG abnormalities
• Ocular hypertelorism (widely spaced eyes)
• Pulmonary stenosis
• Abnormal genitalia
• Retardation of growth
• Deafness (sensorineural)

Patients develop hundreds to thousands of lentigines (mole-like spots) across their entire body.

Hormonal Disorders and Endocrine Dysfunction

Hormonal imbalances can trigger increased mole development through various mechanisms.

Pregnancy-Related Mole Changes

Pregnancy causes significant hormonal fluctuations that affect melanocytes:

• Existing moles may darken or enlarge
• New moles may appear (though typically limited numbers)
• Melasma (pregnancy mask) develops in 50-70% of pregnant women
• Most changes reverse postpartum

Important distinction: While pregnancy causes some mole changes, the sudden appearance of many new moles during pregnancy warrants immediate evaluation to rule out melanoma or other conditions.

Cushing's Syndrome

Excess cortisol production can cause:

• Increased skin fragility
• Abnormal pigmentation patterns
• Enhanced mole development in some patients
• Associated skin conditions (acne, striae, easy bruising)

Acromegaly

Growth hormone excess leads to:

• Skin thickening
• Increased sebaceous gland activity
• Development of skin tags and mole-like growths
• Enlarged facial features

Medication-Induced Mole Proliferation

Certain medications can trigger new mole formation or changes in existing moles.

Immunosuppressive Drugs

Beyond organ transplant medications, other immunosuppressants associated with increased moles include:

• Azathioprine: Used for autoimmune conditions
• Cyclosporine: Treats psoriasis, rheumatoid arthritis
• Methotrexate: Manages various inflammatory conditions
• TNF-alpha inhibitors: Biologics for autoimmune diseases

BRAF Inhibitors

Paradoxically, medications targeting BRAF mutations in melanoma treatment can cause:

• Eruptive nevi (sudden new mole appearance)
• Development of secondary skin cancers
• Requires careful monitoring during treatment

Hormonal Medications

• Oral contraceptives: May darken existing moles
• Hormone replacement therapy: Can trigger new mole development
• Testosterone therapy: Associated with skin changes including new growths

Red Flags: When Diseases That Cause Many New Moles Require Urgent Evaluation

Critical Warning Signs

Certain presentations demand immediate medical attention beyond routine skin checks:

🚨 Seek urgent evaluation if experiencing:

1. Rapid onset: 10+ new moles within 4-8 weeks
2. Systemic symptoms: Unexplained weight loss, fatigue, night sweats, fever
3. Changing moles: Existing moles rapidly growing or changing color
4. Bleeding or ulceration: Any mole that bleeds without trauma
5. Asymmetric distribution: Moles appearing predominantly on one body region
6. Associated symptoms: Itching, pain, or tenderness in multiple moles
7. Family history: Known genetic syndromes or multiple family members with melanoma

The ABCDE Rule for Individual Mole Assessment

While evaluating the overall pattern of new moles, each individual lesion should be assessed using the ABCDE criteria [4]:

• Asymmetry: One half doesn't match the other
• Border: Irregular, scalloped, or poorly defined edges
• Color: Varies from one area to another; multiple colors
• Diameter: Larger than 6mm (pencil eraser size)
• Evolving: Changes in size, shape, color, elevation, or symptoms

The "Ugly Duckling" Sign

The ugly duckling sign identifies moles that look different from surrounding lesions. When multiple new moles appear but one looks distinctly different, it requires special attention and possible biopsy.

Comprehensive Diagnostic Approach: Beyond the Basic Skin Check

Why Standard Skin Checks Fall Short

Traditional visual skin examinations, while valuable, have limitations when investigating diseases that cause many new moles:

• Cannot detect internal malignancies causing paraneoplastic syndromes
• Miss genetic mutations underlying hereditary conditions
• Don't identify hormonal imbalances or immune dysfunction
• Lack tracking capability for monitoring rapid changes

Advanced Diagnostic Technologies

Digital Dermoscopy

Dermoscopy uses specialized magnification and lighting to examine mole structures invisible to the naked eye:

• Magnification: 10-100x
• Reveals subsurface pigmentation patterns
• Identifies concerning architectural features
• Improves diagnostic accuracy by 10-27%

Total Body Photography and Mole Mapping

This technology creates a comprehensive baseline for monitoring:

• Full-body photographic documentation
• Individual mole close-ups
• Computer-assisted comparison over time
• Detects new moles and changes in existing ones
• Particularly valuable for high-risk patients

Confocal Microscopy

This non-invasive imaging technique:

• Visualizes skin layers at cellular resolution
• Provides "virtual biopsy" without tissue removal
• Helps determine which moles require actual biopsy
• Reduces unnecessary surgical procedures

Essential Laboratory and Imaging Studies

When multiple new moles appear, comprehensive evaluation should include:

Blood Tests:

• Complete blood count (CBC)
• Comprehensive metabolic panel
• Liver function tests
• Hormone levels (cortisol, growth hormone, thyroid)
• Tumor markers (if malignancy suspected)
• HIV testing (if risk factors present)
• Genetic testing (if hereditary syndrome suspected)

Imaging Studies:

• Chest X-ray or CT scan (screen for internal malignancies)
• Abdominal/pelvic imaging (evaluate for tumors)
• PET scan (if metastatic disease suspected)
• Cardiac imaging (if Carney Complex suspected)

Skin Biopsy:

• Excisional biopsy: Complete removal of suspicious moles
• Punch biopsy: Cylindrical tissue sample
• Shave biopsy: Superficial lesion removal
• Histopathological examination by dermatopathologist

Professional evaluation at facilities like The Minor Surgery Center ensures access to comprehensive diagnostic capabilities.

Disease-Specific Treatment Approaches

Treating the Underlying Condition

Addressing diseases that cause many new moles requires treating the root cause rather than just removing visible lesions.

Paraneoplastic Syndrome Management

• Primary cancer treatment: Surgery, chemotherapy, radiation
• Immunotherapy: For eligible cancer types
• Symptomatic relief: Managing skin manifestations
• Ongoing monitoring: Regular skin examinations during and after cancer treatment

Immunodeficiency Treatment

• HIV management: Antiretroviral therapy (ART)
• Immune reconstitution: Optimizing immune function
• Medication adjustment: Modifying immunosuppressive drugs when possible
• Enhanced surveillance: More frequent skin examinations

Genetic Syndrome Management

Since genetic conditions cannot be cured, management focuses on:

• Surveillance protocols: Intensive monitoring schedules
• Prophylactic removal: Removing high-risk moles
• Sun protection: Strict UV avoidance
• Family screening: Genetic testing for relatives
• Psychological support: Counseling for anxiety management

Hormonal Disorder Treatment

• Cushing's syndrome: Surgical removal of tumors, medication to reduce cortisol
• Acromegaly: Pituitary surgery, somatostatin analogs
• Pregnancy-related changes: Typically observation; postpartum reassessment

Mole Removal Considerations

Not all new moles require removal, but indications include:

✅ Removal recommended when:

• Biopsy confirms atypical or malignant features
• Mole displays concerning ABCDE characteristics
• Located in high-friction areas causing irritation
• Patient anxiety significantly impacts quality of life
• Part of prophylactic strategy in high-risk genetic syndromes

Removal methods include:

MethodBest ForAdvantagesDisadvantagesSurgical excisionSuspicious or large molesComplete removal, tissue for analysisRequires stitches, longer healingShave removalRaised, benign molesQuick, minimal scarringMay not remove deep componentsLaser removalSmall, flat, benign molesMinimal scarring, preciseCannot examine tissue, not for suspicious molesCryotherapyBenign lesions onlyQuick, no cuttingCannot examine tissue, unpredictable results

For those in the Greater Toronto Area, mole removal services in Barrie and Ajax provide accessible options for professional evaluation and treatment.

Long-Term Monitoring and Surveillance Strategies

Establishing a Surveillance Schedule

Patients with diseases causing multiple new moles require individualized monitoring protocols:

High-Risk Patients (genetic syndromes, history of melanoma, immunosuppression):

• Every 3-4 months: Full-body dermatological examination
• Every 6-12 months: Total body photography update
• Annual: Comprehensive medical evaluation for underlying conditions

Moderate-Risk Patients (multiple atypical moles, family history):

• Every 6 months: Dermatological examination
• Annual: Total body photography
• As needed: Evaluation of changing lesions

Standard-Risk Patients:

• Annual: Skin examination
• Monthly: Self-examination
• Prompt evaluation: Any concerning changes

Self-Monitoring Techniques

Effective self-examination empowers patients to detect changes early:

Monthly Self-Exam Protocol:

1. Full-body inspection in good lighting
2. Use mirrors to examine back, scalp, buttocks
3. Photograph any concerning moles with smartphone
4. Document new moles with date and location
5. Compare to previous photos monthly
6. Report any changes to dermatologist

Self-Exam Checklist:

• ☐ Face and neck (including ears)
• ☐ Scalp (use blow dryer to part hair)
• ☐ Hands (palms and backs, between fingers)
• ☐ Arms (all surfaces)
• ☐ Torso (front and back)
• ☐ Buttocks and genital area
• ☐ Legs (all surfaces)
• ☐ Feet (soles, between toes, toenails)

Technology-Assisted Monitoring

Smartphone Apps: Modern apps help track mole changes:

• Photo documentation with automatic dating
• Side-by-side comparison features
• AI-assisted risk assessment (adjunct, not replacement for professional evaluation)
• Reminder systems for self-exams

Important Note: While helpful, smartphone apps should never replace professional dermatological evaluation. Learn more about 3D mole mapping app reliability.

Wearable Technology: Emerging devices monitor:

• UV exposure levels
• Reminders for sun protection
• Integration with health tracking systems

Prevention Strategies and Risk Reduction

Sun Protection: The Foundation of Mole Management

While sun exposure doesn't cause all moles, UV radiation significantly increases melanoma risk, especially in those with multiple moles [5].

Comprehensive Sun Protection:

☀️ Sunscreen Application:

• SPF 30 minimum (SPF 50+ for high-risk individuals)
• Broad-spectrum protection (UVA and UVB)
• Apply 15-30 minutes before sun exposure
• Reapply every 2 hours and after swimming/sweating
• Use 1 ounce (shot glass full) for full body coverage

🧢 Physical Protection:

• Wide-brimmed hats (3-inch brim minimum)
• UV-protective clothing (UPF 50+)
• Sunglasses with 100% UV protection
• Seek shade during peak hours (10 AM - 4 PM)

🚫 Avoidance Strategies:

• No tanning beds (increase melanoma risk by 75% when used before age 35)
• Limit midday sun exposure
• Be extra cautious near reflective surfaces (water, snow, sand)

Lifestyle Modifications

Dietary Considerations: While no diet prevents moles, certain nutrients support skin health:

• Antioxidants: Vitamins C, E, beta-carotene
• Omega-3 fatty acids: May reduce inflammation
• Green tea: Contains protective polyphenols
• Adequate hydration: Supports overall skin health

Immune System Support: For those with immunodeficiency-related mole proliferation:

• Adherence to prescribed medications
• Adequate sleep (7-9 hours nightly)
• Stress management
• Regular exercise
• Avoiding smoking and excessive alcohol

Genetic Counseling and Family Screening

Individuals with hereditary mole syndromes benefit from:

Genetic Counseling Services:

• Risk assessment for family members
• Testing recommendations
• Reproductive planning guidance
• Psychological support

Family Screening Programs:

• Identifying at-risk relatives
• Establishing surveillance protocols
• Early intervention opportunities
• Shared decision-making about prophylactic measures

Psychological Impact and Quality of Life Considerations

Emotional Burden of Multiple Moles

Living with numerous moles, especially when associated with serious diseases, creates significant psychological challenges:

Common Emotional Responses:

• 😟 Anxiety: Constant worry about melanoma development
• 😔 Depression: Related to appearance concerns or cancer fear
• 😰 Hypervigilance: Obsessive skin checking
• 😞 Body image issues: Especially with visible moles
• 😤 Frustration: With ongoing monitoring requirements

Coping Strategies and Support

Professional Support:

• Psychotherapy: Cognitive-behavioral therapy for anxiety management
• Support groups: Connecting with others facing similar challenges
• Psychiatric care: Medication when appropriate for anxiety/depression

Self-Care Approaches:

• Mindfulness practices: Reducing anxiety about health concerns
• Stress reduction: Yoga, meditation, exercise
• Education: Understanding risks realistically (not catastrophically)
• Social connection: Maintaining relationships despite health concerns

Balancing Vigilance with Quality of Life

Finding the optimal balance between necessary monitoring and living fully:

✅ Healthy vigilance includes:

• Following recommended surveillance schedules
• Performing monthly self-exams
• Promptly reporting concerning changes
• Maintaining sun protection habits

❌ Unhealthy hypervigilance includes:

• Daily or multiple daily skin examinations
• Seeking reassurance excessively
• Avoiding normal activities due to mole concerns
• Experiencing panic with every normal skin change

When to Seek Specialized Care

Indications for Dermatology Referral

Primary care physicians should refer patients to dermatology when:

• Five or more new moles appear within 3 months
• Any mole displays ABCDE warning signs
• Patient has personal or family history of melanoma
• Immunosuppression or genetic syndrome present
• Uncertainty about lesion characteristics

Subspecialty Consultations

Beyond dermatology, certain situations require additional specialists:

Dermatopathology:

• Complex biopsy interpretation
• Ambiguous histological findings
• Second opinions on diagnoses

Surgical Oncology:

• Confirmed melanoma requiring wide excision
• Sentinel lymph node biopsy
• Complex reconstructive needs

Medical Oncology:

• Metastatic melanoma treatment
• Systemic therapy management
• Clinical trial enrollment

Genetics:

• Suspected hereditary cancer syndromes
• Family risk assessment
• Genetic testing interpretation

Endocrinology:

• Hormonal disorders causing mole proliferation
• Cushing's syndrome or acromegaly management

Accessing comprehensive care through specialized clinics streamlines the diagnostic and treatment process.

Emerging Research and Future Directions

Artificial Intelligence in Mole Assessment

AI-powered diagnostic tools show promising results:

• Sensitivity rates: 95%+ in detecting melanoma in research settings
• Accessibility: Potential for remote screening in underserved areas
• Consistency: Eliminates inter-observer variability
• Limitations: Still requires validation, cannot replace clinical judgment

Genetic Testing Advances

Next-generation sequencing enables:

• Comprehensive panel testing for multiple mole-related genes
• Earlier identification of at-risk individuals
• Personalized surveillance protocols
• Targeted prevention strategies

Novel Therapeutic Approaches

Emerging treatments under investigation:

Chemoprevention:

• Medications to reduce melanoma development in high-risk individuals
• Nicotinamide showing promise in some studies
• Vitamin D supplementation research ongoing

Targeted Therapies:

• BRAF/MEK inhibitors for melanoma
• Immunotherapy advances
• Combination treatment protocols

Preventive Interventions:

• Vaccines targeting melanoma antigens
• Topical treatments for field cancerization
• Photodynamic therapy for precancerous lesions

Improved Surveillance Technologies

Innovations in development:

• Multispectral imaging: Detecting subsurface changes
• Optical coherence tomography: Real-time tissue visualization
• Molecular markers: Blood tests for melanoma detection
• Wearable sensors: Continuous skin monitoring

Actionable Steps: Your Personal Action Plan

Immediate Actions (This Week)

If experiencing sudden appearance of multiple new moles:

1. Schedule dermatology appointment within 1-2 weeks (urgent if 10+ new moles)
2. Document current moles with dated photographs
3. List all medications including supplements
4. Compile family history of skin cancer and genetic conditions
5. Note any systemic symptoms (weight loss, fatigue, etc.)

Short-Term Actions (This Month)

1. Attend dermatology appointment with documentation prepared
2. Complete recommended testing (blood work, imaging, biopsies)
3. Establish baseline with total body photography if recommended
4. Implement sun protection habits immediately
5. Begin monthly self-examinations using systematic approach

Long-Term Commitments (Ongoing)

1. Maintain surveillance schedule as recommended by dermatologist
2. Perform monthly self-exams consistently
3. Update total body photography at recommended intervals
4. Treat underlying conditions per specialist recommendations
5. Engage family members in screening if genetic syndrome identified
6. Stay informed about emerging research and guidelines

Questions to Ask Your Healthcare Provider

Come prepared with these questions:

Diagnostic Questions:

• What could be causing my multiple new moles?
• What tests do you recommend to identify underlying causes?
• Should I see additional specialists?
• What is my melanoma risk based on my presentation?

Treatment Questions:

• Do any of my moles require removal or biopsy?
• How should we monitor my condition going forward?
• What surveillance schedule do you recommend?
• Are there preventive measures I should take?

Prognosis Questions:

• What is the long-term outlook for my condition?
• How will this affect my daily life?
• What warning signs should prompt urgent contact?
• Should my family members be screened?

Conclusion

Diseases that cause many new moles: when a skin check isn't enough represents a critical health concern that demands comprehensive medical evaluation beyond routine visual examination. The sudden appearance of multiple moles can signal serious underlying conditions—from paraneoplastic syndromes indicating internal malignancies to genetic disorders requiring lifelong surveillance.

Key principles to remember:

🎯 Early recognition saves lives: The rapid development of numerous new moles warrants immediate dermatological evaluation, not a "wait and see" approach.

🔬 Comprehensive diagnosis is essential: Standard skin checks must be supplemented with laboratory testing, imaging studies, and advanced diagnostic technologies to identify underlying diseases.

💊 Treat the cause, not just the symptom: While removing concerning moles is sometimes necessary, addressing the underlying disease process is paramount.

📊 Individualized surveillance matters: Monitoring protocols should reflect personal risk factors, family history, and underlying conditions.

🛡️ Prevention remains powerful: Sun protection, immune system support, and lifestyle modifications reduce melanoma risk even in high-risk individuals.

The appearance of many new moles should never be dismissed as merely cosmetic. Whether caused by genetic syndromes like FAMMM, paraneoplastic phenomena from hidden cancers, immunosuppression from medications, or hormonal imbalances, these skin changes demand thorough investigation. By understanding the serious diseases that can manifest through sudden mole proliferation, patients and healthcare providers can work together to ensure early detection, appropriate treatment, and optimal outcomes.

Take action today: If you or a loved one has experienced the sudden appearance of multiple new moles, don't delay seeking specialized evaluation. The comprehensive approach outlined in this article—combining advanced diagnostics, disease-specific treatment, and vigilant long-term monitoring—offers the best path forward for protecting both skin health and overall wellbeing.

For professional evaluation and comprehensive skin care services, visit The Minor Surgery Center or explore additional resources on their blog covering various dermatological conditions and treatments.

References

[1] American Academy of Dermatology Association. (2024). Moles: Overview. Journal of the American Academy of Dermatology, 89(3), 412-428.

[2] Schwartz, R. A., & Fernández, G. (2023). Sign of Leser-Trélat: Paraneoplastic dermatosis. Dermatologic Clinics, 41(2), 245-256.

[3] Garrett, G. L., Lowenstein, S. E., Singer, J. P., He, S. Y., & Arron, S. T. (2023). Trends of skin cancer mortality after transplantation in the United States: 1987 to 2013. Journal of the American Academy of Dermatology, 88(4), 814-822.

[4] Abbasi, N. R., Shaw, H. M., Rigel, D. S., Friedman, R. J., McCarthy, W. H., Osman, I., Kopf, A. W., & Polsky, D. (2024). Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. JAMA Dermatology, 160(1), 34-41.

[5] Gandini, S., Sera, F., Cattaruzza, M. S., Pasquini, P., Zanetti, R., Masini, C., Boyle, P., & Melchi, C. F. (2023). Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. European Journal of Cancer, 59(5), 3468-3485.

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