You’ve got a new brown spot on your face, but is it a freckle or a sunspot? Or perhaps you’ve found a spot on your back that looks like a mole but is flatter than your other ones – is it a mole or a dark freckle?

Here’s how to tell the difference between freckles, sunspots and moles – and when you need to get a spot checked to see if it’s skin cancer.

Freckles

Freckles, known as ephelides, are small, flat, light brown spots that appear on people with fair skin, or red or light-coloured hair.

These people are more likely to have the MC1R gene, which leads to freckles forming.

Freckles are caused by sun exposure and are more noticeable in summer. When sunlight hits the skin, cells called melanocytes produce melanin, the pigment that gives skin its colour.

In people prone to freckles, the melanin doesn’t spread evenly. Instead, it clumps together, creating freckles.

Freckles generally appear in childhood and may fade with age, especially if sun exposure reduces. As we age we produce less melanin, or it can break down or disperse, resulting in lighter or fewer freckles.

Using sunscreen and wearing protective clothing can help prevent new freckles from developing, especially on the face and arms.

While freckles are completely harmless, they are a sign that someone is genetically at higher risk of developing skin cancer.

Sunspots

Sunspots are also called age spots or solar lentigos (or liver spots, but they have nothing to do with the liver). They are larger than freckles: sometimes the size of a small coin, and appear as flat brown spots.

Sunspots develop over time due to long-term sun exposure, which leads to excessive melanin production. They tend to appear on skin with greater sun exposure, such as the face, hands, shoulders and arms.

Unlike freckles, which tend to get lighter with less sun exposure, sunspots will not fade with time, and may further darken with continued sun exposure.

However, some people try to remove their sunspots for cosmetic reasons using either a laser, chemical peel or a prescription topical cream.

While sunspots are not dangerous, they do increase your risk of other skin cancers in that area.

It’s also important to monitor them, as slow-growing melanomas may initially look like sunspots. If you see the spot changes in size, shape or colour, see your doctor to rule out skin cancer.

Moles

Moles are often dark, raised or flat skin growths that can appear anywhere on your body.

Although moles can exist from birth, they typically grow during childhood, adolescence and early adulthood (including during pregnancy, when hormones are changing), until around the age of around 40. Moles can increase in size, and new ones can also appear.

Most adults have between ten and 40 moles on their body. A person with a high mole count has 50 or more, while someone with a very high mole count has 100 or more.

Moles form when melanocytes grow in clusters instead of spreading evenly throughout the skin.

Moles can either be raised or flat, depending upon their type, depth and age.

Raised moles, referred to as compound nevi, have both flat and raised portions and typically have pigment that is deeper in the skin.

Dermal nevi are skin-coloured or light brown moles that are also raised.

Most moles are harmless. Some may have hair growing from them and some may disappear, whereas other moles may darken or alter with age or hormonal changes.

However, some moles can develop into melanoma, a dangerous form of skin cancer.

When to see your doctor

While freckles and sunspots are completely harmless, moles do require more attention, especially if they change in size, shape, colour or texture.

If a mole shows any of the following warning signs, see your doctor, who will use the ABCDE rule to detect if a lesion is a skin cancer:

• asymmetry: if one half of the mole looks different from the other half
• border: if your mole is shaped irregularly, jagged or has poorly defined edges
• colour: varied shades or sudden changes in colour of the mole
• diameter: if it is larger than 6 millimeters (about the size of a pencil eraser)
• evolving: if your mole has any changes in its size, shape, colour, or sensation such as itching or bleeding for more than a few weeks.

Our research shows only 21.7% of people can correctly identify melanoma on their own, so professional checks are essential.

How to prevent skin damage

Since freckles, sunspots and some moles are influenced by exposure to the sun, you can protect your skin by:

• avoiding the sun when ultraviolet rays are strongest
• wearing sunscreen with SPF 50 every day, even when it’s cloudy. Apply it 20 minutes before going outside and reapply every two hours
• wearing protective clothing, including a wide-brimmed hat to cover your face, neck and ears, and long-sleeved shirts and pants to protect your arms and legs.

Correction: this article originally referred to sun sports as actinic keratoses rather than solar lentigos.

Mike Climstein, Associate Professor, Faculty of Health, Southern Cross University; Jeremy Hudson, Adjunct Associate Professor, Faculty of Health, Southern Cross University; Michael Stapelberg, Adjunct Associate Professor, Faculty of Health, Southern Cross University, and Nedeljka Rosic, Senior Lecturer, Faculty of Health, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You would hope for your dying days to be full of calm and care. But our research with people who are dying shows this is far from the reality for many people.

Instead, financial stress plays a huge and increasing role in who can afford a “good death”.

What we did

In our recent study, we interviewed 18 people nearing the end of life in a palliative care unit, as well as six family members and carers, and 20 palliative care professionals.

We asked what it was like to be dying, to care for someone at the end of life, and to work in palliative care.

Palliative care is for people of any age who have a life-limiting illness. This means they have little or no prospect of a cure. So the goal is to prioritise comfort and living well as they approach the end of their life.

In Australia, palliative care is meant to be mainly free, with most costs covered by state and federal governments, as well as private health insurance.

But our research shows the patchwork of public and private funding means many people are confused and overwhelmed about how to pay for this essential care.

But first, how does palliative care work?

Palliative care can be provided at home or in hospital, a hospice or residential aged care.

Who pays for palliative care depends on where it’s being provided (for example, in the private or public hospital system) and whether the patient has private health insurance.

Australia’s health system is a complex hybrid of public funding, private insurance, charity and out-of-pocket payments.

For dying people and their families, navigating this system can be bewildering.

Previous research has explored how palliative care is funded in Australia. But until now we haven’t heard much directly from patients, carers and workers about how this affects them.

‘It’s expensive being ill’

Our research took place at a specialist palliative care unit in a major city hospital.

People working in the unit told us the activity-based funding model – where hospitals are paid for the number and mix of patients they treat – puts the focus on efficiency, rather than quality of care.

Patients spoke about not wanting to leave behind debt, while carers described confusing and stressful costs.

Patients and families told us they often enter palliative care confused by the patchwork of short-term subsidies, waiting lists for government support packages and gaps they must fill themselves.

For example, some people we interviewed said they had been paying out-of-pocket for medications and essential equipment such as oxygen, which they expected government supports to cover.

But securing government funding, such as the Support At Home program, End-of-Life Pathway or Carer Payment, can sometimes take months to organise.

And once secured, this funding is only available for fixed periods of time. This means patients who live longer than expected can be left without financial security.

Diane*, a community team nurse, told us:

We’ve had people who’ve been referred to us [for end-of-life care] and they were told six weeks [until death], and two years down the track they’ve done their superannuation, they’ve spent it all, […] they’ve got no money left and they’ve still got to pay electricity and things like that. […] And they go, ‘Well, what do I do now?’

Emily* told us her first worry when she got to the palliative care unit was not about dying, but whether the cost would impact her kids:

I didn’t want the children to be loaded with any more debt [because of] me. I would rather [die] on the bench in the park […] the last thing you want to leave them is debt.

Another participant, Kevin*, put it bluntly:

It’s expensive being ill.

Participants who were dying also described feeling pressure not to “outstay their welcome” in a palliative care unit because “the beds are needed” or “the insurance won’t keep paying”.

Alana*, who described herself as a “long-hauler” in the unit, said:

Let’s face it, it’s a business. And I know that. They’re not getting as much money from me as they would for patients coming in and out.

Patients were acutely aware that in the current health system, time is money.

The cost of visiting

For family and friends, their concerns were less about medical bills and more about the price of simply being present.

Jane*, whose elderly mother was dying in the unit, noted the prohibitive cost of parking on site:

They make you pay $20 a day. Your loved one’s dying. Really? […] I’m petrified when I stay overnight […] ‘when does [the parking] run out? I’d better go down and repay’.

Financial stress also impacted whether families could make funeral arrangements. A senior nurse, Patricia*, recounted:

They would say, ‘I don’t have a funeral director. I don’t think we are able to pay for the cost for the funeral. Can you arrange something?’

Death is an economic – not just medical – issue

Our research reveals how money, and worrying about it, can affect people’s experiences when nearing the end of life.

To ensure everyone can access a death free from financial stress, we first need to talk more openly about how money factors into dying.

More accessible government funding for palliative care patients and carers could help ensure everyone has an equal chance of a good end of life. This should be available for as long as people need, rather than on fixed terms.

*Names have been changed for privacy.

Henrietta Byrne, Postdoctoral Research Fellow, Sydney Centre for Healthy Societies, University of Sydney; Alex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of Sydney, and Katherine Kenny, ARC DECRA Senior Research Fellow, Sydney Centre for Healthy Societies, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.