Persistent moles
Q In recent years, doctors at my local hospital have removed 10 moles they suspected might be skin cancer. Only two turned out to be malignant, both non-life-threatening basal cell carcinomas. This has left me with unpleasant visible scarring. Now doctors want to remove two more suspect moles. Given that eight out of 10 previous removals were unnecessary, I have asked if they could take a small biopsy unlikely to lead to scarring. Then, if analysis shows evidence of cancer, the rest of the mole and surrounding tissue could be removed in a follow-up operation.
The doctors say this is "not possible". It is, apparently, their policy to remove the whole of any suspect mole and all surrounding tissue. They say that taking a small sample might miss the cancerous element and could depress any cancerous cells downwards, encouraging invasive body growth. Are the doctors right? Is their policy standard practice for identifying potential skin cancers? I want any suspect moles investigated, but I am not happy that the removal of moles about 4mm in diameter have left me with 10 12mm by 30mm scars. Doctors admit that I am likely to need many more exploratory removals. Fair enough, but I don't want to be covered in scars if I can possibly avoid it.
A You've got two different and unrelated skin problems. Basal cell cancers, also known as rodent ulcers, are usually readily identifiable by doctors and do need to be removed by cutting, scraping, freezing or burning. You also seem to have a lot of moles that need watching to ensure that you aren't developing a melanoma. Melanomas don't kill you if you catch them early but rapidly become more dangerous as they extend deeper into the skin. That's why all your doctors have erred on the side of caution - any number of skin scars has to be better than missing a treatable melanoma. You could ask to have all your moles photographed regularly so that any changes could be measured. Also look out for changes of colour and size in moles, and any itching, bleeding or crusting which can be early signs of melanoma.
Boozing and dozing
Q Is there such a condition as "alcoholic narcolepsy"? Of course alcohol can put people to sleep eventually. The question is how little alcohol it takes to put somebody to sleep before such a condition could be called a medical problem? In my case, that can be as little as eight units of alcohol depending on physical environment, the company I'm in and whether I mix kinds of alcoholic drinks. The sleep can be for relatively short times such as 10 to 15 minutes and the people I usually drink with are aware of the problem and do not take it personally if I fall asleep on them.
However last night I had something of a record. After 10 to 15 units of alcohol (all beer), I got home at 7pm, turned on the TV, lay down on the bed and woke three-and-a-half hours later. Assuming I wanted to get rid of this condition, is there something a doctor could give me (whether in tablet form or an operation) to have the desired effect ?
A After 10-15 units of alcohol (ie more than seven pints of beer) you had a three-and-a-half-hour sleep. I'd be unconscious for days. The effect that alcohol has on an individual depends on numerous factors - whether you've eaten first, what you drink, your size, fatness, gender and genetic susceptibility. Excess alcohol is bad for our brains; it can induce fits, memory loss and confusion. In smaller doses it loosens inhibitions, then makes us sleepy. I asked Alcoholics Anonymous whether they'd heard of "alcoholic narcolepsy". "We call it being sloshed," was their reply.
These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
