Can a spot be skin cancer? Warning signs

First: a spot is not a diagnosis

A pigmented lesion can be completely benign.

It may be a solar lentigo. A nevus. A seborrheic keratosis. A post-inflammatory pigmentation.

But certain malignant lesions can also begin as an apparently innocent spot.

That is why, when someone searches for skin cancer spots or spots skin cancer, the right question is not simply: 'Is it brown?' but rather: 'How does that lesion behave?'

What types of skin cancer are there?

The three best-known types are: basal cell carcinoma, squamous cell carcinoma, and melanoma.

Not all of them look the same.

Melanoma can resemble a mole or a pigmented spot.

Basal cell carcinoma can present as a shiny, pink, ulcerated, or bleeding lesion.

Squamous cell carcinoma can appear as a rough plaque, a crusted lesion, a persistent wound, or a growth that changes over time.

That is why: skin cancer does not necessarily mean a black spot.

Melanoma: the ABCDE rule

To help recognise suspicious lesions, we use the well-known ABCDE melanoma rule.

A — Asymmetry. One half of the lesion does not match the other.

B — Border. The borders are irregular, poorly defined, or scalloped.

C — Color. There are different colors within the same lesion: brown, black, reddish, white, or bluish. Color variation within a lesion can be a warning sign.

D — Diameter. Classically, we pay attention to lesions larger than about 6 mm. But this is very important: a melanoma can be smaller. Therefore, a lesion is not reassuring simply because it measures less than 6 mm.

E — Evolution. Probably the most important letter. A lesion changes. It grows. It changes shape. It changes color. It becomes different from what it was. Evolution is one of the main warning signs.

The 'ugly duckling' rule

There is another extremely useful concept.

Most of our moles tend to look similar to one another.

But sometimes one appears that simply does not look like the others. Darker. More irregular. Larger. Redder. Or with a different shape.

This idea is known as the 'ugly duckling' sign.

A lesion that stands out clearly from the usual pattern of the rest deserves attention.

The AAD recommends seeking consultation if a new lesion appears, one that is different from the others, or one that is changing.

Does a lesion have to hurt to be dangerous?

No. This is a very common misconception.

A melanoma may not hurt. It may not itch. It may cause no discomfort whatsoever.

Sometimes the only sign is simply that the lesion is changing.

Therefore: 'it doesn't hurt' does not mean 'it is benign'.

What if it itches?

Itching does not establish a diagnosis either.

A dermatitis can itch intensely and be completely benign.

But if a mole or a previously stable lesion starts to itch, bleed, or change, it deserves a dermatological evaluation.

What if it bleeds?

A lesion that bleeds spontaneously or with minimal trauma deserves attention.

Especially if it bleeds repeatedly, forms a crust, appears to heal and reopens, or has not healed for weeks.

Both melanoma and other skin cancers can present as lesions that bleed or do not heal.

A wound that won't heal

This is one of the signs of skin cancer that many people are unaware of.

We don't always see a spot. Sometimes we see a small wound, a recurring crust, a 'pimple' that never goes away, or an area that seems to heal and then ulcerates again.

A persistent lesion that does not heal deserves to be examined.

Is melanoma always black?

No.

Some melanomas can be brown or black.

But there are also melanomas with reddish, pink, white, or bluish areas.

There are even melanomas with very little pigment, called amelanotic melanomas. The AAD notes that melanoma can take many different forms, including a reddish or pink lesion.

That is why we should not reduce diagnosis to: "dark = dangerous, light = safe."

Can it appear in an area that never gets sun?

Yes.

Melanoma can appear in virtually any area of the skin.

Including the palms, soles, between the fingers, the scalp, the genital region, and beneath the nails.

That is why a skin check does not consist solely of looking at the face and arms.

What about the nails?

A new or changing pigmented band beneath a nail may also need to be evaluated.

Ungual melanoma can present as a longitudinal brown or black line beneath the nail.

This does not mean that every melanonychia is melanoma. In fact, many are benign.

But a new band that changes or displays certain characteristics needs to be evaluated.

What about a new spot after the age of 30?

A new nevus in adulthood does not automatically mean melanoma.

But a new lesion that appears from a certain age onwards deserves more attention than a stable mole that has been present for many years.

The AAD recommends having a new or changing mole evaluated in adults, especially if it appears after the age of 30.

Which red lesions can be skin cancer?

Not all skin cancers are pigmented.

A squamous cell carcinoma can appear as a red or rough plaque, a crusty lesion, an ulcer, a raised growth, or a bleeding lesion.

A basal cell carcinoma can also present as a pink, shiny, or ulcerated lesion.

That is why a persistent red lesion should not be dismissed simply because it "doesn't look like a mole."

What does the dermatologist do when they see a suspicious lesion?

First: they examine it clinically.

Afterwards, we frequently use dermoscopy.

The dermatoscope allows us to visualize structures that we cannot adequately appreciate with the naked eye.

This improves our ability to differentiate many benign lesions from those that require further study.

And if it remains suspicious?

Then we may indicate a biopsy or excision.

And here there is a fundamental concept: the definitive diagnosis of a skin cancer is established through histological examination of the tissue.

Not through an internet photograph. Not through an app. And not simply by color.

Can a suspicious spot be removed with a laser?

It should not be done without a diagnosis.

If a pigmented lesion presents suspicious characteristics, we should not simply destroy it with a laser.

Why? Because we can remove tissue that could have provided diagnostic information.

When facing a suspicious lesion: diagnosis first. Then we decide on treatment.

Should we check all our moles every month?

There is no single universal frequency that applies to the entire population.

Follow-up depends on individual risk.

But it is useful to know our own skin. To know which lesions we have. And to observe whether any of them change.

The AAD recommends regular self-examination of all the skin and paying attention to new, different, or evolving lesions.

Which areas do we tend to forget?

Many.

The scalp. Behind the ears. The back. The buttocks. The soles of the feet. Between the toes. The nails.

That is why, when we perform a self-examination, we must look at the entire body.

So, when should I seek medical advice?

A lesion deserves evaluation especially when it is new and keeps growing; changes in size, shape, or color; looks different from your other moles; displays several colors; bleeds without a clear explanation; itches persistently; forms a wound that does not heal; partially disappears and reappears; or simply seems different from how it looked before.

What I want you to remember

If you are looking for skin cancer spots, I want you to take away one very simple idea: the vast majority of spots are not cancer.

But a lesion that changes deserves attention.

We don't need to memorize hundreds of photographs of melanoma. We can remember something far more practical: ABCDE. Asymmetry. Border. Color. Diameter. Evolution.

And add two questions: is it different from the rest? Is it changing?

Because detecting a suspicious lesion early can enormously simplify its treatment. Early detection of melanoma is especially important because when it is identified before it spreads, the prognosis is much better.

That is why I don't want you to be afraid of your moles. I want you to know your skin.

And if a lesion changes: don't wait for it to hurt before showing it to a dermatologist.