Early skin cancer usually shows up as a small change on your skin that doesn’t go away: a new bump with a pearly sheen, a scaly red patch, a sore that won’t heal, or a mole that starts changing shape or color. The specific appearance depends on the type of skin cancer, and some forms look surprisingly different from what most people expect. Catching these changes early matters enormously. Localized melanoma has a five-year survival rate of nearly 100%, but that drops to 34% once it has spread to distant parts of the body.
Precancerous Patches: Actinic Keratosis
Before skin cancer fully develops, you may notice precancerous spots called actinic keratoses. These are rough, dry, scaly patches of skin, usually less than one inch across, that feel like sandpaper when you run your finger over them. They range in color from pink to red to brown and tend to appear on areas that get the most sun exposure: the face, lips, ears, forearms, scalp, neck, and backs of the hands.
Most actinic keratoses are flat or only slightly raised. Some develop a hard, wart-like surface. They’re not cancer yet, but a small percentage will progress into squamous cell carcinoma if left untreated, which is why dermatologists typically recommend removing them.
Basal Cell Carcinoma
Basal cell carcinoma is the most common type of skin cancer, and its earliest sign is often a shiny, translucent bump. On lighter skin, this bump looks pearly white or pink, and you can sometimes see tiny blood vessels running through it. On brown and Black skin, the same growth often appears brown or glossy black with a rolled border, which can make it harder to recognize as a warning sign.
Not all basal cell carcinomas look like bumps. Some appear as flat, scaly patches with a slightly raised edge. Others resemble a white, waxy, scar-like area without a clear border. One of the most reliable clues is a sore that bleeds, scabs over, and then never fully heals, or heals and reopens repeatedly. If you have a spot like this that has persisted for more than a few weeks, it’s worth getting checked.
Squamous Cell Carcinoma
Squamous cell carcinoma typically starts as a growing bump with a rough, scaly surface, or as a flat reddish patch that looks crusted over. In its earliest stage, called squamous cell carcinoma in situ, it can appear as a large, scaly, reddish patch bigger than one inch across. This stage is confined to the top layer of skin and is highly treatable.
Like basal cell carcinoma, squamous cell cancer can also present as a sore that doesn’t heal. Any change in an existing wart, mole, or long-standing skin lesion can be a sign as well. These cancers tend to develop on sun-exposed areas but can appear anywhere on the body.
Melanoma and the ABCDE Rule
Melanoma is less common than basal or squamous cell cancers but far more dangerous. The classic screening tool is the ABCDE rule, which describes five features to watch for in a mole or dark spot:
- Asymmetry: one half of the mole doesn’t match the other half.
- Border: the edges are ragged, notched, or blurred, and pigment may spread into surrounding skin.
- Color: instead of a uniform shade, you see a mix of brown, black, tan, white, gray, red, pink, or blue within the same spot.
- Diameter: the spot is larger than about 6 millimeters, roughly the size of a pencil eraser. Melanomas can be smaller, but most exceed this threshold.
- Evolving: the mole has visibly changed in size, shape, or color over the past few weeks or months.
A mole doesn’t need to meet all five criteria to be suspicious. Even one of these features, particularly a spot that is clearly evolving, warrants a closer look.
Melanoma Types That Don’t Follow the Rules
Some melanomas don’t look like the textbook description, and these are the ones most likely to be missed.
Nodular melanoma grows rapidly as a raised, firm lump rather than spreading outward as a flat spot. It may not show the classic asymmetry or irregular borders that the ABCDE rule describes. Dermatologists use a separate set of warning signs for this type: Elevated, Firm, and Growing (EFG). If you notice a new raised bump that feels firm and is noticeably changing over days or weeks, take it seriously.
Amelanotic melanoma lacks the dark pigmentation people associate with melanoma. Instead, it appears as a pink, red, or skin-colored nodule. Because it doesn’t look like a typical mole, it’s frequently misdiagnosed as something harmless like eczema, a cyst, or even a pimple that won’t go away. About 35% of misdiagnosed cases are initially mistaken for basal cell carcinoma. A useful shortcut for spotting these is the “3 Rs”: a Red, Raised lesion with Recent change.
How Skin Cancer Looks on Darker Skin
Skin cancer can develop in people of any skin tone, but it often appears in different locations and with different features in people with darker skin. The most important type to know about is acral lentiginous melanoma, which develops on the palms, soles of the feet, and under fingernails or toenails. This subtype accounts for only 2 to 3% of all melanoma diagnoses overall, but it’s the most common form of melanoma among Black, Hispanic, and Asian individuals.
Unfortunately, acral lentiginous melanoma is often caught late. Studies consistently show that Black, Hispanic, and Asian patients are diagnosed with thicker, more advanced tumors. Part of this is because people don’t think to check these areas, and part of it is that skin cancer education has historically focused on sun-exposed skin and lighter-skinned populations. A dark streak under a nail, a new spot on the sole of your foot, or a darkening patch on your palm all deserve attention.
How to Check Your Own Skin
A thorough self-exam takes about 10 minutes and should cover areas you’d never think to look. The Skin Cancer Foundation recommends checking your entire body once a month, using a full-length mirror and a hand mirror to see hard-to-reach spots.
Start with your scalp, using a blow dryer to part your hair section by section. Check between your fingers and under your fingernails. Scan your arms, including the underarms. Inspect your torso front and back, and lift the breasts to check the undersides. Use a hand mirror to examine the genital area. Then work down both legs, finishing with your ankles, the soles of your feet, between your toes, and your toenails (remove polish if needed).
The goal isn’t to diagnose yourself. It’s to notice changes. A spot that’s new, growing, changing color, bleeding without injury, or simply looks different from everything else on your body is the kind of thing worth bringing to a dermatologist. Most of the time it will turn out to be nothing, but the stakes of missing something early are high enough to justify the visit.