Sun-caused skin cancer can look like a pearly bump, a scaly red patch, a sore that won’t heal, or a mole that’s changed shape or color. The specific appearance depends on which type of skin cancer it is. There are three main types, and each one shows up differently on your skin.
Basal Cell Carcinoma: The Most Common Type
Basal cell carcinoma accounts for roughly 80% of all skin cancers. It grows slowly and rarely spreads to other parts of the body, but it can damage surrounding tissue if left alone. The classic sign is a small, raised bump with a pearly or waxy sheen. The bump often looks translucent, almost like you can partially see through it, and you may notice tiny blood vessels running across its surface.
These lesions typically show up on areas that get the most sun: the face, ears, nose, neck, and scalp. They can also appear as a flat, flesh-colored or pinkish patch that looks a bit like a scar, or as a sore that bleeds, scabs over, and then reopens. Some basal cell carcinomas develop a central depression or crater as they grow. The key feature is persistence. A spot that heals and then comes back in the same place is worth getting checked.
Squamous Cell Carcinoma: Rough and Scaly
Squamous cell carcinoma is the second most common skin cancer. It tends to be more aggressive than basal cell carcinoma and can spread if untreated. The Skin Cancer Foundation describes several recognizable forms: a thick, rough, scaly patch that may crust or bleed; an open sore that persists for weeks without fully healing; or a wart-like growth that crusts and occasionally bleeds.
The scaly patches often have irregular borders and a red or inflamed base. They feel rough to the touch, almost like coarse sandpaper. These growths favor chronically sun-exposed skin, particularly the face, ears, lips, backs of the hands, and forearms. The lower lip is an especially common site for people who’ve had decades of sun exposure. Unlike basal cell carcinoma’s pearly smoothness, squamous cell carcinoma tends to look and feel textured.
What Comes Before: Actinic Keratosis
Many squamous cell carcinomas start as actinic keratoses, which are precancerous patches caused by years of UV damage. These are dry, rough, scaly spots usually less than an inch across. They can be pink, red, or brown, and sometimes develop a hard, wart-like surface over time. You’ll often feel them before you see them. Running your fingers across one feels like touching fine sandpaper on otherwise smooth skin.
Actinic keratoses show up on the same sun-exposed zones: the face, scalp (especially in people with thinning hair), ears, forearms, and backs of the hands. Not every one of these spots will become cancer, but there’s no reliable way to predict which ones will. Treating them early eliminates that uncertainty.
Melanoma: The One to Watch Closely
Melanoma is far less common than the other two types, affecting roughly 2.2% of people over a lifetime, but it’s the most dangerous because it can spread quickly to other organs. It usually develops in or near an existing mole, though it can appear on previously clear skin.
The standard screening tool is the ABCDE rule, developed by the National Cancer Institute:
- Asymmetry: One half of the mole doesn’t match the other.
- Border: The edges are ragged, notched, or blurred rather than smooth and round. Pigment may spread into the surrounding skin.
- Color: The mole contains uneven shading, with mixes of black, brown, tan, white, gray, red, pink, or blue.
- Diameter: Most melanomas are larger than 6 millimeters across (about the size of a pencil eraser), though they can be smaller.
- Evolving: The mole has changed in size, shape, or color over the past few weeks or months.
There’s also a simpler screening concept called the “ugly duckling” sign. Most of your moles probably look similar to each other. If one mole stands out as clearly different from the rest, it deserves attention. A study in JAMA Dermatology found that dermatologists identified all melanomas in their sample using this approach, and it was more specific than analyzing individual lesions in isolation.
In younger adults (under 50), melanoma density is highest on the back, which makes sense since the back gets intense intermittent sun during activities like swimming or sunbathing but is hard to monitor yourself. In people over 50, the face becomes the most common site. Interestingly, areas like the forearms and backs of the hands, despite getting heavy sun exposure, show very low melanoma rates.
How Skin Cancer Looks Different on Darker Skin
Most images of skin cancer show what it looks like on light skin, which can make detection harder for people with medium to dark complexions. The visual presentation genuinely differs. More than 50% of basal cell carcinomas in people of color contain visible pigment, compared to just 5% in white patients. In people of Asian descent, basal cell carcinoma can appear brown to glossy black, described clinically as a “black pearly” look.
Color changes like the redness of squamous cell carcinoma or the violaceous (purple-tinged) hue of certain lesions can be much harder to detect against darker skin. Features like color variegation in melanoma, a key part of the ABCDE criteria, are also more difficult to spot.
Location patterns shift too. In Black and Asian patients, melanoma most commonly appears on non-sun-exposed areas: the palms of the hands, the soles of the feet, and under the nails. The sole of the foot is involved in 30 to 40% of melanoma cases in non-white patients. A pigmented band on a nail that’s wider than 3 millimeters, especially if it’s growing rapidly or has variable coloring, is a warning sign for subungual melanoma (melanoma under the nail). Because these locations aren’t typically associated with skin cancer in public awareness campaigns, diagnosis often comes at a more advanced stage.
Merkel Cell Carcinoma: Rare but Fast
Merkel cell carcinoma is uncommon, but it deserves mention because it grows rapidly and is easy to dismiss. It typically appears as a firm, dome-shaped nodule that’s flesh-colored, reddish, or bluish-purple. It favors sun-exposed areas, especially the face, scalp, and lower legs, and occurs most often in elderly patients. Because it grows quickly and can look like a cyst or other benign bump, any firm nodule that’s expanding noticeably over weeks rather than months warrants a prompt evaluation.
Spots That Should Get a Second Look
Across all types, a few patterns consistently signal trouble. A sore that doesn’t heal within three to four weeks, or heals and then reopens. A new growth that’s pearly, translucent, or has visible blood vessels. A scaly patch that persists despite moisturizing. A mole that changes size, shape, or color. A firm lump that’s growing quickly. Any spot that bleeds without clear cause.
The most commonly overlooked locations are the scalp (hidden by hair), the ears, the back of the neck, and the tops of the feet. If you’re doing a self-check, these areas are easy to skip and receive more cumulative sun than most people realize.