A spot does not need to be large, dark or painful to deserve attention. If you are wondering which lesions need urgent review, focus less on trying to name the condition yourself and more on what the skin is doing: changing, bleeding, failing to heal or looking distinctly different from your other marks. In Australia, where UV exposure is high and skin cancer is common, acting early can make a life-saving difference.
Most lesions are not cancer. They may be harmless moles, sunspots, cysts, bites or inflammatory skin conditions. But a visual check alone cannot reliably rule out skin cancer, particularly melanoma. A GP or trained skin cancer clinician can examine a concerning area with a dermatoscope and decide whether monitoring, treatment or biopsy is needed.
Which lesions need urgent review?
Arrange a same-day GP appointment or urgent medical assessment for a lesion that is actively bleeding without a clear injury, bleeding repeatedly, ulcerated, rapidly enlarging, or changing noticeably over days to weeks. The same applies to a sore that will not heal, especially if it has lasted longer than four weeks.
A lesion should also be assessed promptly if it becomes painful, tender, itchy or crusted and these symptoms persist. Symptoms alone do not prove cancer, but skin cancers can become itchy, bleed or form a persistent scab. Do not assume a recurring scab is simply dry skin or a shaving cut.
For a new or changing pigmented spot, use the ABCDE signs as a practical prompt:
- A for asymmetry – one half does not resemble the other.
- B for border – edges are blurred, notched or irregular.
- C for colour – there is more than one colour, or a new black, blue, red, white or grey area.
- D for diameter – the spot is growing, particularly beyond about 6 mm, although melanomas can be smaller.
- E for evolving – any change in size, shape, colour, surface or sensation.
The most useful sign is often evolution. A mole you have had for years that begins changing warrants review, as does a completely new spot appearing in adulthood. Melanoma does not always follow the ABCDE pattern. Some are pink, red, skin-coloured or evenly coloured rather than dark and irregular.
The ‘ugly duckling’ sign
Your skin has its own pattern. If most of your moles look similar but one stands out as different, it is an ugly duckling and should be checked. It may be darker, lighter, larger, raised, unusually flat or simply unlike the rest.
This approach is particularly helpful for people with many moles, where checking every mark against a checklist can be difficult. Trust a genuine observation that a lesion is new or does not fit your usual pattern. Take a clear photo with the date if it helps you describe the change, but do not use photographs as a reason to delay an appointment.
Lesions that may be non-melanoma skin cancer
Basal cell carcinoma and squamous cell carcinoma are also common in Australia. They may not look like a classic mole. Book a prompt skin check for a spot that is pearly, shiny, pink, scaly, thickened, crusted or persistently red, especially on a sun-exposed area such as the face, ears, neck, scalp, forearms or lower legs.
A basal cell carcinoma can resemble a small shiny bump with fine blood vessels, a pale scar-like patch, or a sore that heals and then returns. It usually grows slowly, but it still needs treatment. Left untreated, it can invade surrounding tissue and cause significant local damage.
A squamous cell carcinoma may appear as a growing rough or tender lump, a crusted plaque, or a sore that does not heal. These lesions need timely assessment because some can spread beyond the skin. Rapid growth, pain, bleeding and a firm raised edge should move the appointment higher on your priority list.
Do not overlook rough, scaly patches known as actinic keratoses. They are not always urgent, but they signal sun damage and should be discussed at a skin check, particularly if a patch thickens, becomes painful or starts bleeding.
Do not miss hard-to-see areas
Skin cancers can develop where sun exposure is less obvious and where people rarely look. Check your scalp, behind the ears, between the toes, soles of the feet, palms, under the nails and genital area. Ask a partner, family member or hairdresser to flag a new or unusual scalp lesion, then have it assessed by a clinician.
A dark streak under a nail, particularly one that is widening or spreading onto the surrounding skin, needs prompt review. So does a non-healing sore on the lip. Smokers and people with significant sun exposure should take persistent lip changes seriously, including crusting, thickening, a white or red patch, or recurrent ulceration.
People with skin of colour can develop melanoma on the palms, soles and nails, and may experience later diagnosis when warning signs are dismissed. Skin cancer is less common in deeply pigmented skin, but it is not impossible. Any evolving lesion deserves the same careful response.
When should you seek emergency care?
Most suspicious lesions require urgent clinical review, not an emergency department visit. However, seek immediate help if bleeding will not stop after applying firm, continuous pressure with a clean cloth for 10 to 15 minutes. Call 000 for severe bleeding, fainting, breathing difficulty, facial or throat swelling, or signs of a severe allergic reaction.
A hot, rapidly spreading red area around a lesion, fever, escalating pain or pus may indicate infection and needs same-day medical care. This may be unrelated to skin cancer, but delaying treatment can make infection more serious.
If you are unsure whether a symptom is urgent, contact your GP, local urgent care service or Healthdirect for advice. It is better to ask than to wait for a lesion to become more obvious.
Who should have a lower threshold for a skin check?
Anyone can develop skin cancer, but prompt assessment matters even more if you have previously had melanoma or another skin cancer, have a strong family history of melanoma, many moles, fair skin that burns easily, or a history of frequent sunburns. People who work outdoors, spend long periods boating, fishing, gardening or playing outdoor sport, and people taking medicines that suppress the immune system should also be particularly vigilant.
Age matters, but it should not create false reassurance. Skin cancer is more common as we get older, yet melanoma can occur in younger adults. A new changing lesion is worth checking at any age.
What to do while waiting for your appointment
Do not pick, cut, burn or use over-the-counter wart or mole-removal products on a suspicious lesion. These products can irritate the skin, cause scarring and make later assessment more difficult. Avoid repeated sun exposure to the area, but do not cover it with a dressing unless it is bleeding, weeping or being rubbed by clothing.
Write down when you first noticed the lesion and what has changed. If it has bled, record how often. Bring a list of medicines and any personal or family history of skin cancer to your appointment. A clinician may photograph the lesion, examine your full skin surface and, if required, arrange a biopsy or removal.
The purpose of urgent review is not to create panic. It is to replace uncertainty with an informed clinical decision. A concerning spot may prove benign, and that is good news. If it is skin cancer, early diagnosis often means simpler treatment and a better outlook. Every minute counts when a lesion is changing – booking a skin check is a practical step you can take today.