Skin cancer checks and skin procedures

The three main types

Basal cell carcinoma is the most common, making up around 70 per cent of non-melanoma skin cancers. It often appears as a pearly or pink lump, or a scaly, shiny patch that looks like a sore which has not healed. It grows slowly over months to years and very rarely spreads, but it will keep growing locally if left.

Squamous cell carcinoma accounts for most of the remainder. It tends to appear as a thickened, scaly or crusted spot, or a fast-growing pink lump that may be tender. It grows over weeks to months and can spread if untreated, so it is generally dealt with more promptly.

Melanoma is the least common of the three and the most dangerous. It can appear as a new spot or as a change in an existing one. Five-year survival is now around 94 per cent, and that figure depends heavily on thickness at diagnosis — which is another way of saying it depends on how early it is found.

What to look for

The ABCDE guide is a reasonable starting point for pigmented spots: asymmetry, an irregular or notched border, blotchy or uneven colour, a spot that is getting bigger, and any spot that is changing or evolving.

Two additions matter more than the acronym itself. The first is the ugly duckling sign — most of a person’s moles resemble each other, so the one that looks unlike its neighbours deserves attention regardless of whether it satisfies ABCDE.

The second is nodular melanoma, which makes up 10 to 15 per cent of melanomas in Australia and contributes disproportionately to melanoma deaths because it grows quickly and is often thick by the time it is diagnosed. It typically appears as a firm, raised, growing lump — round, symmetrical, often a single even colour, and sometimes red or skin-coloured rather than brown. It fails almost every part of ABCDE. A new firm lump that is growing should be looked at promptly whatever colour it is.

Who actually needs regular checks

This is where public understanding and the evidence diverge, and it is worth being straightforward about it. Australia has no national skin cancer screening program, and routine whole-body checks are not currently recommended for everyone at average risk. The evidence that population-wide screening reduces deaths is not strong enough, and there is a real cost on the other side: it is estimated that up to half of melanoma in situ diagnoses and around 15 per cent of invasive melanomas are overdiagnosed — found and treated when they would never have caused harm.

Roughly a third of Australian adults aged 45 to 69 report having an annual whole-body skin check, which is more than current recommendations support.

What is recommended for everyone is knowing your own skin and getting anything new or changing looked at promptly. For people at higher risk, regular clinical skin checks are recommended — typically every six to twelve months, with self-examination every three months. A national targeted melanoma screening program, aimed at those at highest risk rather than the whole population, has been in development since 2025 and is not yet in place.

What raises your risk

Pale or freckled skin that burns rather than tans, red or fair hair with light eyes, a history of sunburn or intense sun exposure, many moles or several atypical ones, a weakened immune system, previous skin cancer, and a family history.

Some of the numbers are striking. Having more than five dysplastic naevi is associated with around a six-fold increase in melanoma risk. More than five sunburns roughly doubles it. Solarium use before the age of 35 increases risk by around 59 per cent. Outdoor workers have close to double the squamous cell carcinoma risk of indoor workers. And after one non-melanoma skin cancer, 44 per cent of people develop another within three years — which is why previous skin cancer changes the recommendation more than almost anything else.

What a skin check involves

The skin is examined systematically, including areas that never see the sun — the scalp, behind the ears, between the toes, the soles of the feet, and under the nails. Skin cancers do occur in these places, which is why a check that only covers exposed areas is not a full check.

Suspicious spots are examined with a dermatoscope, a handheld magnifier with a light that allows structures below the surface to be seen. This matters: naked-eye examination identifies melanoma correctly around 60 per cent of the time, and dermoscopy raises that to roughly 89 per cent, though the accuracy depends considerably on the examiner’s training and experience.

Not every unusual spot is removed. Some are photographed and reviewed at an interval, because change over time is often more informative than any single appearance.

Biopsies and excisions

If a spot needs closer assessment, a sample is taken under local anaesthetic. A punch biopsy takes a small core of tissue and usually takes ten to fifteen minutes; a shave biopsy takes a thin surface layer; an excision biopsy removes the whole spot with a margin of normal skin.

For a spot suspicious of melanoma, an excision biopsy is preferred over sampling, because the pathologist needs the whole lesion to measure how deep it goes accurately.

Results usually take about one to two weeks. If the whole cancer and an adequate margin came out with the biopsy, that may be the only treatment needed. If cancer cells reach the edge of what was removed, further surgery is usually required.

Most wounds are closed with stitches and leave a scar that fades over time. The area often feels tight and tender for a few days. Larger defects may need a skin flap or graft. Some sites — around the eye, nose, lips and ears — and some recurrent cancers are better handled with Mohs surgery, a staged technique performed by specifically trained dermatologists.

Aftercare

Most people return to work the following day. Avoid a hot bath for two to three days and strenuous exercise for the first week. Bleeding, infection and wound breakdown are uncommon but possible, and are worth having reviewed rather than waiting.

Prevention still does more than detection. Sun protection is recommended whenever the UV index is forecast to be 3 or above, which in Sydney is most of the year: sun-protective clothing, SPF 50 or 50+ broad-spectrum sunscreen applied twenty minutes beforehand and reapplied every two hours, a broad-brimmed hat, shade, and sunglasses. A full-body application takes about seven teaspoons of sunscreen — considerably more than most people use.

When to get something looked at

A new mole appearing after the age of 25; any spot changing in size, shape, colour or texture; a sore that has not healed within a few weeks; a spot that itches, tingles, bleeds or weeps; a new firm lump that is growing; or a spot that simply looks unlike the others.

There is no need to wait for a scheduled check. A single spot can be looked at in an ordinary appointment.