Not All Skin Cancers Look the Same… Which is The Problem

Dr Chaudhry Mansoor Ahmed · May 2026 · 4 min read

The Three Main Types — and Why They Behave Differently

When most people imagine skin cancer, they picture a dark, irregular mole. That's melanoma — the least common but most dangerous of the three main types. In reality, the majority of skin cancers diagnosed in Australia are basal cell carcinomas (BCC) or squamous cell carcinomas (SCC), and they often look nothing like what patients expect.

• Basal Cell Carcinoma (BCC) — the most common skin cancer in Australia. Often appears as a pearly or flesh-coloured bump, a flat scar-like lesion, or a pink growth with a rolled border. Slow-growing and rarely spreads, but causes local destruction if left untreated.

• Squamous Cell Carcinoma (SCC) — typically presents as a firm, red nodule or a flat lesion with a scaly crust. More likely to spread than BCC, particularly in immunocompromised patients or when it arises on sun-damaged skin.

• Melanoma — can arise in an existing mole or as a new lesion. May be flat or raised, and colours can include brown, black, red, white, or blue. Even small melanomas can be aggressive.

The Lesions Most Commonly Missed

In my experience, the lesions patients most commonly dismiss are the pale, subtle ones — a shiny patch on the nose that seems like dry skin; a pink lesion on the ear that's been there for a year. These are often BCCs. Because they don't look "cancerous" in the popular sense, they're ignored until they become difficult to manage.

Any new or changing skin lesion that persists beyond a few weeks deserves assessment. The threshold to get something checked should be low — the inconvenience of a consultation is trivial compared to the consequences of a delayed diagnosis.

Why Dermoscopy Changes Everything

A trained eye with a dermatoscope can distinguish between a benign seborrhoeic keratosis and an early melanoma that look nearly identical to the naked eye. Dermoscopy reduces unnecessary biopsies and improves diagnostic accuracy significantly. It's one of the most important tools in modern skin cancer medicine, and it's available at every consultation I conduct.

When a Lesion Needs to Come Off Straight Away

Not every suspicious lesion needs to wait for a biopsy result before being removed. If a lesion has features strongly suggestive of melanoma or an aggressive SCC, I will often proceed directly to excision rather than a punch biopsy — preserving the architecture for pathological assessment and reducing the risk of incomplete sampling. I carry out these excisions in-clinic under local anaesthetic, including in complex areas like the face and scalp.