Melanoma awareness campaigns have done a fantastic job educating the public on the classic ABCDEs—Asymmetry, Border irregularity, Color variation, Diameter, and Evolution—of skin lesions. These signs are crucial for identifying potential skin cancers, particularly melanoma, early. But there’s a catch: many early skin cancer signs don’t fit neatly into these categories, leading them to be overlooked.
The truth is, many people have skin lesions that could be cancerous but don’t exhibit the telltale ABCDE features. These lesions may seem benign, like pimples or sores that never seem to heal, and so they get brushed off as nothing serious. But the reality is, they could be early signs of skin cancer, and ignoring them can have dangerous consequences. Let’s take a look at a few cases to illustrate why it’s essential to pay attention to more than just the ABCDEs.
Case 1: The Non-Healing Ulcer
One patient came to my office complaining of a sore on his back that wouldn’t heal. He’d been scratching it, and every time it would heal briefly, only to return. This had been going on for months. Upon closer inspection, it turned out to be a melanoma—specifically a "melanotic" melanoma, meaning it lacked the typical pigmentation. Instead, it appeared as an ulcer or sore that just wouldn’t resolve. This is an important red flag: melanoma can sometimes look like a non-healing ulcer or a stubborn pimple, especially when it’s devoid of color.
Case 2: The Painful Pimple
Another patient, a man in his 50s, came in with what he thought was a pimple on his hand. It had been there for months, was painful, and no matter how much he tried to treat it himself, it wouldn’t go away. After examining it, I found a raised, red lesion with a crust at the center—classic signs of squamous cell carcinoma (SCC), a serious skin cancer that can spread. SCC often presents as a painful bump or nodule, and it can grow quickly if ignored. Thankfully, this gentleman came in early enough for treatment, but in some cases, delayed attention can lead to metastasis.
Case 3: A Persistent Pimple on the Ear
Another patient had a similar issue, but this time it was a persistent pimple near his ear. Like the previous cases, the pimple would heal, only to return and crust up again. This pattern is often seen in skin cancers, especially squamous cell carcinoma, which can develop as a skin-colored bump with a keratin-filled horn or an ulcer at the center. It’s important to note that a skin lesion that repeatedly heals and reopens, especially with crusting or bleeding, may not be a harmless blemish—it could be skin cancer.
Case 4: A Sore on the Foot
A woman came in for a routine skin check, and when I asked about a Band-Aid she was wearing on her ankle, she explained that her new sandals had caused a small irritation. Upon removing the Band-Aid, we found a non-healing sore with a hint of pigment around the edges. It turned out to be melanoma of the foot. This case highlights an often-overlooked area for melanoma: the feet. Melanoma can show up anywhere on the body, and even in areas like the feet.
The Big Takeaway: Don’t Ignore Pimples or Sores That Won’t Heal
These cases illustrate an important point: not all skin cancers follow the ABCDE pattern. Skin cancers like melanoma, squamous cell carcinoma, and basal cell carcinoma can show up as pimples, sores, or ulcers that won’t heal. If you have a blemish or pimple that’s been there for weeks or months, it’s time to see a dermatologist. Likewise, ulcers or sores that persist for over two weeks, especially if they repeatedly heal and reopen, should raise concern.
Early detection is key to successful treatment. While the ABCDEs are a helpful guideline, don’t ignore the other potential signs of skin cancer. Pimples, sores, or ulcers that don’t heal are not just cosmetic concerns—they may be a warning that something more serious is going on underneath the skin.
So, if you've been ignoring a blemish or sore that's sticking around longer than it should, make an appointment with your dermatologist today. It's always better to get it checked out than to wait and risk missing an early diagnosis.
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Thanks for reading and God bless.
Yuval Bibi, MD/PhD - Board Certified Dermatologist
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