Most moles and skin growths are not cancerous, but some changes should not be ignored.
A lesion that is new, growing, changing colour or shape, bleeding without an obvious cause, crusting, becoming painful or failing to heal should be medically assessed.
These features do not automatically mean that a lesion is cancerous.
They are reasons to have the area examined rather than assuming it is harmless.
At our Newmarket clinic, suspicious and changing skin lesions are assessed by Dr. Victoria Hayward, Chief of Plastic Surgery at Southlake Regional Health Centre and a board-certified plastic surgeon. Suspicious lesion assessment is one of several minor procedures offered at our clinic. PSSC also sees patients from surrounding communities and the broader region.
What makes a skin lesion worth assessing?
Changes that should prompt assessment include:
- increasing size
- changing shape
- new or multiple colours
- irregular borders
- unexplained bleeding
- persistent crusting
- new pain or itching
- ulceration or a sore that does not heal
- a lesion that looks noticeably different from others
A new or changing lesion should be assessed as soon as reasonably possible.
The ABCDE rule
For pigmented lesions and moles, the ABCDE rule is a useful warning framework:
- A — Asymmetry: one half looks different from the other.
- B — Border: the border becomes irregular, uneven or poorly defined.
- C — Colour: there are multiple colours or a noticeable change in colour.
- D — Diameter: a lesion larger than about 6 mm may warrant attention, although melanomas can also be smaller.
- E — Evolution: any meaningful change in size, shape, colour, elevation or symptoms over time.
Evolution — change over time — is particularly important.
What happens during assessment?
Dr. Hayward will examine the lesion and review relevant history.
Depending on what she finds, the next step may include observation, removal, biopsy or another appropriate form of investigation or referral.
What is pathology testing?
Pathology testing means that tissue removed during a biopsy or procedure is sent to a laboratory and examined under a microscope by a pathologist.
Pathology can confirm what type of tissue is present and whether cancer cells are identified.
A pathology report is often an important part of determining what treatment or follow-up is required.
What if skin cancer is diagnosed?
Treatment depends on the type of skin cancer, its size, location, risk characteristics and other clinical factors.
Basal cell carcinoma and squamous cell carcinoma are often treated surgically, but the appropriate surgical technique depends on the individual lesion.
Melanoma is managed differently and may require wider excision and, depending on the diagnosis, additional investigation or treatment.
Dr. Hayward will discuss the appropriate next step based on the assessment and any pathology findings.
Why location matters
Skin cancers and suspicious lesions can develop in highly visible or anatomically sensitive areas.
The location and size of a lesion can influence:
- how it is assessed
- what biopsy or surgical approach is appropriate
- how much tissue needs to be removed
- how the resulting wound is closed
- scar planning
These considerations are particularly relevant for lesions on the face, nose, ears, eyelids and other sensitive areas.
Are suspicious or cancerous lesions covered by OHIP?
Lesions determined to be medically necessary or suspicious for skin cancer may qualify for OHIP-covered treatment.
Dr. Hayward will assess the lesion and determine the appropriate pathway.
Can assessment and treatment happen during the same visit?
Sometimes.
A straightforward lesion may be assessed and treated during the same appointment when medically appropriate.
Other lesions may require biopsy, pathology, additional testing or another step before definitive treatment.
The patient should be told what is recommended and why before proceeding.