You've noticed a mole. Maybe it's new, maybe it's one you've had for years that suddenly looks different, or maybe it's a spot that itches or bled once when you caught it with a towel. Now you're trying to work out the only question that really matters: is this the kind of thing that can wait, or the kind of thing that can't? This article is written for exactly that moment. It walks through the types of skin cancer, the ABCDE rule that helps you tell an ordinary mole from a worrying one, what actually qualifies as urgent in the Canadian system — and one point that gets badly overlooked for people with brown or darker skin.
The two families of skin cancer — and why the distinction matters
Not all skin cancers are equal. Understanding which is which tells you how much urgency a lesion deserves.
Melanoma — the dangerous one
Melanoma is the skin cancer that can spread (metastasise) to lymph nodes and distant organs, and it is responsible for the large majority of skin-cancer deaths despite being far less common than the other types. The single most important fact about melanoma is that early detection changes everything. Caught early, while it is thin and confined to the surface, melanoma is very often curable with a simple excision. Caught late, once it has grown deeper or spread, it becomes a far more serious disease. This is the entire reason screening and self-checks matter: melanoma rewards catching it early more dramatically than almost any other cancer.
Non-melanoma skin cancers
Basal cell carcinoma (BCC) is the most common skin cancer by a wide margin. It is slow-growing and rarely spreads, but left alone it can invade and damage nearby tissue locally. It often shows up as a pearly or waxy bump, a flat scaly patch, or a sore that heals and then breaks down again. Squamous cell carcinoma (SCC) is the second most common. It grows faster than BCC and has a somewhat higher (though still low) potential to spread, and it often appears as a firm red nodule or a rough, crusted, scaly patch. Both are usually very treatable, especially when addressed early — but they still need a doctor's assessment rather than watchful waiting once you suspect them.
The ABCDE rule for melanoma
This is the checklist dermatologists teach for spotting a melanoma. You can run through it on any mole in under a minute. The more boxes a lesion ticks, the more seriously it needs to be taken.
- A — Asymmetry. Draw an imaginary line through the middle. In a harmless mole the two halves match. In melanoma, one half often doesn't look like the other.
- B — Border irregularity. Ordinary moles have smooth, even edges. Melanomas tend to have ragged, notched, scalloped, or blurred borders.
- C — Colour variation. A benign mole is usually a single even shade of brown. Watch for a mix of colours in one lesion — different browns, black, and sometimes patches of red, white, or blue.
- D — Diameter. Melanomas are often larger than 6mm across — roughly the width of a pencil eraser — though they can be smaller when caught early, so size alone is not reassuring.
- E — Evolving. This is the most important letter. Any lesion that is changing — in size, shape, colour, or elevation, or that starts to itch, bleed, or crust — deserves attention regardless of how it scores on the others.
The "ugly duckling" sign
Alongside ABCDE, dermatologists use a second, very human rule of thumb: the ugly duckling. Most of a person's moles tend to resemble one another — they have a family look. The one to worry about is the outlier, the mole that simply looks different from all the rest, whether it's darker, larger, or shaped unlike its neighbours. If one spot stands out from the crowd on your skin, that's the one to show a doctor.
Other warning signs worth knowing
Beyond ABCDE and the ugly duckling, three patterns should always prompt a check: a new lesion (especially after age 30, when new moles are less common); a sore that won't heal — a spot that scabs, seems to get better, then breaks down again over weeks; and any lesion that itches, bleeds, or oozes without an obvious cause. None of these guarantees cancer, but all of them are reasons to have a doctor look rather than wait.
What actually counts as urgent — and how the referral works
Here is the part that gives people real leverage in the Canadian system. Routine dermatology referrals — for acne, eczema, a cosmetic concern, a long-standing rash — commonly run 6 to 12 months. That number frightens people who have found a worrying mole, and it shouldn't, because a lesion suspicious for melanoma is not a routine referral. It is triaged in a completely different lane.
A lesion that a GP considers suspicious for melanoma should be referred urgently, and in most systems a suspicious or rapidly changing pigmented lesion is seen much faster than the routine queue. The mechanism that unlocks this speed is straightforward: your GP has to actually examine the lesion and explicitly mark the referral as urgent and suspicious for melanoma. A referral that just says "please assess mole" may land in the slow queue; one that says "changing pigmented lesion, suspicious for melanoma, urgent" does not.
Your GP also has more tools than people assume. Many family doctors can biopsy or excise certain lesions themselves, or refer specifically for dermoscopy (examination under a specialised magnifier) rather than a full general dermatology consult. So the practical goal, when you're worried, is not simply "get on the dermatology list" — it's "get this specific lesion examined and, if it looks suspicious, flagged urgent."
Run the ABCDE check on the lesion that's worrying you — and don't skip the easy-to-miss sites: palms, the soles of your feet, and under your nails. Photograph anything concerning with a ruler or coin for scale. Then book your GP, ask them to examine the specific lesion, and — if it looks suspicious or has been changing — ask directly for the referral to be flagged urgent and suspicious for melanoma, not routine.
Skin cancer on brown and darker skin — the point that gets missed
This section matters, because it's where the biggest gaps in outcomes appear. Melanoma is less common in people with brown or darker skin — but it is frequently diagnosed later and carries worse outcomes. Part of that is a dangerous assumption, held by patients and sometimes clinicians alike, that darker skin doesn't get skin cancer. It does.
Crucially, melanoma in people of colour more often appears in less sun-exposed sites — the palms of the hands, the soles of the feet, under the nails (known as acral and subungual melanoma), and on mucosal surfaces. A dark streak under a nail, or a new spot on the sole of the foot, is exactly the kind of thing that gets dismissed or simply never looked at — and these are the sites that deserve deliberate attention. If you have brown or darker skin, the takeaway is simple: check your palms, soles, and nails as part of any self-exam, and never let a doctor wave off a changing spot in those areas just because melanoma there is "unexpected." For our South Asian readers in particular, this is the single most important habit to build.
What you can do yourself
Screening isn't only a doctor's job. A few habits meaningfully shift the odds toward catching something early:
1. Photograph and monitor
Take clear, well-lit photos of any mole you're watching, ideally with a ruler or coin beside it for scale, and repeat every few weeks. The camera sees change that memory doesn't. A documented before-and-after is also powerful evidence for your GP that a lesion is evolving — the "E" that most reliably triggers urgency.
2. Protect your skin
Sun safety — broad-spectrum sunscreen, shade during peak hours, hats and covering clothing, and avoiding tanning beds entirely — reduces your long-term risk of all skin cancers. This applies to every skin tone; darker skin has more natural protection but is not immune.
3. Ask your GP to examine anything concerning — and to flag it correctly
If a lesion worries you, don't self-diagnose into either panic or false reassurance. Have your GP look at it. If it's suspicious, the words that matter are "urgent" and "suspicious for melanoma" on the referral. And if you're stuck in a long queue for a general concern, our companion guides on dermatologist wait times in BC and dermatologist wait times in Ontario explain how the triage lanes work in each province and how to make sure a genuinely urgent lesion doesn't get stuck behind routine ones.
How a specialist opinion from Ginie Health helps
The hardest part of a worrying mole is the uncertainty in the middle — you're not sure if it's urgent, and you don't want to either overreact or sit on something dangerous while a slow queue moves. That's the gap a written specialist opinion fills. You upload clear photographs of the lesion and describe its history — how long it's been there, whether it's changed, whether it itches or bleeds. Within 6 hours, for $45 CAD, a dermatologist trained at PGIMER Chandigarh or AIIMS reviews it and tells you how concerning it looks, whether it warrants an urgent in-person referral, and exactly what to say to your GP.
To be clear about the boundary: a remote opinion does not replace an in-person examination, dermoscopy, or the biopsy that ultimately diagnoses skin cancer — nothing does. What it does is help you act quickly and correctly, so a genuinely worrying lesion gets pushed into the urgent lane instead of languishing, and a harmless one stops costing you sleep. If you'd rather talk it through, a live video consultation is available for $75 CAD. No referral is required for either.
A note on safety: a rapidly changing, bleeding, or ulcerating lesion, or one meeting the ABCDE criteria, should be seen by your GP promptly — and you should ask directly for an urgent dermatology referral. Don't wait on it.