“I have this tiny rough spot on the bridge of my nose. If I scrub it off, it bleeds,” I said.

He looked at it under the magnifying light.

“It could be precancerous. Let’s freeze it and see if it comes back,” he said, spraying it with liquid nitrogen. It did come back, twice, so I made an appointment for a biopsy. I felt only a pinch of the needle numbing the area before the doctor shaved off a thin layer of skin for testing.

A week later he called with the results: squamous cell carcinoma in situ. In situ meant it had not spread past the top layer, but because this early-stage cancer could become invasive, my doctor recommended Mohs surgery to ensure all of it was removed. (See “What Is Mohs Surgery?” bottom.) The following week I had the procedure.

SEE SOMETHING, SAY SOMETHING

My father died of stage 4 melanoma when he was 76, so I take skin cancer seriously. Yet even though I was religious about getting annual exams, it turns out that wasn’t enough. On top of dermatology exams every year (or more frequently, based on your history), monthly self-checks at home are important, says Karen Stolman, M.D., a board-certified dermatologist with Park City Dermatology in Utah and a spokesperson for the Skin Cancer Foundation.

“You’re just looking for something that’s new or unexpected or a change that you don’t think is right for your skin,” Stolman explains. “You don’t have to know what you’re looking at or diagnose it.”

When I began seeing a dermatologist in my early 40s, I was skeptical I’d notice any new moles or marks. But by paying attention, I’ve become familiar with the landscape of my skin. I’m learning that skin cancer (and precancer) can take on a different texture or appearance than the classic signs people are usually told to watch out for.

LOOK FOR THE UGLY DUCKLINGS

Dermatologists have done a pretty good job educating the public about malignant melanoma, says Alix J. Charles, M.D., a board-certified dermatologist and chairman of the department of dermatology at Duly Health and Care in Hinsdale, Illinois. One of the deadliest forms of skin cancer, melanoma often begins as a brown or black mole that becomes larger or irregular. When you Google “warning signs of skin cancer,” what you’ll typically get are the ABCDE’s of melanoma:

▶︎ Asymmetry: Two halves that don’t match

▶︎ Border: Irregular, scalloped or poorly defined edges

▶︎ Color: Multiple colors or shades

▶︎ Diameter: The size of a pencil eraser (can start smaller)

▶︎ Evolving: Changes in size, shape, color or presentation (itching, bleeding, crusty, raised)

While these signs are important, the two most common types of skin cancer—basal cell carcinoma and squamous cell carcinoma—typically present in other ways, including:

▶︎ A reddish irritated area or open sore that persists (may crust, bleed or ooze)

▶︎ A pearly bump or nodule (clear or pink; may be pigmented in people of color)

▶︎ A small pink or elevated growth (crusted indentation in center, raised edges, may bleed)

▶︎ A scar-like area (often with poorly defined borders)

▶︎ A wart-like growth (may crust or bleed)

The precancers that dermatologists find daily, called actinic keratoses, start out pink or red and scaly, “and they’re typically where we’ve had the most sun,” Stolman says.

A good takeaway is to look for the “ugly duckling,” says Kelly Nelson, M.D., a board-certified dermatologist and professor of dermatology at the University of Texas MD Anderson Cancer Center in Houston. “If you have one thing on your skin that is looking or behaving in a way that’s different, that one thing should probably be evaluated by a doctor,” she explains.

Though skin cancer occurs most often in people with fair complexions, Nelson says it can strike anyone, even patients with very dark skin. Because of a misperception that people of color don’t develop skin cancer, they—and their physicians—may not be on the lookout. As a result, skin cancer is often diagnosed at a later stage in patients of color. (Several brands of sunscreen—such as Black Girl Sunscreen, Bolden Brightening Moisturizer and EltaMD UV Clear—that are now available can protect people with darker skin without leaving a dull white coating.)

PREPARE FOR YOUR NEXT CHECKUP NOW

Skin cancer is of increasing concern as we age. Stolman says today’s precancer may be from sun damage 10 to 20 years ago, but it can also build over time with each exposure. In addition, “with age, our immune system becomes less capable of protecting us from all forms of cancer, including skin cancer.”

Staying on top of your risk positions you to take advantage of breakthrough skin cancer treatments. In February 2024, the Food and Drug Administration approved Amtagvi (lifileucel), the first cellular therapy for advanced melanoma. It follows a number of recent breakthroughs on this form of skin cancer, which accounts for the majority of fatalities from the disease.

I keep a list on my phone of suspicious spots to ask about at my next checkup. If something new appears that I’m especially worried about, I’ll make an appointment right away. It doesn’t hurt to take a photo of anything that looks odd so you can track how it changes over time.

If you don’t already have a dermatologist, it can be a long wait for an opening. Try elsewhere if a practice can’t see you within three months. You can also ask your primary care provider to take an initial look and help with a referral or next steps.

Abby Alten Schwartz has reported on health and relationships for Wired, Salon and other publications.

What Is Mohs Surgery?

For more on one of the deadliest forms of skin cancer, go to aarp.org/melanoma.