By Dr Maxton Bergin
Many harmless skin conditions can look worrying. A spot may be dark, raised, crusted, shiny, red, irregular-looking or irritated and still turn out to be benign. However, appearance alone cannot reliably establish that an individual lesion is harmless.
Benign and malignant skin lesions can sometimes look similar, especially in photographs or without close examination. If a lesion is new, changing, unusual, bleeding, painful, non-healing or simply concerning to you, arrange assessment with an appropriately qualified medical practitioner.
The purpose of this guide is to explain why some common benign lesions may resemble skin cancer—not to help you self-diagnose a skin spot from an online description.
Why can benign skin lesions look worrying?
Skin lesions change for many reasons. Some benign lesions become darker with age, develop a rough or irregular surface, become raised, appear suddenly, vary in colour or become irritated after rubbing, scratching or catching on clothing.
These features can overlap with warning signs seen in melanoma, basal cell carcinoma and squamous cell carcinoma. For example:
-
A benign mole may be raised or have more than one shade of brown.
-
A seborrhoeic keratosis may be dark, crusted or uneven in surface texture.
-
A cherry angioma may bleed after trauma.
-
A solar lentigo may be brown or irregularly shaped.
-
A dermatofibroma may feel firm and persist for many years.
The overlap is why visual similarity does not establish a diagnosis. A clinician considers the lesion’s history, whether it has changed, its position on the body, surrounding skin, your medical history and features seen through dermoscopy.
What benign skin lesions can look like skin cancer?
Several common benign lesions can resemble skin cancer. The important point is that a condition may be common and usually benign in general, while an individual lesion can still require assessment if the diagnosis is uncertain.
Seborrhoeic keratosis
Seborrhoeic keratoses are common non-cancerous skin growths that often become more common with age. They can be flat or raised and may look waxy, rough, scaly, crusted or as though they are “stuck on” to the skin. Colours vary from light tan to brown, grey or almost black.³
They commonly occur on the trunk, back, chest, face and scalp. Some become irritated by clothing, jewellery, shaving or scratching and may then become red, crusted or sore.
Seborrhoeic keratoses can sometimes mimic melanoma, BCC or SCC clinically and on dermoscopy.³˒⁴ Certain forms can have unusual pigment patterns, while irritated lesions can look inflamed or crusted. For this reason, a changing, dark, bleeding, symptomatic or uncertain lesion should not simply be assumed to be a seborrhoeic keratosis.
Solar lentigo
A solar lentigo is a flat, brown pigmented spot associated with cumulative sun exposure. They are often called sun spots, age spots or liver spots, although these everyday names are not diagnostic.
Solar lentigines commonly occur on chronically sun-exposed areas such as the face, shoulders, forearms and backs of the hands. They may be light brown, dark brown or unevenly pigmented and can vary in shape.⁵
Many pigmented sun spots are benign. But not every brown spot is a solar lentigo. A new, changing, unusually dark, irregular or otherwise concerning pigmented lesion should be assessed rather than diagnosed from appearance alone.
Common moles
A mole is also called a melanocytic naevus. “Naevus” is simply the medical term for a mole. Benign moles can vary naturally in size, colour, elevation and shape. Some are flat and brown, some are raised and skin-coloured, and some have more than one shade of pigment.
An atypical-looking mole is not automatically melanoma. However, multiple atypical moles can be associated with increased melanoma risk, and an individual mole that is new, changing or different from your other moles deserves assessment.⁶
The “ugly duckling” sign can be useful here. Most people have a general pattern to their moles. A lesion that looks noticeably different from the rest may need closer review, even if it does not fit every classic ABCDE feature.
For more detail, see our related article: Early Signs of Melanoma: Beyond the ABCDEs.
Cherry angioma
Cherry angiomas are common small blood-vessel growths. They often appear as bright red, dark red or purple round spots and become more common with age. They can occur anywhere but are especially common on the trunk and arms.⁷
They are often smooth and may be slightly raised. Because they contain small blood vessels, they can bleed heavily if scratched, shaved or caught on clothing.
However, not every red or purple spot is a cherry angioma. A lesion that is new, enlarging, repeatedly bleeding without clear trauma, changing significantly or otherwise concerning should be assessed.
Dermatofibroma
A dermatofibroma is a common benign growth made up of fibrous tissue in the skin. It often appears as a small firm bump, usually on the legs but sometimes elsewhere. It may be skin-coloured, pink, red-brown or dark brown.⁷
Dermatofibromas can persist for years and may look alarming because they are firm, pigmented or raised. However, firm persistent lesions can have several possible causes. It is not appropriate to diagnose a dermatofibroma using a home “pinch test”, a photograph or an online description.
If a firm lesion is new, enlarging, changing colour, bleeding, painful or uncertain, it should be assessed.
Sebaceous hyperplasia
Sebaceous hyperplasia refers to enlarged oil glands. It commonly appears as small pale yellow, skin-coloured or slightly pink raised bumps on the forehead, cheeks or other areas of the face.⁷
These lesions can sometimes resemble early BCC because both may occur on the face and may appear shiny or raised. Clinicians use the lesion’s pattern, surface features, dermoscopy and clinical context to distinguish between possibilities.
A new or growing facial bump should not be assumed to be sebaceous hyperplasia based on an online image.
Benign lesions can still change
Benign lesions can change gradually with age. They can darken, become raised, thicken, get irritated, bleed after trauma or develop a rougher surface.
That does not mean change should automatically be attributed to a benign process—especially when the diagnosis has not previously been established. A lesion may be benign and still need assessment because its change, location or appearance creates uncertainty.
The safest approach is not to decide that change is harmless. It is to notice the change and have it assessed when appropriate.
When should a skin spot be checked?
A skin lesion should be assessed if it is:
-
new and persistent;
-
changing in size, shape, colour, surface or height;
-
growing rapidly;
-
noticeably different from your other moles or spots;
-
bleeding without a clear injury or bleeding repeatedly;
-
ulcerated, broken down or non-healing;
-
persistently crusted;
-
painful, tender or persistently itchy;
-
becoming very dark, multi-coloured or unusually pale;
-
difficult to explain; or
-
simply concerning to you.
These features do not diagnose cancer. Some benign lesions can itch, bleed after trauma or change slowly. But they are reasons to seek professional assessment rather than relying on an online description.
For a related explanation of painless lesions, see our related article: Can Skin Cancer Be Painless?.
Can you tell whether a lesion is benign from a photo?
No. A photograph can provide useful information, but it cannot reliably establish that every skin lesion is benign or malignant.
Photos can be affected by lighting, focus, skin tone, distance, image processing and whether a lesion is flat, raised, firm, scaly or tender. They also cannot show the lesion’s full history or how it feels on examination.
A professional assessment may include:
-
your history, including when the lesion appeared and how it has changed;
-
close visual examination;
-
palpation, meaning gentle assessment by touch, where relevant;
-
dermoscopy;
-
comparison with previous photographs;
-
additional non-invasive imaging in selected cases; and
-
biopsy when tissue diagnosis is required.
Photography can be useful for documenting change, but it is not a reliable standalone diagnostic tool.
How dermoscopy helps
Dermoscopy allows clinicians to examine structures and patterns within a skin lesion that are not readily visible to the naked eye. It combines magnification with specialised light and can add important diagnostic information when assessing pigmented, vascular, scaly or raised lesions.⁸
Dermoscopy can improve diagnostic confidence, but it does not make every diagnosis certain. Some lesions still have overlapping features and require further assessment, follow-up imaging or biopsy.
For more information, see our related article: Dermoscopy, Biopsy and Confocal: Which Test When?.
Can mole mapping help assess changing lesions?
Mole mapping and total body photography can help document the skin over time. For selected patients, baseline images can make it easier to identify a lesion that is new or changing at future appointments.⁹˒¹⁰
This can be especially helpful for people with many moles or an atypical mole pattern, where remembering every lesion by eye is difficult. Digital dermoscopy may also be used to record selected lesions at high magnification.
Mole mapping does not independently determine that a lesion is benign or malignant. It is a comparison and surveillance tool used as part of clinician-led assessment.
For more information, see Mole Mapping Melbourne and Who Should Get Mole Mapping? High-Risk Groups.
Can optical biopsy help clarify an uncertain lesion?
Sometimes. When a lesion remains diagnostically uncertain after clinical examination and dermoscopy, reflectance confocal microscopy—also called RCM or optical biopsy—may provide additional non-invasive diagnostic information in selected cases.¹¹
RCM allows microscopic structures within living skin to be visualised at approximately cellular-level resolution. No tissue is removed. It may help distinguish some benign lesions from lesions that require biopsy, particularly when the decision remains uncertain after earlier assessment.
However, RCM does not provide certainty in every case and does not replace a necessary surgical biopsy. It is not appropriate for every lesion, and a highly suspicious or unsuitable lesion should not have biopsy delayed for non-invasive imaging.
For more detail, see our related articles: Imaging for Borderline Lesions: Reducing Unnecessary Biopsies and Can Skin Imaging Help Avoid an Unnecessary Skin Biopsy?.
When is biopsy still necessary?
A surgical biopsy may be required when melanoma, BCC, SCC or another skin cancer is sufficiently suspected; when imaging remains uncertain; when the lesion cannot be assessed adequately with non-invasive imaging; or when tissue diagnosis is needed to guide management.
Histopathology means laboratory examination of tissue removed during a surgical biopsy. It remains necessary when tissue confirmation is clinically indicated.
A biopsy is not a failure of dermoscopy or advanced imaging. These tools are complementary. The role of imaging is to add useful diagnostic information, while biopsy provides tissue for laboratory diagnosis when that is the safest and most appropriate next step.
How Skintel fits into skin lesion assessment
Skintel is a diagnostic skin imaging service. Our skin cancer screening protocol includes full-body scanning or body mapping, high-magnification assessment of selected lesions and reflectance confocal microscopy, or optical biopsy, where clinically appropriate. Findings are reviewed by accredited skin cancer doctors and reported with recommendations for follow-up.¹²
The imaging assessment involves trained melanographers, while accredited skin cancer doctors review the images and clinical findings.¹²
Skintel’s role is diagnostic. It does not guarantee that a lesion is benign and does not remove the need for biopsy where tissue diagnosis is necessary. Patients who require biopsy, excision or other treatment return to their treating or referring clinician for management.
For an overview of the appointment process, see What Happens in a Full Body Skin Cancer Check?.
Not sure what a skin spot is?
Uncertainty is a reasonable reason to seek professional assessment. If you have a skin lesion that is new, changing, looks different from your other spots or simply concerns you, a professional skin assessment can help determine whether further investigation is needed.
To arrange an assessment, Book a skin check at Skintel.
Medical safety disclaimer
This article provides general educational information only and cannot determine whether an individual skin lesion is benign or malignant. Benign and malignant skin lesions can sometimes look similar. If you have a new, changing, bleeding, painful, non-healing, unusual or otherwise concerning skin lesion, seek assessment from an appropriately qualified medical practitioner. Do not use photographs or descriptions in this article to self-diagnose a lesion as harmless.
Frequently Asked Questions
What benign skin lesions can look like melanoma?
Some benign lesions, including pigmented seborrhoeic keratoses, common moles, solar lentigines and certain irritated skin growths, can sometimes resemble melanoma.³˒⁵˒⁶ However, descriptions and photographs cannot establish that an individual lesion is benign. A new, changing, unusually dark, irregular or different-looking lesion should be assessed by a qualified medical practitioner.
Can seborrhoeic keratosis look like skin cancer?
Yes. Seborrhoeic keratoses can sometimes mimic melanoma, BCC or SCC, especially when they are darkly pigmented, irritated, crusted or have unusual dermoscopic patterns.³˒⁴ A clinician may identify typical features through examination and dermoscopy, but biopsy can be required when a lesion cannot be confidently distinguished from skin cancer.
Can a benign mole look irregular?
Yes. Benign moles can vary in shape, colour, elevation and size, and some may appear unusual. However, irregularity does not prove a mole is benign, and a person cannot reliably classify a mole from appearance alone. A new, changing or “ugly duckling” mole that looks different from your other moles should be assessed.⁶
What can look like basal cell carcinoma?
Several benign lesions can resemble BCC, including sebaceous hyperplasia, irritated seborrhoeic keratoses, scars, some moles and inflammatory skin changes.⁷ The fact that a lesion resembles a benign condition does not confirm the diagnosis. A persistent pearly, shiny, pink, scar-like, crusted or changing lesion may need professional assessment.
Can you tell if a skin spot is harmless from a photo?
No. A photograph alone cannot reliably determine whether a skin spot is harmless. Photos do not provide the full history, texture, firmness, symptoms, dermoscopic structures or clinical context needed for diagnosis. Professional assessment may include examination, dermoscopy, image comparison, advanced imaging in selected cases and biopsy where needed.
When should a skin lesion be checked?
Have a lesion assessed if it is new and persistent, changing, rapidly growing, bleeding without clear trauma, ulcerated, crusted, painful, non-healing, significantly changing colour or unlike your other skin markings. These signs do not diagnose skin cancer, but they are reasons not to rely on online reassurance.
Can dermoscopy tell whether a lesion is benign?
Dermoscopy can provide important information beyond naked-eye examination and can increase diagnostic confidence.⁸ However, it cannot make every diagnosis certain. Some lesions have overlapping features and may require comparison over time, additional non-invasive imaging or biopsy. Dermoscopy should be interpreted by a trained clinician as part of the whole clinical assessment.
Can optical biopsy avoid a surgical biopsy?
For selected diagnostically uncertain lesions, optical biopsy may provide additional information that helps a clinician decide whether surgical biopsy is required.¹¹ It may help avoid some unnecessary procedures for benign lesions, but it is not suitable for every lesion and does not replace biopsy when tissue diagnosis is clinically indicated.
Do benign skin lesions need treatment?
Not always. Some benign lesions require no treatment once a diagnosis has been established. Others may be treated if they are irritated, symptomatic, repeatedly traumatised or cosmetically bothersome. However, a lesion should not be treated or dismissed as benign without appropriate assessment if the diagnosis is unclear or the lesion is changing.
Conclusion
Common benign skin lesions can sometimes look dark, raised, crusted, irregular, shiny or otherwise worrying. Seborrhoeic keratoses, solar lentigines, common moles, cherry angiomas, dermatofibromas and sebaceous hyperplasia are examples of lesions that may resemble skin cancer in some circumstances.
But the key safety message remains: appearance alone cannot confirm that a lesion is harmless. A lesion that is new, changing, bleeding, painful, non-healing, unusual or simply concerning should be assessed by a qualified medical practitioner.
References
-
Dinnes J, Bamber J, Chuchu N, Bayliss SE, Takwoingi Y, Davenport C, et al. Reflectance confocal microscopy for diagnosing cutaneous melanoma in adults. Cochrane Database Syst Rev. 2018;12(12):CD013190.
-
Liopyris K, Navarrete-Dechent C, Yélamos O, et al. Reflectance confocal microscopy and dermoscopy for the diagnosis of pink skin lesions: a review. Dermatol Pract Concept. 2024;14(3):e2024160.
-
Braga JC, Scope A, Klaz I, Mecca P, Gonzalez S, Rabinovitz H, et al. Melanoma mimicking seborrheic keratosis: an error of perception precluding correct dermoscopic diagnosis. J Am Acad Dermatol. 2008;58(5):875-880.
-
De Giorgi V, Trez E, Salvini C, Duquia R, De Villa D, Sestini S, et al. Dermoscopy–pathology relationship in seborrheic keratosis. J Dermatol. 2016;43(7):803-809.
-
Carrera C, Puig S, Malvehy J. Dermoscopy of pigmented lesions: clues for diagnosis of solar lentigo and lentigo maligna. Dermatol Clin. 2013;31(4):545-555.
-
Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28-44.
-
Luba MC, Bangs SA, Mohler AM, Stulberg DL. Common benign skin tumors. Am Fam Physician. 2003;67(4):729-738.
-
Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002;3(3):159-165.
-
Ji-Xu A, Dinnes J, Matin RN. Total body photography for the diagnosis of cutaneous melanoma in adults: a systematic review and meta-analysis. Br J Dermatol. 2021;185(2):302-312.
-
Tzellos T, Kyrgidis A, Zouboulis CC. The value of total body photography for the early detection of melanoma: a systematic review. J Eur Acad Dermatol Venereol. 2021;35(2):230-237.
-
Pellacani G, Farnetani F, Ciardo S, Chester J, Kaleci S, Mazzoni L, et al. Effect of reflectance confocal microscopy for suspect lesions on diagnostic accuracy in melanoma: a randomised clinical trial. JAMA Dermatol. 2022;158(7):754-761.
-
Skintel. The Skintel skin check. Melbourne: Skintel; accessed 2026 Sep 13.
