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Check your whole skin, including nails, palms, soles, and areas that are difficult to see. Keep dated notes or photographs so you can describe changes to a dermatologist. Only examination of removed tissue under a microscope can establish whether a spot is melanoma.
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What a concerning mole change looks like
Skin cancer often first appears as a change in the skin. The Centers for Disease Control and Prevention (CDC) states: “A change in your skin is the most common sign of skin cancer.” A change does not prove cancer, but it is a reason to arrange a medical assessment rather than waiting for more signs to appear.
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The American Academy of Dermatology Association (AAD) advises an appointment for spots that are new, different from a person’s other spots, changing, itching, or bleeding. Painful growths, sores that do not heal, and sores that heal and return also merit attention. A family doctor can examine an unusual spot and refer you to a dermatologist if one is not readily available.
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Use your own previous appearance as the baseline
A spot that has looked the same for years may be less concerning than one that recently changed, even if the older spot is not perfectly round. Compare a mole with its earlier appearance and with the person’s other moles. The “ugly duckling” idea is useful here: a spot that stands out from the rest deserves assessment even when it does not match every ABCDE feature.
When comparing, ask practical questions: Is one side now unlike the other? Has an edge become less distinct? Is a new shade appearing? Is the spot becoming thicker or rougher? Does it feel different when you lightly touch the surrounding skin? A difference from your own previous appearance is often more useful than comparing the spot with an arbitrary size rule.
Changes can involve more than size
Evolution includes a shift in size, shape, color, texture, or sensation. A mole may become raised, hard, lumpy, dry, or scaly. It may start itching, feel tender or painful, bleed, ooze, crust, or form a sore that persists. A spot that repeatedly heals and then breaks down again should be checked.
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ABCDE: a prompt to seek an examination
ABCDE is a recognition aid, not a pass-or-fail test. The National Cancer Institute (NCI) notes that some melanomas show only one or two of these features. Do not wait for every letter to appear.
| Letter | What to look for | What it means for your next step |
|---|---|---|
| A — Asymmetry | One half does not resemble the other half when you imagine a line through the spot. | Arrange a clinical assessment, particularly if the asymmetry is new or increasing. |
| B — Border | Edges are irregular, ragged, scalloped, blurred, or poorly defined instead of smooth and clear. | A changing or irregular edge should be shown to a dermatologist. |
| C — Color | Color is uneven or includes multiple shades, such as tan, brown, black, white, red, blue, gray, or pink. | Several colors or a new color within a spot warrant an appointment. |
| D — Diameter | The spot is large, or its diameter is increasing. | Melanomas are often diagnosed above 6 mm, but they can be smaller. Never use 6 mm as a safe threshold. |
| E — Evolving | Size, shape, color, height, surface, or sensation changes over time. | Evolution is a key reason to seek assessment, even when the spot is small or only one other sign is present. |
Diameter is the most commonly misunderstood part of ABCDE. A small melanoma can occur, and a large mole can be benign. The direction and speed of change, along with the overall pattern, are more useful than measuring against a single cutoff. A ruler can document approximate size for a visit, but it cannot determine whether a lesion is safe.
How to compare one spot with another
Comparison works best when you look at several features together. Consider symmetry, edge regularity, color uniformity, size and change over time, symptoms, and location. A mole that is unlike the others—the “ugly duckling”—may merit evaluation even if it is small and does not display every ABCDE letter. Conversely, several ordinary-looking features do not prove that a spot is harmless.
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New, unusual, or symptomatic spots need attention
A new spot in adulthood
Many melanomas do not begin in an existing mole. A new, unusual area can be the first visible sign. Adults should ask a clinician about a newly appearing mole or pigmented spot, especially when it differs from the person’s other marks or continues to evolve.
A new mark is not automatically melanoma. The important point is that a new or unusual adult spot cannot be cleared by comparing it with a generic picture online. A clinician can decide whether it needs observation, removal, or another step.
Itching, bleeding, pain, and nonhealing sores
Contact a clinician when a spot starts itching, is tender or painful, bleeds, oozes, crusts, or develops a sore that does not heal. A lesion that heals and then returns is also concerning. These symptoms can have causes other than melanoma, so they are signals for examination—not a diagnosis.
Texture and height
Notice whether a previously flat area becomes raised, firm, hard, lumpy, scaly, or persistently dry. Run a fingertip lightly over the skin during a check, but do not pick at, scratch, or attempt to remove the spot. Repeated irritation can cause bleeding and make it harder for a clinician to understand what changed.
Check places people often miss
Melanoma can occur on skin that receives little obvious sun exposure. Include the scalp, behind the ears, the back, buttocks, genitals, between the toes, and the backs of the legs in a systematic check. Ask another person to look at areas you cannot see safely, or use a handheld mirror as an optional viewing aid.
Move in a consistent order so that an overlooked area is less likely to be forgotten. If someone is helping, explain which mark prompted the check and ask them to describe location and change without trying to diagnose it.
Nails
Look for a new dark streak, a band that is widening or changing, pigment that extends onto the surrounding skin, or a nail that is lifting or changing shape. A changing band of pigment should be assessed rather than covered with polish and ignored. Check fingernails and toenails, including the skin around each nail.
Palms and soles
Inspect the palms, fingertips, soles, and sides of the feet. These acral locations matter for people of every skin tone, including people with darker skin. Their appearance can differ from the moles commonly seen on the trunk, so compare each area with its own earlier appearance and with surrounding skin.
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How normal moles can vary
Common moles are often round or oval, fairly even in color, and stable, but normal moles are not identical. They can differ in shade, size, and elevation. During childhood and adolescence, some moles grow along with the child and may darken or lighten. That pattern is different from a new or changing mole in an adult, which should be discussed with a clinician.
A normal-looking description cannot rule out melanoma. Conversely, an irregular-looking mole is not automatically cancer. A dermatologist combines the history, examination, and—when indicated—laboratory analysis rather than relying on a checklist or photograph.
Skin tone changes risk, not the need to check
Melanoma can affect people of all skin tones. NCI reported that, in 2017–2018, the estimated lifetime risk of diagnosis was 2.9% (1 in 34) for White people, 0.1% (1 in 1,000) for Black people, and 0.5% (1 in 200) for Hispanic people. These are population estimates from that period, not an individual risk calculator or a reason to dismiss a changing spot.
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NCI also notes later-stage diagnosis patterns among people with darker skin. Checking nails, palms, and soles is therefore important even when a person’s overall population risk is lower. A clinician should interpret personal factors such as family history, prior skin cancers, immune status, and the number and type of moles.
Dysplastic nevi and other risk context
A dysplastic nevus is an atypical mole; it is not the same thing as melanoma. NCI says researchers estimate melanoma risk is about 10 times higher for someone with more than five dysplastic nevi than for someone with none. NCI also states that about 1 in 10 Americans has at least one dysplastic nevus. These figures describe group-level risk and do not predict what will happen to one particular mole.
NCI’s fact sheet estimated 99,780 new melanoma cases in the United States in 2022. That dated estimate provides context, not a current incidence count. Regardless of a person’s risk category, a new or evolving spot should be evaluated on its own merits.
A practical, repeatable skin self-examination
Self-examination is for noticing and documenting change; it cannot confirm that a spot is benign or cancerous. Follow any schedule your dermatologist recommends, because the sources do not establish one universal frequency for every person.
- Choose good conditions. Use bright, even light and a full-length mirror. A handheld mirror can help with the back, scalp, and other hard-to-see areas; it is only a viewing aid, not a diagnostic device.
- Start with the face and scalp. Check the face, ears, hairline, scalp, and neck. Part the hair or ask someone you trust to inspect the scalp.
- Work down the front. Examine the chest, abdomen, arms, underarms, hands, fingers, and the spaces between fingers.
- Check the legs and feet. Inspect thighs, knees, shins, ankles, tops and bottoms of the feet, soles, heels, toenails, and toe spaces.
- Turn to difficult areas. Use the mirror or assistance for the back, buttocks, backs of the legs, and other areas you cannot see directly.
- Include nails, palms, and soles. Look for new streaks, bands, spots, or changes in existing marks.
- Record what you find. Note the body location, approximate size, color, symptoms, and the date. The AAD provides a free body mole map for recording moles and other spots.
- Use photographs carefully. Take dated, well-lit images from the same distance and angle when practical. Photos help document change for a visit; they cannot diagnose a lesion or replace an examination.
- Arrange care for a concern. If a mark is new, different, evolving, symptomatic, or repeatedly nonhealing, contact a dermatologist or family doctor instead of monitoring it indefinitely.
How to keep a useful mole record
For each concern, write the body location in plain language—for example, “left outer calf” or “right thumbnail”—and note when you first noticed it. Record approximate size, colors, whether the surface is flat or raised, and symptoms such as itch, tenderness, bleeding, or crusting. Add the date of each photograph. A simple body outline or the AAD’s free body mole map can help you distinguish one spot from another.
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Bring the record to an appointment. It can help the clinician understand whether the change was sudden, gradual, or uncertain, but it should not delay care while you collect more images.
When to make an appointment
Make an appointment with a dermatologist for a spot that is new, unlike your other spots, changing, itching, bleeding, painful, oozing, or not healing. Also arrange an evaluation for a changing nail streak or a suspicious mark on a palm or sole. The evidence supports prompt appointment language, but it does not establish a universal number of hours or days for every stable spot. If you are unsure how urgently to be seen, call a clinician and describe the change.
If a dermatologist is not directly accessible, start with a family doctor. NCI notes that a primary-care clinician can assess an unusual mole or skin concern and refer you for specialist care. When calling, mention when the change began, what changed, any symptoms, and whether you have a photograph or mole-map entry.
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Preparing for the visit
Before the appointment, list the spots that concern you and any others that have changed. Note personal history that may matter, such as previous skin cancers, a family history of melanoma, immune status, and whether you have been told you have dysplastic nevi. Bring dated images if you have them. Do not apply makeup, polish, acids, or other products intended to hide or alter the area before it is examined.
Ask what the clinician saw, whether the spot should be photographed or rechecked, and whether tissue removal is recommended. If follow-up is advised, write down the proposed plan rather than relying on memory.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What happens at a clinical evaluation
History and visual examination
The clinician will ask when the spot appeared or changed, whether it itches or bleeds, and whether you have noticed other unusual areas. They may examine the whole skin surface, not only the mark you first noticed, and may use magnification or a specialized light.
Biopsy when indicated
If the appearance warrants testing, the clinician may remove all or part of the abnormal tissue. NCI states: “The only way to diagnose melanoma is to remove tissue and check it for cancer cells.” A laboratory pathologist examines the specimen. A photograph, online image comparison, or ABCDE checklist cannot provide that diagnosis.
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Do not cut, burn, freeze, tie off, scrape, or apply acids or home remedies to a suspicious spot. Such actions can injure skin, obscure important features, delay diagnosis, and leave tissue unavailable for proper examination. Arrange professional care instead.
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Questions a photograph cannot answer
A picture may show color or shape, but it cannot reliably show a lesion’s full history, texture, firmness, bleeding pattern, or whether it differs from a person’s other spots. Lighting, focus, skin tone, and camera processing can also alter appearance. Send a photograph only through a clinician’s secure system if requested, and still attend the examination they recommend.
Key decisions at a glance
- New in an adult: schedule a clinical assessment, particularly if the spot is unusual or continues to change.
- Different from surrounding moles: use the difference as a reason to seek advice, even without a complete ABCDE pattern.
- Changing size, shape, color, surface, or feel: make an appointment; do not wait for a 6 mm measurement.
- Itching, pain, bleeding, oozing, crusting, or nonhealing: contact a clinician.
- Nail, palm, or sole involvement: include it in your check and have changes assessed.
- Uncertainty after self-checking: ask a family doctor or dermatologist; self-examination is observation, not diagnosis.
Frequently Asked Questions
How do I know if a mole is changing?
Compare it with dated photographs or notes and look for changes in size, shape, border, color, height, texture, or sensation. New itching, pain, bleeding, oozing, crusting, or repeated breakdown also counts as a change. Contact a clinician rather than trying to decide the cause yourself.
What does an abnormal mole look like?
Warning patterns include asymmetry, an irregular or poorly defined border, varied colors, evolution, or a spot that looks unlike your other spots. These signs are prompts for examination, not a diagnosis; ordinary moles can vary too.
Can melanoma be smaller than 6 millimeters?
Yes. Melanomas are often diagnosed above 6 mm, but they can be smaller. Do not wait for a spot to reach 6 mm or to show every ABCDE feature before seeking care.
Can you tell if a mole is cancerous from a picture?
No. A photograph cannot establish a diagnosis or reliably show history, texture, firmness, or microscopic changes. Only examination of removed tissue can diagnose melanoma.
Should I see a dermatologist for a new adult mole?
Yes, particularly if it is unusual, differs from your other spots, or continues to change. If a dermatologist is not available, a family doctor can assess it and arrange referral.
What if the spot is on a nail, palm, or sole?
Include these areas in regular checks. A new or changing nail streak or a spot on a palm or sole should be clinically assessed, regardless of skin tone.
Do all ABCDE signs have to be present?
No. Some melanomas show only one or two ABCDE features. A single evolving, symptomatic, or distinctly unusual spot is enough reason to ask a clinician.
How quickly should I be seen?
The guidance supports arranging a prompt appointment but does not set one universal number of hours or days for every stable spot. Call a clinician and describe the change so they can advise based on your circumstances.
The Bottom Line
Use ABCDE and the “ugly duckling” comparison to notice change, not to clear a mole. New, different, evolving, itchy, painful, bleeding, oozing, or nonhealing spots—including marks on nails, palms, and soles—should be examined by a dermatologist or family doctor. Only tissue examination can diagnose melanoma.
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