What are the key characteristics to distinguish between benign and potentially malignant skin growths?

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Last updated: June 10, 2025View editorial policy

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From the Guidelines

Distinguishing between benign and potentially malignant skin growths involves examining several key characteristics known as the ABCDE rule, which includes asymmetry, border irregularity, color variation, diameter greater than 6mm, and evolution over time, as recommended by the most recent study 1. The ABCDE rule is a widely accepted method for identifying potentially malignant skin growths.

  • Asymmetry is a warning sign, as benign moles are typically symmetrical while melanomas often have irregular shapes.
  • Border irregularity suggests potential malignancy, with benign growths having smooth, even borders while cancerous lesions may have notched or blurred edges.
  • Color variation within a single growth (multiple shades of brown, black, red, white, or blue) is concerning, whereas benign moles usually maintain a uniform color.
  • Diameter exceeding 6mm (about the size of a pencil eraser) warrants attention, though some melanomas can be smaller.
  • Evolution or change in a skin growth over time is perhaps the most important indicator, including changes in size, shape, color, elevation, or symptoms like itching or bleeding. Additional concerning features include ulceration, bleeding, crusting, pain, or rapid growth, as noted in previous studies 1. Benign growths typically maintain stable appearance, have regular borders, uniform coloration, and don't change significantly over time. When in doubt about any skin growth, prompt evaluation by a healthcare provider is essential, as early detection of skin cancer significantly improves treatment outcomes, as emphasized by the US Preventive Services Task Force recommendation statement 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Characteristics of Benign and Potentially Malignant Skin Growths

The following are key characteristics to distinguish between benign and potentially malignant skin growths:

  • History and Clinical Examination: Most lesions can be diagnosed on the basis of history and clinical examination 2.
  • Symptoms and Changes: Lesions that are suspicious for malignancy, those with changing characteristics, symptomatic lesions, and those that cause cosmetic problems may warrant medical therapy, a simple office procedure, or referral 2.
  • Growth Pattern: Benign skin tumors can often be diagnosed by their history, distribution, and characteristic morphology, while malignant lesions may exhibit rapid growth or uncharacteristic changes 3.
  • Morphology: Characteristics such as size, shape, color, and texture can help distinguish between benign and potentially malignant skin growths 4, 3.
  • Location and Distribution: The location and distribution of skin growths can also provide clues about their nature, with some types of lesions being more common in certain areas of the body 4, 3.

Examples of Benign and Potentially Malignant Skin Growths

Examples of benign skin growths include:

  • Acrochordons (small, pedunculated benign neoplasms) 2, 3
  • Sebaceous hyperplasia (asymptomatic, discrete, soft, pale yellow, shiny bumps) 2, 3
  • Lipomas (soft, flesh-colored nodules) 2
  • Keratoacanthomas (rapidly growing, squamoproliferative benign tumors) 2, 3
  • Pyogenic granuloma (rapidly growing nodule that bleeds easily) 2, 3
  • Dermatofibromas (idiopathic benign proliferation of fibroblasts) 2, 3
  • Epidermal inclusion cysts (can be treated by simple excision) 2
  • Seborrheic keratoses and cherry angiomas (generally do not require treatment) 2, 3

Examples of potentially malignant skin growths include:

  • Basal cell carcinoma 4, 5
  • Squamous cell carcinoma 4
  • Melanoma in situ (lentigo maligna subtype) 6
  • Lentigo maligna melanoma 4
  • Dermatofibrosarcoma protuberans 4
  • Merkel cell carcinoma 4

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Diagnosing Common Benign Skin Tumors.

American family physician, 2015

Research

Diagnosing Common Benign Skin Tumors.

American family physician, 2024

Research

Cutaneous lesions: benign and malignant.

Facial plastic surgery clinics of North America, 2005

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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