Urgent Dermatology Referral Required
This lesion requires immediate evaluation by a dermatologist via a 2-week-wait urgent cancer pathway, as the rapid change from flat to raised with scab-like appearance over 2 months raises significant concern for squamous cell carcinoma (SCC) or other malignancy. 1
Why This Requires Urgent Referral
The British Association of Dermatologists specifically identifies the following features as requiring urgent specialist evaluation via the 2-week-wait route for possible skin cancer: 1
- Bleeding lesions
- Painful lesions
- Thickened lesions with substance when held between finger and thumb
- Lesions that fail to respond to standard treatments
Your lesion's transformation from flat to raised with a scab-like appearance over just 2 months represents rapid morphological change that could indicate progression from actinic keratosis to invasive SCC, or potentially a de novo malignancy. 1
What Makes This High-Risk
Cutaneous horns and rapidly changing lesions on sun-exposed areas (like the thumb) in adults carry significant malignancy risk. The British Journal of Dermatology emphasizes that high-risk features include: 2
- Lesions on sun-exposed areas
- Rapid growth or recent changes in appearance
- Protuberant (raised) appearance
- Bleeding or scab formation
The progression you describe—from flat brown spot to raised scab-like lesion—fits multiple concerning patterns that require histopathological diagnosis. 2
Critical Next Steps
Do not attempt home treatment or wait-and-see approach. Contact your primary care physician immediately and request urgent dermatology referral. 1
When you see the dermatologist, they will likely perform a complete excisional biopsy including the entire base of the lesion with 2-4 mm margins of normal-appearing skin. 2 This is essential because:
- Partial biopsies or shave biopsies can miss underlying malignancy 2
- The base of the lesion determines the diagnosis and treatment 2
- Accurate staging requires full-thickness tissue examination 1
Common Pitfall to Avoid
Never allow a provider to simply remove the raised/scab portion without taking the base. This is inadequate for diagnosis and could delay appropriate cancer treatment if malignancy is present. 2 The entire lesion with its base must be excised and sent for pathology. 2
Timeline Matters
The 2-month timeframe of change is clinically significant. While some benign lesions like actinic keratoses can spontaneously regress, rapid progression to a raised, scab-like appearance suggests active pathological change requiring immediate investigation. 1