Do Skin Cancer Lesions Itch?
Yes, skin cancer lesions can itch, and itching is recognized as a clinical feature that should prompt evaluation for melanoma and other skin cancers, though it is classified as a "minor sign" rather than a primary diagnostic criterion.
Itching as a Clinical Feature of Melanoma
The relationship between itching and melanoma has evolved in clinical guidelines over time:
Sensory change, including mild itch, was historically recognized as a feature of early invasive melanoma, often described by patients as a greater awareness of the lesion 1
In the revised UK melanoma checklist, sensory change (including itching) is classified as a "minor sign" rather than a major diagnostic criterion, as it was found in only 46% of melanomas studied 1
The three major signs that should trigger referral are: change in size, change in shape, and change in color, with any single major sign warranting consideration for specialist referral 1
Current Diagnostic Framework
A pigmented lesion with any one major sign (size/shape/color change) should be referred to a specialist, with minor signs like itching serving as additional stimulus for referral 1:
Major Signs (Present in 89-95% of melanomas):
Minor Signs (Less consistently present):
- Inflammation (51% of cases) 1
- Sensory change including itching (46% of cases) 1
- Crusting or bleeding (31% of cases) 1
- Diameter ≥7 mm 1
When Itching Should Raise Concern
Urgent referral is indicated when a mole is itching AND accompanied by other features 1:
- Any mole with three or more colors or loss of symmetry that is also itching 1
- A mole that is both itching and bleeding 1
- Change in shape, color, or size in addition to itching 1
Mechanism of Pruritus in Skin Cancer
Localized pruritus occurs when skin cancer directly affects tissue at the tumor site itself 2:
- Primary skin lesions cause itching directly at the location of the malignancy 2
- Treatment of the underlying malignancy often resolves the associated pruritus 2
- Cancer treatments themselves (radiotherapy, EGFR inhibitors) can paradoxically cause or worsen itching 2
Critical Clinical Pitfalls
Do not dismiss an itching lesion simply because itching alone is not highly specific for melanoma—the presence of itching should lower your threshold for referral when combined with any major sign 1
Never remove suspicious pigmented lesions in primary care, as clinicopathological correlation by specialists is vital for accurate diagnosis and prognosis 1
Document both the presence AND absence of itching symptoms in the clinical record, as this forms part of the minimum recommended documentation for suspected melanoma 1