Spotting Suspicious Spots: An Esthetician’s Guide to Skin Cancer Awareness and Referral

I’ll never forget pausing mid-facial because a spot along a client’s hairline just looked off: a little shiny, a little pink, and she mentioned it had “bled a couple of times.” She thought it was a stubborn pimple. I didn’t know what it was, and that’s the point. It isn’t our job to know. It is our job to notice and to say something kindly and clearly. Here’s how I think about skin cancer awareness in the treatment room, and how to turn “that looks different” into a confident, caring referral.

What We’re Actually Looking For

You will never diagnose skin cancer, but knowing the general patterns of the three main types helps you recognize when something deserves a physician’s eyes.

Basal cell carcinoma (BCC). The most common skin cancer. Often a pearly or shiny bump, a pink patch, an unexplained scar-like area, or a sore that bleeds, seems to heal and comes back.
Squamous cell carcinoma (SCC). Often a rough, scaly or crusted patch, a firm wart-like growth or an open sore, typically on sun-exposed skin.
Melanoma. Less common but the most dangerous because it can spread. It may be a new spot or a changing mole, and it doesn’t always look like a “bad mole.” Some have little or no pigment.

Why Our Eyes Matter

We look closely, under magnification and good light, at places clients can’t easily see: the hairline, behind the ears, the back of the neck and, during body and waxing services, the back and legs. We also see the same clients every few weeks, so we can notice change, one of the most important warning signs there is.

This matters even more here. According to CDC and National Cancer Institute data reported by Axios in July 2026, Utah had the highest melanoma incidence in the country in 2023, about 46 new cases per 100,000 people compared with a national rate of about 25. Utah’s health department notes the state has consistently ranked near the top even after accounting for race and ethnicity, and points to our elevation and sunny days.

A quick nerd note: the ABCDEs are a great starting point, but they were built around the classic flat, spreading melanoma. Some fast-growing melanomas, called nodular melanomas, don’t follow those rules at all. That’s why many clinicians also teach a simpler idea for raised spots: if it’s elevated, firm and growing over weeks to a month or so, it deserves prompt attention, no matter how symmetrical or evenly colored it looks.

What the Research Shows

The ABCDEs. The American Academy of Dermatology describes melanoma warning signs as Asymmetry, an irregular or poorly defined Border, uneven Color (tan, brown, black, or areas of red, white or blue), a Diameter that is often larger than a pencil eraser (though melanomas can be smaller), and Evolving, meaning a spot that looks different from the rest or is changing in size, shape or color.
The “ugly duckling” sign. Described by Grob and Bonerandi in Archives of Dermatology in 1998, this is the idea that a person’s moles tend to resemble one another, so the one that stands out from the rest is the one to flag. It’s an easy concept to use during a service.
Beauty professionals already notice. In a 2011 survey in Archives of Dermatology, Bailey and colleagues asked 203 hair professionals in Houston about their habits. About 37% said they had looked at more than half of their customers’ scalps for suspicious spots in the past month, and 58% had recommended at least once that a client see a health professional about an abnormal mole. It was one salon chain in one city and didn’t measure outcomes, but it shows how naturally our industry can play this role.

Who Deserves Extra Attention

Clients with lots of sun history, including outdoor workers, skiers and anyone with past tanning bed use or blistering burns
Clients with many moles, or a personal or family history of skin cancer, who often benefit from regular dermatology skin checks
Fair-skinned clients who burn easily, and older clients with decades of sun
Clients with deeper skin tones, who get skin cancer less often but tend to be diagnosed later. Melanoma in Black, Asian and Hispanic clients more often appears on the palms, soles or nails; the AAD lists a dark line under a nail or darkening skin around it as warning signs. SCC in deeper skin may appear in old scars or less sun-exposed areas. For more on assessing skin across tones, see Beyond Fitzpatrick.
Clients with suppressed immune systems, such as organ transplant recipients, who carry higher risk

How to Bring It Up and What to Do Next

Keep your language observational. Say what you see, not what you think it is: “This spot looks a little different from your others. Has a dermatologist taken a look?” Never say cancer, and never reassure a client that a spot is “nothing.”
Ask about change. Is it new? Has it grown, bled, itched or failed to heal? A client’s answer is useful information for their physician.
Don’t treat over it. Skip extractions, waxing, dermaplaning, exfoliation and devices over a suspicious spot. Work around it or reschedule.
Document it. Chart the location, size, what you saw and that you recommended a medical evaluation. Photos only with permission.
Follow up gently. Ask at the next visit whether they got it checked, and keep a list of trusted board-certified dermatology offices to share.
Make sun protection part of every home-care plan. Daily broad-spectrum sunscreen, reapplication, hats and shade, especially at Utah altitudes and around snow.

And always, work within your license scope and your state’s regulations. In Utah, estheticians are licensed through the Division of Professional Licensing, and diagnosing lesions belongs to medical providers. Our role is observation, education and referral, following any documentation policies your state or employer sets.

Common Myths

“If it doesn’t hurt, it’s fine.” Most early skin cancers are painless. Change, bleeding and failure to heal matter more than pain.
“Melanoma is always dark and irregular.” Some melanomas are pink, red or skin-colored, and some are raised and symmetrical.
“Darker skin doesn’t get skin cancer.” It is less common, but it happens, often in places people don’t think to check, like the soles, palms and nails.
“Mentioning it will scare my client.” A calm, specific, kind comment is usually received as care. Saying nothing is the bigger risk.
“A spot that heals was just a pimple.” A sore that keeps healing and returning in the same place needs a dermatologist.

The Takeaway

You don’t need to know what a spot is to know it deserves a second look. Learn the general patterns, pay attention to anything new, changing or different from the rest, use calm observational language, skip treating over it, document your recommendation and follow up. In a state with the highest melanoma rate in the country, that quiet habit is one of the most meaningful things we can offer our clients.

Sources

Further reading: Taylor and Kelly’s Dermatology for Skin of Color, edited by Susan C. Taylor and colleagues; Oncology Esthetics: A Practitioner’s Guide by Morag Currin.

This lesson is for general education and is not a substitute for a personalized consultation with a licensed skin professional or a medical provider.