Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Skin Lesions, moles and skin cancer

Suspicious pigmented lesions

ABCDE of suspicious lesions

ABCDE of suspicious lesions

A pigmented lesion is regarded as suspicious if it displays any of the above features. If suspicious it warrants an excision biopsy: the lesion is excised in its entirety and sent to the pathology laboratory for examination to exclude melanoma. The result may come back as benign in which case you can be reassured, or it can come back as melanoma in which case you will require further treatment, including a wider excision to prevent local recurrence, X-rays and blood tests to check for spread and follow up.

Skin lesions

Skin lesions include benign lesions like moles (naevi) and skin cancers. Skin cancer is the commonest form of cancer, accounting for 40% of all cancers. It usually occurs in light skinned individuals and is related to UV exposure from the sun. It is important to know your skin and report any new or changed lesions to your doctor.

Moles, or naevi, are very common – the average adult┬áhas over 30 of them. They develop with age. They are usually pigmented, brownish, (but not always) and may be flat or raised. Patients may seek removal of moles for one of 3 reasons:

  1. The mole exhibits suspicious features and there is concern that it might be a cancerous growth
  2. It catches on things: bra strap, belt, when combing the hair, etc
  3. It is unaesthetic, you just don’t like it

Whenever a mole is cut out, one is exchanging that mole for a scar. While that scar may be hardly visible, there will always be one.

Skin Cancer

The rodent ulcer or basal cell carcinoma is the most common form of skin cancer occurring in about 75% of cases. This usually presents as a non healing nodule or ulcer which can be felt and which may have tiny red blood vessels around its outside.

Treatments include cytotoxic creams such as effudix, freezing with liquid nitrogen, curettage and surgery. Surgical treatment is often best. Once the lesion is completely excised then the cancer is cured.

Basal Cell Carcinoma

Basal Cell Carcinoma

Squamous cell carcinoma is similar to basal cell carcinoma and occurs in 15% of cases. SCC may arise in chronic wounds or old scars such as burn wound scars. The treatment is as for BCC – usually surgery.

Malignant melanoma is the dangerous type of skin cancer, but fortunately only makes up about 5% of skin cancers. Malignant melanoma may present in a variety of different ways, most commonly as a pigmented lesion which has suspicious features as documented above.

Malignant Melanoma

Malignant Melanoma


From a cleft patient who had secondary surgery to help her speech: It is one year ago that i was blessed to meet and know you. Thank you very much for the support you rendered to me while I was in South Africa. I will never forget your acts of kindness. I am fine now and my speech has greatly improved! I think I don’t need another operation. Even though I don’t communicate that often, you are always at heart.