Medical Dermatology

Skin Cancer

Skin cancer is less common in Asian populations than in fair-skinned ones — but it is more often found late, and it frequently appears in places people do not think to look. Knowing what to look for, and where, makes a genuine difference.

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At a glance

What it is: Malignant growth of skin cells. The three most common forms are basal cell carcinoma, squamous cell carcinoma and melanoma.
Who it affects: Most commonly older adults, and more often those with fair skin — but it occurs in all skin types.
Important locally: Acral melanoma, affecting the palms, soles and nails, is proportionally far more common in Asian populations. Singapore data show most melanoma here is not on sun-exposed sites.
Key message: Any new, changing or non-healing lesion deserves assessment. Change over time is the most important single feature.
Diagnosis: Clinical examination, often with dermoscopy, and biopsy where a lesion is suspicious.

Understanding the condition

What is skin cancer?

Skin cancer occurs when skin cells multiply in an uncontrolled way. Several distinct types exist, each with its own characteristics, behaviour and treatment. The three most common are:

Basal cell carcinoma (BCC) — the most common form of skin cancer. Slow-growing and locally invasive, very rarely life-threatening, but it will not resolve on its own.
Squamous cell carcinoma (SCC) — the second most common. Typically a firm, scaly or crusted lump, sometimes tender, with a greater capacity to spread than BCC.
Melanoma — less common but more serious, arising from pigment cells. It may develop within an existing mole or appear as a new lesion, and early diagnosis substantially affects outcome.

Earlier or more superficial forms also exist, including superficial BCC, in-situ squamous cell carcinoma and melanoma in situ, where the abnormal cells remain confined to the surface layer.

The reassuring partThe great majority of skin lesions people worry about turn out to be entirely benign — moles, seborrhoeic keratoses, skin tags and other harmless growths. Having something checked is not overreacting; it is the appropriate response to uncertainty.

Particularly important here

Skin cancer in Asian skin

Melanin offers some protection against ultraviolet damage, and the overall incidence of melanoma in Singapore has remained low — around 0.5 per 100,000 person-years, compared with far higher rates in Caucasian populations. But the pattern of disease differs in ways that matter.

Where it appears

Acral lentiginous melanoma — melanoma of the palms, soles and nail units — accounts for roughly 40–50% of cutaneous melanoma in Asian populations, compared with only 2–3% in Western populations. Singapore Cancer Registry data indicate that sun-exposed areas accounted for only about 27% of melanoma cases here, in contrast to the large majority of basal and squamous cell cancers.

When it is found

Published Singapore studies have reported that acral melanoma was diagnosed after a considerably longer delay than other subtypes, and that Asian patients tended to present with thicker lesions and at a later stage than Caucasian patients seen here. The conclusion drawn by those authors was that greater awareness — among both patients and physicians — is needed.

The practical implicationWhen checking your skin, include the soles of your feet, between your toes, your palms, and your fingernails and toenails. A new or widening pigmented band in a nail, or a pigmented patch on the sole, should be assessed rather than watched.

What to look for

Recognising the common types

These descriptions are a guide to what prompts assessment — not a substitute for examination. Appearances vary considerably.

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Basal cell carcinoma

The most common skin cancer.

Slow-growing nodule or plaque
Skin-coloured, pink or pigmented
May have a pearly rolled edge with fine surface vessels
Can bleed spontaneously or ulcerate and fail to heal

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Squamous cell carcinoma

Second most common.

Firm, scaly or crusted lump
Rough to the touch, sometimes tender
May ulcerate or bleed
Often on sun-exposed sites, but not exclusively

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Melanoma

Less common, more serious — early detection matters.

A new pigmented lesion, or change in an existing mole
Irregular outline or more than one colour
In Asian skin, frequently on the soles, palms or nails
May itch, bleed or change in sensation

A checklist for pigmented lesions

The ABCDEs of melanoma

A widely used framework for deciding whether a mole warrants assessment. It is a prompt for seeking review — not a diagnostic tool.

	What to look for
A — Asymmetry	One half of the lesion does not match the other
B — Border	Irregular, notched, blurred or poorly defined edges
C — Colour	More than one colour, uneven distribution, or loss of colour
D — Diameter	Generally larger than about 6mm — though smaller lesions can still matter
E — Evolving	Any change in size, shape, colour, or new symptoms such as itch or bleeding

Also useful is the “ugly duckling” sign: a lesion that looks clearly different from your other moles deserves attention even if it does not tick the boxes above.

Assessment and treatment

How skin cancer is diagnosed and treated

Assessment

Examination of the lesion, commonly with a dermatoscope — a magnifying device that reveals features not visible to the naked eye — together with a review of the surrounding skin. Where a lesion is suspicious, a biopsy or excision is performed so the tissue can be examined microscopically. This is what establishes the diagnosis definitively.

Treatment

Treatment depends entirely on the type of cancer, its size, its site, and its microscopic features. Options include:

Surgical excision — removal of the lesion with a margin of surrounding skin, the mainstay for most skin cancers
Mohs micrographic surgery — a staged technique in which tissue is removed and examined layer by layer, used for selected cancers in cosmetically or functionally sensitive sites
Cryotherapy or topical therapy — for certain superficial lesions where appropriate
Referral for further management — where disease is advanced or requires multidisciplinary input

Follow-up is usually recommended afterwards, because those who have had one skin cancer are at increased risk of developing another.

Prevention and vigilance

Reducing your risk

Sun protection and self-examination are the two measures most within your control.

Helpful

Use broad-spectrum sunscreen daily — Singapore's ultraviolet levels are high year-round
Seek shade around the middle of the day
Wear a hat and protective clothing outdoors
Check your own skin periodically, including palms, soles, between toes and nails
Note anything new, changing or non-healing, and have it assessed
Attend recommended follow-up if you have had a skin cancer before

Unhelpful

Assuming darker skin means no risk
Ignoring a sore that has not healed after several weeks
Watching a changing mole for months before seeking review
Using sunbeds
Overlooking the feet and nails when checking your skin
Attempting to treat or remove a suspicious lesion yourself

Seeking help

When to see a dermatologist

Arrange an assessment if you notice:

A new lesion that is growing, or an existing mole that has changed
A sore or scab that has not healed after several weeks
A lesion that bleeds spontaneously or repeatedly
A pigmented patch on the palm, sole, or a new or widening pigmented band in a nail
A mole that looks clearly different from your others
Any lesion that is causing you concern — including simply for reassurance

If you have had a skin cancer previously, have many atypical moles, a family history, or are taking medication that suppresses the immune system, discuss an appropriate schedule for regular skin review.

Assessment is quick and worthwhileHaving a lesion examined is a short, straightforward consultation. Most turn out to be benign. For the minority that are not, finding them earlier meaningfully changes what treatment is required and how well it works.

Dr Chen Qiping

Consultant Dermatologist · MBBS, MRCP (UK), M.Sc, FAMS (Dermatology)

Skin cancer is one of Dr Chen's two subspecialty interests, alongside pigmentary disorders. She practises surgical dermatology including skin cancer surgery. Consultations are available in English and Mandarin.

Full profile →

Common questions

Skin cancer — frequently asked questions

Can people with darker skin get skin cancer?

Yes. Skin cancer is less common in richly pigmented skin than in fair skin, but it does occur — and it is more often diagnosed at a later stage. Studies from Singapore have found that Asian patients tended to present with thicker melanomas and at a later stage than Caucasian patients here, with a longer interval before diagnosis. Lower incidence does not mean no risk, and awareness matters.

Where does melanoma occur in Asian skin?

Often not where people expect. Acral lentiginous melanoma — which occurs on the palms, soles and under the nails — accounts for a much higher proportion of melanoma in Asian populations than in Caucasian populations. Singapore Cancer Registry data indicate that sun-exposed areas accounted for only about a quarter of melanoma cases here. This is why examining the soles of the feet, the palms and the nails is important.

What are the ABCDEs of melanoma?

A widely used checklist for assessing a pigmented lesion. A is for Asymmetry — one half does not match the other. B is for Border — irregular, notched or blurred edges. C is for Colour — more than one colour, or uneven colour. D is for Diameter — generally larger than about 6mm, though smaller lesions can still be significant. E is for Evolving — any change in size, shape, colour or symptoms over time. Change is the single most important feature.

What is the 'ugly duckling' sign?

Most moles on one person tend to resemble one another. A lesion that looks clearly different from the rest — the ugly duckling — deserves attention even if it does not obviously meet the ABCDE criteria. It is a useful complement to the checklist when checking your own skin.

Is basal cell carcinoma dangerous?

Basal cell carcinoma is the most common form of skin cancer. It grows slowly, is locally invasive, and is very rarely a threat to life. However, it does not resolve on its own and will continue to enlarge and invade locally if left, which is why treatment is recommended. A small proportion behave more aggressively. Outcomes are generally good when treated appropriately.

How is skin cancer diagnosed?

Assessment begins with examination of the lesion, often using a dermatoscope, together with a review of the rest of the skin. Where a lesion is suspicious, a biopsy or excision is performed so that the tissue can be examined under the microscope. This is what establishes the diagnosis definitively and guides subsequent treatment.

How often should I have my skin checked?

There is no single answer for everyone. Anyone can perform periodic self-examination, including the palms, soles and nails. More regular professional review is generally advised if you have had a previous skin cancer, have many or atypical moles, have a family history, or are immunosuppressed. Discuss an appropriate interval with your doctor.

References

DermNet. Skin cancer and Basal cell carcinoma. dermnetnz.org
Lee HY, Chay WY, Tang MBY, Chio MTW, Tan SH. Melanoma: Differences between Asian and Caucasian Patients. Ann Acad Med Singapore 2012;41:17–20. annals.edu.sg
Lee HY, Oh CC. Melanoma in Singapore: Putting our best foot forward! Ann Acad Med Singapore 2021;50:454–5. annals.edu.sg
Yeo PM, Lim ZV, Tan WDV, et al. Melanoma in Singapore: A 20-year review of disease and treatment outcomes. Ann Acad Med Singapore 2021;50:456–66.
Cleveland Clinic. Mohs Surgery. clevelandclinic.org

Page last reviewed: 28 July 2026.

Important — This page is general information about a skin condition and is not medical advice. It cannot take the place of an individual consultation, examination and diagnosis. Treatment options, their suitability and their possible side effects should be discussed with a qualified doctor who has assessed your skin. Individual results vary. If you have concerns about your skin, please arrange a consultation.

Noticed a spot that concerns you?

Arrange an assessment with Dr Chen Qiping, whose subspecialty interests include skin cancer, at our Collyer Quay clinic — two minutes' walk from Raffles Place MRT.

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