4.4 Skin Cancers, ABCDE Criteria, UV Radiation, and When to Stop Service
Key Takeaways
- Basal cell carcinoma, squamous cell carcinoma, and melanoma are medical diagnoses; the esthetician’s job is to recognize warning looks, stop service on the lesion, and refer—not to name a cancer as a clinical diagnosis.
- The American Academy of Dermatology ABCDE cues are Asymmetry, irregular Border, varied Color, Diameter often over 6 mm (can be smaller), and Evolving change in size, shape, or color.
- UVA is the longer-wavelength ultraviolet band associated with aging and dermal reach; UVB is the burning band; UVC is absorbed by the ozone layer and is not the salon-window story.
- Do not wax, extract, peel, or scrape a mole, a pearly rolled-border bump, a scaly non-healing sore, or any bleeding growth in the service field.
- AAD public guidance tells people to see a board-certified dermatologist for new, changing, itching, or bleeding spots; a Georgia esthetician repeats that referral instead of offering dermatological therapy.
You will see the lesion before a dermatologist does
Estheticians look at faces, necks, décolletage, and waxed limbs under magnifying light more often than many clients look at themselves. That frequency is why cancer recognition belongs in this chapter. It is also why scope belongs in the same paragraph. O.C.G.A. § 43-10-1(8) excludes diagnosis, treatment, and therapy of dermatological conditions. You do not tell a client “you have melanoma.” You do say: “This spot is changing / bleeding / irregular compared with the rest. I will not wax or extract it. Please see a licensed medical professional, such as a dermatologist, promptly.” The American Academy of Dermatology (AAD) public pages tell people the same action: new, changing, itching, or bleeding spots should be examined by a board-certified dermatologist.
Do not invent unpublished incidence percentages in a client consult or on an exam answer. You do not need a homemade death-rate to justify a referral. A non-healing sore or an evolving mole is enough.
Three cancers you must be able to describe, not diagnose
Textbooks group the common skin cancers as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. AAD public education describes warning looks that overlap what you will see on an analysis table.
Basal cell carcinoma is often taught as the most common skin cancer in general public education. Classic looks include a pearly or waxy bump, a rolled border, a sore that bleeds and appears to heal and then returns, or a pinkish patch. You may notice telangiectasia on the surface of a pearly papule on the nose. That is not a “clogged pore” for extraction. It is not a skin tag to twist off with a fingertip.
Squamous cell carcinoma is often taught as a scaly red patch, a crusted open sore, or a wart-like growth that may bleed. A scaly patch on an ear, lip, or sun-exposed cheek that will not heal is not a seborrheic flake to rotary-brush. SCC can arise on chronically sun-exposed skin and on lips. A wax on a crusted lower lip that the client calls chapped for “months” is a stop.
Melanoma arises from melanocytes. It may look like a mole that broke the usual pattern. It can be brown, black, or show red, white, or blue areas. It can be smaller than a pencil eraser. AAD states that while melanomas are usually greater than 6 millimeters (about a pencil eraser) when diagnosed, they can be smaller. Diameter alone never gives you permission to ignore a tiny, changing, jet-black streak.
| Teaching name | Frequent look (public/textbook) | Typical wrong salon move | Correct Georgia move |
|---|---|---|---|
| BCC | Pearly bump, rolled border, bleeding sore that returns | Extract, lance, or “cauterize” with high frequency as therapy | Stop on the lesion; refer |
| SCC | Scaly red patch, crusted sore, wart-like bump | Rotary-brush the scale; peel the crust | Stop; refer |
| Melanoma | Asymmetric, irregular, multi-color, changing mole | Wax over it; pick it; apply acid to “fade” it | Stop; refer using ABCDE language |
A sore that does not heal, a spot that itches or bleeds, or a band of color in a nail (AAD also flags nail-band color as a reason to see a dermatologist) is outside cosmetics. You may still perform a facial on other intact areas if you can truly isolate the field—but most Georgia facial beds do not need that heroics. When in doubt, reschedule the whole service after medical evaluation.
ABCDE criteria (AAD wording you should be able to quote)
The AAD lists ABCDEs of melanoma for public self-exam. Use them as observation cues, not as a pathology report.
| Letter | AAD cue | What you write in a salon chart |
|---|---|---|
| A — Asymmetry | One half of the spot is unlike the other half | “Left half darker/raised compared with right half” |
| B — Border | Irregular, scalloped, or poorly defined border | “Border not smooth” |
| C — Color | Varying colors: tan, brown, black, or areas of white, red, or blue | “More than one color in the same spot” |
| D — Diameter | Usually greater than 6 mm (pencil eraser) when diagnosed, but can be smaller | “Largest width about X mm; still referring because of change” |
| E — Evolving | Looks different from the rest or is changing in size, shape, or color | “Client reports growth / color change / new itch” |
Evolving is the letter candidates skip when they memorize only “bigger than an eraser.” A 4 mm mole that used to be flat and brown and is now raised and black is an E problem even though it is under 6 mm. AAD is explicit that melanomas can be smaller than 6 mm.
The ugly duckling idea in public education is the same instinct: the mole that does not match the client’s other moles. You do not need a ruler to decide to refer. You need the humility not to wax it.
UV radiation: UVA, UVB, UVC, without invented statistics
Ultraviolet radiation from the sun and from indoor tanning lamps is a recognized contributor to photoaging and to skin-cancer risk in dermatology public education. You may say that. You may not invent a percentage of Georgia cases, a ranking of counties, or a fake “PSI-required SPF number.”
| Band | Teaching role | Practical salon point |
|---|---|---|
| UVA | Longer UV wavelengths; associated with aging (wrinkle/elastosis teaching) and deeper reach, including through window glass in many textbook discussions | Daytime clients still need photoprotection talk; a window-side facial bed is not a UV-free life |
| UVB | Shorter UV that is classically tied to sunburn | A client who arrives sunburned does not have intact, healthy, comfortable skin for wax or peel |
| UVC | Shortest; absorbed by the ozone layer in ordinary sunlight teaching | Do not claim a salon UV tool is a legal sterilizer; Georgia Rule 240-4-.04 rejects UV lights as a disinfection method |
Sunburn is erythema plus damage. Wax on a sunburned bikini line in July in Savannah is a tear-and-blister plan. Chemical exfoliation on a burn is a PIH and barrier disaster. Tanning-bed “base tans” do not make skin healthier for wax; they add UV. You do not lecture with fake mortality tables. You do decline the service until the burn has healed and the barrier is intact.
Home-care SPF as a finishing step after a facial is beautifying and protecting cosmetics, which sits inside stimulating/cleansing/beautifying language, not inside cancer therapy. You still do not sell SPF as a cure for an existing melanoma warning lesion.
When to stop service: a Georgia checklist
Stop on that site—and usually stop the whole facial or wax—when you see any of the following in the service field:
- A mole or spot that meets any ABCDE cue, especially evolving, bleeding, or itching.
- A pearly, rolled-border bump you were about to extract as a comedone.
- A scaly, crusted, non-healing patch you were about to rotary-brush.
- A growth that bleeds with light touch or has a persistent scab.
- Sunburn, open vesicles of sun damage, or heat rash in the wax path.
- Client request to cut, freeze, laser, or medicate a growth (lasers are already outside § 43-10-1(8); cutting is not esthetics).
Georgia wax scenario: a bikini wax in Augusta reveals a dark, asymmetric, multi-color macule on the inguinal skin that the client says “changed after last summer.” You do not apply wax on or around it in a way that shears the lesion. You stop, you show the client the mirror, you recommend prompt medical evaluation, and you do not guess a diagnosis name.
Georgia facial scenario: a pearly papule with a rolled edge on the nasal ala, central depression, occasional bleeding when the client towels off. That is not Grade I acne. You skip extraction, skip acid, skip scraping, and refer.
Georgia machine scenario: a student asks to “spark high frequency on a mole to dry it off.” High frequency as a cosmetic germicidal spark on intact acne-prone skin (later device chapter) is not mole destruction. Destroying a growth is dermatological therapy.
Document in ordinary language: location, size if you measured, colors, whether it bleeds, what the client reports about change, that service was declined on that site, and that you recommended a licensed medical professional. Keep the note factual. Do not write a cancer diagnosis.
Traps: waiting for 6 mm before referring; waxing a crusted lip as “dead skin”; extracting a pearly BCC-type bump; quoting invented incidence numbers; using a UV cabinet as disinfection (illegal as a disinfection method under 240-4-.04) and then claiming the room is “sterile for cancer clients”; telling the client you will “treat the melanoma with vitamin C.” Independent OpenExamPrep material covering these topics does not replace a dermatologist visit.
A client points to a 4 mm mole that used to be flat and even in color and is now raised, blacker, and itching. The client says it is 'too small to worry' because it is under a pencil eraser. What does AAD ABCDE teaching require you to treat as the priority cue?
During a nasal extraction preview you see a waxy, pearly bump with a rolled border that sometimes bleeds when the client uses a towel. Which teaching identification and action are correct?
Which ultraviolet teaching pair is accurate for home-care coaching and for declining service on a sunburn?
A bikini-wax client in Augusta has an asymmetric, multi-color patch in the wax path and reports it changed after last summer. She asks you to wax over it so the hair will hide the spot. What do you do?