9.2 Skin Growths and Cancers

NIC I.F.6 is skin growths (examples: skin tags, moles, keratoma). NIC I.F.7 is skin cancers (basal cell carcinoma, squamous cell carcinoma, melanoma). Illinois then layers a legal education mandate that national textbooks do not write for you: 225 ILCS 410/1-7.10 (Public Act 103-0851, the Melanoma Education Law) and 68 Ill. Adm. Code 1175.1225, added October 6, 2025. You recognize abnormal growths in the salon, you refer, and you do not diagnose, freeze, cut, or “treat” them.

Growths You Recognize — and Do Not Remove

A skin tag (acrochordon) is a small, often soft outgrowth, common on the neck, underarms, and under the breasts. It is not a comedone. Snipping, tying off, or “freezing it off in the facial room” is not esthetics. If it is inflamed, bleeding, or in the way of a service, skip that area and, if the client is concerned, refer.

A mole is a nevus: a pigmented spot that may be flat or raised, even in color or mixed. Most moles are unchanged for years. The exam item is the changing mole — new, itching, bleeding, or matching ABCDE. You do not tweeze hairs out of a suspicious mole, you do not apply peel solution over it to “fade” it, and you do not shave it during dermaplaning. Work around a stable, clearly unchanged mole only when the rest of the service is otherwise indicated; a changing mole is a stop.

A keratoma is an acquired, thickened patch of epidermis — a callus of keratin. Pressure and friction build it. If the growth is on the face, do not grind it as if it were a foot file service. If a rough, scaly, sun-exposed patch is new or tender, do not assume “keratoma” and polish it; that presentation may be actinic keratosis, which is a referral.

Verruca is a wart. It is caused by human papillomavirus (HPV) and is contagious. That fact moves the lesion out of “optional growth” and into the refuse rule. 1175.115(b)(34) forbids massaging skin that is inflamed or where a skin infection or eruption is present. A wart is an eruption you do not pick, tweeze, extract, peel, or wax over. Direct-contact and fomite spread (tweezers, files, towels) is the salon risk. Refuse the service on that lesion and refer. Recognition is not a diagnosis of HPV strain; it is enough to stop.

Actinic keratosis (solar keratosis) is a rough, scaly patch on sun-exposed skin. Textbooks treat it as precancerous. You will not confirm that under a Wood’s lamp. You will not freeze it with salon ice, sand it with microdermabrasion, or call it a “keratin plug.” Document the observation, do not treat the patch, and connect the client to a medical professional — the exact skill 1175.1225 trains.

Do not freeze, cut, ligate, electrodesiccate, or apply “wart remover” in an Illinois esthetics room. Those are medical or over-the-counter drug acts, not stratum-corneum cosmetics. 3A-1 is surface, cosmetic, and not for the treatment of disease.

Three Cancers NIC Names

You are not asked to stage a tumor. You are asked to match the name to the usual picture and to know which one is the emergency referral.

Basal cell carcinoma (BCC) is the most common of the three NIC-named skin cancers and the least aggressive of that trio. Typical textbook picture: a pearly or waxy nodule, a sore that does not heal, or a shiny bump, often on sun-exposed skin. It can destroy local tissue. It is still a medical problem. You do not “watch it through a series of facials.”

Squamous cell carcinoma (SCC) often presents as a scaly red papule, a crusted patch, or an open sore. It is more likely than BCC to metastasize. Sun-exposed areas (face, ears, lips, hands) are classic. A scaly patch you were about to enzyme is not a keratoma you get to decide is safe.

Malignant melanoma is the most dangerous of the three. It arises from melanocytes. It can appear as a new dark spot or as a change in an existing mole. It can spread and it can be fatal. Early medical evaluation is the entire point of ABCDE and of Illinois abnormal-skin-growth education. You will not tell the client “that is melanoma.” You will say you are not a physician, you do not like the way that spot looks, and they should see a medical professional promptly.

Do not invent unpublished incidence percentages on the exam. Qualitative ranking is what NIC and 1175.1225 both support: know the types, know that education courses include statistics as a content minimum, and know that melanoma identification is named in 1-7.10.

ABCDE of Melanoma

Use ABCDE on pigmented lesions. One letter is enough to refer. You do not need all five.

A client who says “this mole looks different than last season” has already given you E. Stop. Do not peel over it. Do not extract “the dark clog.” Refer.

1175.1225 and “Skinny on Skin”

Who Must Complete It

225 ILCS 410/1-7.10 requires a Department-approved course in abnormal skin growth education, including training on identifying melanoma, for:

1. An applicant who submits an application for original licensure on or after January 1, 2026.
2. An applicant licensed before January 1, 2026, when submitting the first application for renewal or restoration on or after January 1, 2026.

1175.1225, added at 49 Ill. Reg. 12951, effective October 6, 2025, implements that statute. The Division approves the 1-hour program “Skinny on Skin” by Impact Melanoma, Inc. as the course that fulfills the requirement for original, renewal, and restoration applicants under 1-7.10.

Course Content Minimums

The 1-hour course must, at a minimum, include three subject areas — memorize this triad; it is how Illinois writes the job description:

1. Basic information about abnormal skin growths: definitions, factual information, statistics, types of skin growths.
2. Awareness of abnormal skin growths in the salon (or other practice setting).
3. Tools to assist clients with information about available options, including listening and communicating, the proper ways to support a client who may have an abnormal skin growth, and connecting clients with available medical resources.

That third prong is the opposite of diagnosis. You listen. You support. You connect to medical resources. You do not biopsy, freeze, or write a treatment plan.

Scope Guardrails in 1-7.10

Two statutory guardrails sit in 1-7.10 itself:

• Subsection (b): nothing in the section requires or permits you to practice medicine or otherwise practice outside the scope of a licensed esthetician.
• Subsection (c): a licensee may refer an individual to seek care from a medical professional regarding an abnormal skin growth. Completing the education does not turn you into a dermatologist, and the statute provides good-faith civil and criminal liability protection for acting or failing to act on information obtained in practice concerning potential abnormal growths.

Instructors for Division-approved programs under 1175.1225 are licensed physicians and surgeons, and APRNs. The course may be classroom or online classroom. Keep the certificate; original-licensure applicants on or after January 1, 2026 should expect IDFPR to ask for it.

Impact Melanoma’s program is built for professionals who see skin up close — estheticians included — and to teach how to talk with a client about seeing a dermatologist or other health professional without alarming the client into a false diagnosis. That is salon awareness plus communication, which is exactly 1175.1225(c)(2)–(3).

The exam trap is the helpful student who “treats” the growth so the client does not need a doctor: snip the tag, peel the scale, laser the mole, cryo the wart. All of those fail I.F.6–7, fail 3A-1, fail 1175.115 when the lesion is an eruption, and fail the Melanoma Education Law’s statement that this training does not expand scope. Recognize. Refuse to treat the growth. Refer.