In this insightful piece by plastic surgeon Dr Dèhan Strüwig, the spotlight is placed on the subtle and often misleading signs of skin cancer, those “red herrings” that appear harmless but conceal something more serious. Drawing from real patient experiences, Dr Strüwig unpacks why early detection and proactive care are critical for both patients and doctors. This article serves as a reminder to trust your instincts, question the ordinary, and never underestimate what your skin might be trying to tell you.

We’ve all heard the term “red herring”. It comes from old detective stories, a smoked fish with a strong smell, dragged across the trail to throw off the scent and confuse the dogs. In mystery novels, a false clue leads characters (and readers) away from the real solution. In medicine, a red herring looks like one thing but turns out to be another, distracting us from what’s actually going on.

It might be the “cat scratch” that doesn’t heal, or the “cyst” that keeps growing, or the “beauty mark” that’s been frozen off again and again but won’t go away. These aren’t stories from a textbook. These are real cases – patients I’ve seen recently. They are intelligent, thoughtful individuals who missed the message their skin was sending because the signs didn’t match their perception of what skin cancer looks like.

It’s understandable. The problem is that skin cancer doesn’t always announce itself with flashing lights. It can be boring. It can be quiet. It can be something you’ve lived with for years, or think you have.

But when a red herring distracts us, we lose time. And in skin cancer, time matters.

What skin cancer isn’t

Let’s be clear. Skin cancer doesn’t always look scary. Sometimes it looks like:

A small pink spot that comes and goes

A pimple that never heals

Dry skin

A scab that keeps returning

A mole that’s “always been there”

In other words, it can look like nothing to worry about. And that’s exactly the problem.

One patient told me: “I didn’t want to bother anyone. I thought it was just a scratch.”
It wasn’t. It was squamous cell carcinoma, which had already begun invading deeper tissues.

Another person said, “My beauty spot was frozen off a few times. It kept coming back.”
That “beauty spot” was actually a melanoma. By the time it was diagnosed, surgery was no longer a minor issue.

These cases are hard. But they’re also preventable.

The power of the biopsy

Here’s the good news: skin is visible. We can look at it. We can monitor it. And when something doesn’t feel right, we can take a sample, a biopsy, and get answers.

A biopsy is not a big procedure. It’s quick and low-risk. It gives us clarity. It turns guesswork into a diagnosis.

We live in a time when medicine allows us to find things early. Skin cancers caught early are treatable, often with nothing more than a small surgical excision.

So why wait?

A message to patients: Trust your gut, but back it up

You know your body. If something on your skin doesn’t feel right – if it itches, bleeds, changes, or just stays longer than it should – don’t ignore it.

It’s not overreacting to have it checked. It’s being responsible. The goal isn’t to worry more, it’s to act earlier.

If it turns out to be nothing, wonderful. If it turns out to be something, you’ve given yourself the best chance by catching it now.

A message to doctors: We can do better too

Sometimes, we’re guilty of following the red herring, too. We might hear, “It’s been there for years”, or, “It looks benign”, and brush it off – but we have the tools to know for sure.

Biopsies aren’t a failure of clinical judgment; they’re a strength. They’re how we turn “probably fine” into “definitely fine”, or catch something that isn’t.

We can’t afford to rely on assumptions. We owe it to our patients and ourselves not to miss the obvious.

The balance: Not alarmed, just alert

This isn’t about creating fear. It’s about building awareness.

Skin cancer is common. But it’s also one of the most preventable and treatable cancers, especially when found early. The red herrings are real, but so is the chance to stay ahead of them.

Be curious about that odd spot. Be cautious about that non-healing bump. Be proactive, not panicked.

Final word: Don’t let the distraction win

Red herrings are meant to distract. But we’re smarter than that. In real life, not detective novels, the stakes are too high to follow the wrong trail.

If something on your skin is new, changing, or not healing, get it checked.

If you’re a doctor and your gut says, “Hmm, maybe”, do the biopsy.

It’s not just skin. It’s your health.

Let’s pay attention, before the red herring gets the last word.

Dr Dèhan Strüwig

+27 21 531 4565 | manager@drdehanstruwig.co.za | Website

M.B.Ch.B; M.Med. (Plast&Reconstr) (Stell)

Dr Dèhan is a respected Plastic and Reconstructive Surgeon known for his meticulous attention to detail and unwavering commitment to patient care. With a compassionate and hands-on approach, he supports his patients throughout their surgical journey. His expertise spans both cosmetic and reconstructive surgery, with a particular focus on facial procedures, breast surgery, abdominoplasty, and liposuction.

Dr Dèhan’s experience in treating traumatic injuries, including hand injuries, burns, and lacerations, in children and adults alike. His practice also integrates skin cancer surgery, supported by a dedicated team of nurses, healthcare professionals, and a Skincare Diagnostic Technician.

He completed his medical studies at the University of Stellenbosch and Cape Town Medical School, followed by a prestigious fellowship in Paris under Dr Francoise Firmin, where he specialised in cosmetic surgery and ear reconstruction. Further training across Europe and the U.S. has enriched his practice with global insights into patient care and management.