Recognising the key features of common skin lesions, such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma, and malignant or fungating wounds, is important for early diagnosis and guidance of appropriate management and treatment interventions. There is also the potential for wounds of initially benign aetiologies to evolve into a malignancy over long periods of time, and it is important to act on suspicious lesions and wounds which are failing to respond to standard treatment strategies. Timely referrals to specialities such as dermatology can be the key for preventing unnecessary deterioration, and awareness of local referral pathways and policies can support clinicians with decision-making around this process. While local wound management of malignant wounds should follow the principles of the TIMES framework for assessment, it should also include consideration of common and often distressing associated symptoms such as pain, malodour, high exudate volume and risk of bleeding.