The “fish tumor or other deformities” beneficial use impairment (BUI) occurs at 9 of the 12 areas of concern (AOC) on Lake Erie. As point sources are mitigated and remediation occurs, AOC are faced with determining delisting criteria. The lack of standardized analyses for this BUI has confounded that process. For orocutaneous tumors, different criteria (presumptive tumors and/or abnormal barbels) and methodology (gross versus microscopic observations) have been used. Hence, this project evaluated tumors at numerous AOC and non-AOC sites and compared methodology. In 1998–2000 the prevalence of presumptive orocutaneous tumors and barbel abnormalities was compared in brown bullhead (Ameiurus nebulosus) collected at eight AOC. The Black (46.7%), Buffalo (29.3%), Cuyahoga (58.9%), and Detroit (26.5%) rivers and Presque Isle Bay (28.6%) had high prevalences of orocutaneous tumors, while the Niagara (10%), Maumee (3.9%) and Ashtabula (4.4%) rivers were lower. From 2002 to 2007 the prevalence of orocutaneous tumors at Presque Isle Bay was consistently near 30%. A variety of non-AOC sites, as potential reference sites, were also monitored during this time. By combining years and sites the prevalence of orocutaneous tumors in bullhead (age 2–12 years) at inland lakes was 6.3%, at Long Point Inner Bay was 8.7%, at other bays and harbors was 14.6% and at tributary sites was 12.5%. Overall, 93% of the raised lesions identified as presumptive tumors grossly were verified as neoplasms microscopically. The prevalence of orocutaneous tumors increased with age at both Presque Isle Bay and Long Point Inner Bay, the sites with the largest sample sizes.