There are two things that would concern me about a blemish on a lens:
1) If the blemish were in the light path, it would have a large effect - one could assume that light hitting this blemish would be scattered and would end up on the film in a place other than where it is desired. Depending on the nature of the blemish and the light, this might result in bright spots appearing, or if more diffuse, then a general loss of contrast. If the blemish is on the edge of the rear element, then one could expect these effects to get smaller the smaller the aperture. Note that even with a small aperture, with some movements you may be placing the blemish on the edge of the rear element in the light path.
2) Even if the blemish does not fall in the light path, light from outside the image area is liable to hit the blemish and be scattered onto the film, resulting in a loss of contrast or a flare like anomaly.