Melanoma
What is melanoma?
A type of skin cancer, melanoma is often called the “most serious skin cancer” because it can spread from the skin to other parts of the body.
Is melanoma contagious? No
What are the signs and symptoms of melanoma?
Melanoma is a skin cancer that can show up on the skin in many ways. It can look like a:
Changing mole
Spot that looks like a new mole, freckle, or age spot, but it looks different from the others on your skin
Spot that has a jagged border, more than one color, and is growing
Dome-shaped growth that feels firm and may look like a sore, which may bleed
Dark-brown or black vertical line beneath a fingernail or toenail
Band of darker skin around a fingernail or toenail
Slowly growing patch of thick skin that looks like a scar
Early melanoma
This early melanoma could be mistaken for a mole, so it’s important to look carefully at the spots on your skin.
The ABCDEs of melanoma
To help people find a possible melanoma on their skin, dermatologists created the ABCDEs of melanoma:
A is for Asymmetry
One half of the spot is unlike the other half.
B is for Border
The spot has an irregular, scalloped, or poorly defined border.
C is for Color
The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red, or blue.
D is for Diameter
While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller.
E is for Evolving
The spot looks different from the rest or is changing in size, shape, or color.
If you find a spot on your skin that has any of the ABCDEs of melanoma, see a board-certified dermatologist for a skin exam.
The following pictures can help you see how the ABCDEs of melanoma can appear on the skin.
Pictures of melanoma
How many of the ABCDEs can you find in the following pictures of melanoma?
Melanoma that looks like an odd-shaped mole
Would you mistake these melanomas for odd-shaped moles?
Both show the A (asymmetrical shape) and B (border uneven) of melanoma. The melanoma on the right shows the C (color varies).
Melanoma that looks like a sore
Melanoma often contains shades of brown, black, or tan, but some can be red or pink, such as the one shown here.
Still you can see some of the ABCDEs here. The spot shows the A (asymmetrical shape) and B (uneven border).
Melanoma that looks like a firm, raised growth
Melanoma can spread out as it grows, but this one is growing up and looks like a firm, raised growth.
Did you notice the A (asymmetrical shape) and B (uneven border)?
Melanoma that looks like an age spot
This melanoma is spreading out as it grows.
Did you notice the A (asymmetrical shape), B (uneven border), C (color varies), and D (diameter is bigger than a pencil eraser)?
Melanomas that could be mistaken for a common skin problem
Melanoma that looks like a bruise
Melanoma can develop anywhere on the skin, including the bottom of the foot, where it can look like a bruise as shown here.
Melanoma that looks like a cyst
This reddish nodule looks a lot like a cyst, but testing proved that it was a melanoma.
Dark spot
In people of African descent, melanoma tends to develop on the palm, bottom of the foot, or under or around a nail.
Did you spot the asymmetry, uneven border, varied color, and diameter larger than that of a pencil eraser?
Dark line beneath a nail
Melanoma can develop under a fingernail or toenail, looking like a brown line as shown here.
While this line is thin, some are much thicker. The lines can also be much darker.
Does melanoma hurt?
You can have melanoma without feeling any pain or discomfort. For many people, the only sign of this skin cancer is a spot that has some of the ABCDEs of melanoma or a line beneath a nail.
Sometimes, melanoma causes discomfort. It can:
Itch
Be painful
Bleed
How do people find signs of melanoma on their own skin?
Performing a skin self-exam as often as recommended by your dermatologist is the best way. While examining your skin, you want to look for the following:
Mole (or other spot on your skin) that is changing in any way
Spot that looks different from the rest of the spots on your skin
Growth or spot on your skin that itches, bleeds, or is painful
Band of color beneath or around a nail
Sore that doesn’t heal or heals and returns
The ABCDEs of melanoma can help you find changes to a mole, freckle, or other spot on your skin.
What causes melanoma?
Research indicates that ultraviolet (UV) light from the sun and indoor tanning can:
Cause melanoma
Increase the risk of a normal mole turning into melanoma
How can UV light cause skin cancer?
UV light is a known carcinogen (cancer-causing substance). Every time UV light hits our skin, it can damage some of the DNA inside. The body tries to repair this damage.
When the damage becomes more than the body can repair, changes (mutations) develop in our skin’s cells. As the mutations build up, skin cancer can develop.
The type of skin cancer a person gets depends on which cells have mutations. Melanoma develops when mutations develop inside cells called melanocytes (meh-lan-oh-cites). These cells give skin its color.
How often do you protect your skin from the sun?
Spending time outside without protecting your skin from the sun increases your risk of getting melanoma.
Do some people have a higher risk of developing melanoma?
Yes, you have a higher risk of getting melanoma if you:
Spend time outdoors without protecting your skin from the sun. To protect your skin from the sun, dermatologists encourage everyone to wear sun-protective clothing, such as a wide-brimmed hat, long sleeves, and pants whenever possible.
Use tanning beds or other indoor tanning equipment. The UV light from these tends to be stronger than those from the sun. Not using these can reduce your risk of getting all types of skin cancer.
Have had blistering sunburns. A sunburn means UV light has badly damaged your skin.
Have fair skin, light-colored eyes, or naturally red or blond hair. Your skin is more easily damaged by UV light if you have one or more of the following:
Skin that burns easily and rarely tans
Sun-sensitive skin that freckles easily
Blue or green eyes
Naturally blonde or red hair
Have celebrated your 50th birthday. Being 50 or older increases your risk of developing melanoma; however, some people develop melanoma earlier.
Have certain moles. Most moles are harmless, but you have a higher risk of getting melanoma if you have:
50 or more moles
A mole that covers a large area of skin
1 or more atypical (isn’t perfectly round, has more than one color, or shows a jagged border) moles
Have a weakened immune system. Anything that weakens your immune system increases your risk of developing melanoma. Some medications, such as drugs taken to prevent your body from rejecting a transplanted organ weaken the immune system. Some medical conditions, such as HIV, also weaken the body’s immune system.
Sun protection crucial for organ transplant recipients
If you have received an organ transplant, you have a higher risk of developing melanoma and other skin cancers.
Have had melanoma or another skin cancer. If you’ve had melanoma or another type of skin cancer, your skin has been badly damaged by UV light. This increases your risk of developing more skin cancers, including melanoma.
Have had breast or thyroid cancer. A few other cancers aside from skin cancer can increase your risk of developing melanoma. These include breast and thyroid cancers.
Have one or more blood relative who has (or had) melanoma. Although rare, melanoma can run in a family. When this happens, some people inherit genes for melanoma. Melanoma may run in your family if close blood relatives have had this skin cancer.
Have xeroderma pigmentosum. This is an extremely rare condition, which makes a person’s skin unable to repair any damage caused by UV light. Because the body cannot repair any UV damage, it’s estimated that XP can raise the risk of getting skin cancer 10,000-fold.
Who gets melanoma?
While some people have a higher risk of developing melanoma, it’s important to know that melanoma develops in people of all skin colors from the palest to the darkest.
When melanoma develops in a person who has skin of color, the cancer often begins on the bottom of the foot, palm of the hand, or beneath (or around) a nail. UV light isn’t believed to play a role in these melanomas.
That’s why it’s essential for everyone to:
Check their skin for signs of melanoma
See a board-certified dermatologist if a spot on your skin looks like it could be melanoma
If you find a spot or growth on your skin that you think could be a melanoma, don’t delay making an appointment to see a board-certified dermatologist. When caught early, melanoma is highly treatable.
See a board-certified dermatologist
Dermatologists use tools, such as a dermatoscope, to help them get a close look at a suspicious spot.
How do dermatologists diagnose melanoma?
When you see a board-certified dermatologist, your dermatologist will:
Examine your skin carefully
Ask questions about your health, medications, and symptoms
Want to know if melanoma runs in your family
If any spot on your skin looks like skin cancer, your dermatologist will first numb the area and then remove all (or part) of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.
Having a skin biopsy is the only way to know for sure whether you have skin cancer.
The tissue that your dermatologist removes will be sent to a lab, where a doctor, such as a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.
What this doctor sees while looking at your tissue will be explained in the pathology report, including whether cancer cells were seen. If melanoma cells are seen, the report will include many important details, including:
The type of melanoma
How deeply the melanoma tumor has grown into the skin
How quickly the melanoma cells are growing and dividing
If it’s possible to tell the stage of the melanoma, the report will include this information.
Stages of melanoma
Here’s an explanation of what each stage of melanoma means:
Stages of melanoma
Stage 0
Also called melanoma in situ, this means the cancer occurs in the top layer of skin.
Stage 1
The cancer is found only in the skin, but the tumor has grown thicker. In stage 1A, the skin covering the melanoma remains intact. In stage 1B, the skin covering the melanoma has broken open (ulcerated).
Stage 2
The melanoma has grown thick, with the thickness ranging from 1.01 millimeters to greater than 4.0 millimeters. While thick, the cancer has not grown deeper than the skin or spread to nearby skin.
Stage 3
The melanoma has spread to either:
• One or more nearby lymph node (often called a lymph gland)
• Nearby skin
Stage 4
This is the most advanced stage. It means that the melanoma has spread to one or more parts of the body: An internal organ, such as a lung or the brain; lymph nodes that are not right next to the melanoma; or skin far from where the melanoma first appeared.
It’s not always possible to determine the stage of the melanoma from the biopsy, and it’s essential to know the stage of the melanoma. The stage determines how to treat the melanoma.
When the stage cannot be determined from the biopsy, your dermatologist will recommend more testing.
In some cases, the recommended testing may include a sentinel lymph node biopsy (SLNB) to help determine the stage of the melanoma.
You can learn more about a SLNB at, I have melanoma! Why do I need a sentinel lymph node biopsy?
Once the stage is known, the next step is treatment.
How is melanoma treated?
The type of treatment you receive depends on the following:
How deeply the melanoma has grown into your skin
Whether the cancer has spread to another part of your body
Your overall health
Your dermatologist, oncologist (cancer doctor), or oncology (cancer) team will consider the above when creating your treatment plan, which may include one or more of the following treatments.
Surgery: When treating melanoma, doctors strive to remove all the cancer. Because surgery (aka surgical removal) tends to be the most effective way to do this, a patient who has melanoma will often have surgery.
The type of surgical removal you receive depends largely on the type of melanoma you have, where it’s located, and how deeply it goes. If you have an early melanoma, your dermatologist may treat it with one of the following procedures, which can be performed in a medical office while you remain awake.
Excision: Your dermatologist cuts out the cancer and an area of normal-looking skin around the tumor. Removing some normal-looking skin helps to remove stray cancer cells.
Mohs (pronounced moes) surgery: If you have melanoma on your head, neck, or hand, it can be difficult to remove an area of normal-looking skin. There just isn’t a lot of extra skin on these parts of the body.
If surgery can remove the cancer, this may be your only treatment. This is often the case with an early melanoma.
When melanoma grows deeper into the skin or spreads, treatment becomes more complex. Surgery may be part of your treatment plan, but other treatments will be used as well to help kill cancer cells. Some are given before surgery to shrink the cancer. Others are given after surgery to kill any remaining cancer cells.
The other types of treatment for melanoma are:
Lymphadenectomy: Surgery to remove lymph nodes.
Immunotherapy: Medication is used to help the patient’s immune system find and destroy cancer cells. This may be used after surgery. Sometimes, it’s used as the primary treatment when surgery cannot remove the cancer.
Targeted therapy: These drugs target cancer cells and can temporarily shrink the cancer.
Chemotherapy: These medications kill fast-growing cells, which include cancer cells and some normal cells, such as hair cells. Since the approval of newer medications, such as immunotherapy and targeted therapy, chemotherapy is used less often today.
Radiation therapy: This is used to either kill the cancer cells or stop new cancer cells from forming.
Other treatments that may be recommended include:
Clinical trial: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied could help you. Being part of a medical research study has risks and benefits.
Adoptive T-cell therapy: This treatment uses the patient's immune system to fight the cancer. Instead of receiving medicine, the patient has blood drawn. The blood is sent to a lab so that the T-cells (cells in our body that help us fight cancers and infections) can be removed. These T-cells are then placed in a culture so that they can multiply.
Palliative care: This care can relieve symptoms and improve a patient’s quality of life. It does not treat the cancer. Many patients receive palliative care, not just patients with late-stage cancer.
What is the life expectancy for someone who has been diagnosed with melanoma?
If you have melanoma, many factors affect your life expectancy. Your age, other medical conditions, and stage of the melanoma are just a few factors. For this reason, it’s impossible to predict how long one person who has melanoma will live.
What researchers do instead is predict how long a group of people who have melanoma will live. This is called “survival rate.” If you come across this term while looking for information about melanoma, it is important to know what this means.
Survival rate is “the percentage of people who will be alive within a certain time period, such as 5 years, after being diagnosed with a certain stage of melanoma. Each stage of melanoma has its own survival rate.
Before you search for the melanoma survival rates, it’s important to keep the following facts in mind:
Survival rates are estimates.
Each person diagnosed with melanoma has unique characteristics, so your outlook may be very different from someone else who has the same stage of melanoma.
Newer treatments, such as immunotherapy and targeted therapy, are helping people live longer.
Another important consideration is your self-care after treatment. Protecting your skin from the sun and never tanning can help prevent a new melanoma. Yet, studies reveal that many people continue their old habits after treatment and never protect their skin from the sun.
Finding a new (or returning) melanoma early can also help.
You’ll find out what dermatologists recommend when it comes to protecting your skin and finding melanoma early at, Melanoma: Self-care.