Melanoma is a type of skin cancer that begins in the melanocytes, the cells that produce skin pigment or melanin. Melanoma most often develops on areas of the skin exposed to the sun, such as the chest, back, legs, arms and face. However, melanoma can develop anywhere on the body.
Knowing what to look for and taking prompt action can save your life. Melanoma caught early is highly treatable. So it’s important to examine your skin regularly and look for any new or changing lesions that may indicate melanoma.
Characteristics of early melanoma
Melanoma in its earliest stages, when it is small and has not spread, tends to have the following characteristics:
- Asymmetrical shape. Benign moles are usually symmetrical. Melanoma lesions frequently have an irregular shape.
- Borders that are uneven. Benign moles usually have smooth, even borders. Melanoma borders tend to be notched or ragged.
- Color changes. Watch for different shades of brown, black or tan. The melanoma area may be darker than the surrounding skin or have portions that are lighter. Red, white and blue colors are also sometimes present.
- Diameter greater than 6 millimeters (about 1⁄4 inch). Benign moles are usually smaller than this. Melanoma lesions can sometimes be tiny when first detected but most are larger.
- Evolution. Watch for any changes in the characteristics of a mole over time, such as growing larger or becoming darker.
The ABCDEs of melanoma
An easy way to remember the warning signs of early melanoma is to look for these changes in moles, using the ABCDE guide:
- Asymmetry. One half of the mole does not match the other.
- Border. The edges are irregular, ragged, notched or blurred.
- Color. Shades of black, brown, and tan may be present. Areas of white, grey, red or blue may also be seen.
- Diameter. Melanoma lesions are usually larger than 6 millimeters in diameter when first detected.
- Evolving. The mole has changed in size, shape, colors or symptoms (itching, tenderness).
Any mole that exhibits one or more of these ABCDE criteria should be evaluated by a dermatologist. The more criteria a mole meets, the higher the suspicion that melanoma is present.
What melanoma looks like at the earliest stage
Stage 0 melanoma is called melanoma in situ. This means the cancer is present only in the outer layer of skin cells and has not invaded deeper tissues. It has not spread anywhere else in the body.
Melanoma in situ may appear as:
- A flat area that is darker than surrounding skin.
- A brown or black streak under a fingernail or toenail.
- A mole that stands out from others on the body.
- A bump that looks smooth and usually pink, red, or purple.
Over time, untreated melanoma in situ may eventually progress to more advanced stages of melanoma. But detected early, survival odds are excellent – nearly 100% of people survive melanoma in situ.
Pictures of early stage melanoma
Here are examples of how melanoma may look when first appearing:
Asymmetrical mole
Melanomas often have an irregular, asymmetrical shape. Benign moles are usually symmetrical.
Irregular borders
Melanoma borders tend to be uneven, ragged or notched. Benign moles usually have smooth, even borders.
Mole larger than 6mm
Melanomas are often larger than 6 millimeters in diameter when first detected. Benign moles are usually smaller.
Mole changing over time
Look for moles that are evolving, changing in size, shape or color over time. This can indicate melanoma.
Mole with varied colors
Melanomas sometimes have a mix of colors including tan, brown, black, red, white or blue. Benign moles are usually a single shade.
Melanoma in situ
Early stage melanoma confined to the outer layer of skin. It appears as a brown or black flat lesion.
Under-nail melanoma
Early stage melanoma can occur under nails. It may look like a brown or black streak.
When to see a doctor
Make an appointment with your doctor if you notice any of the following:
- A new mole or spot on your skin
- A mole that looks abnormal
- Changes in the size, shape, or color of an existing mole
- Itching, tenderness, oozing, or bleeding from a mole
- A mole that becomes scaly or hard
- Slow healing of a mole or spot after an injury
Your doctor can examine your skin closely and may remove suspicious growths for biopsy to check for cancer cells. Melanoma is highly treatable when found early.
How melanoma is diagnosed
If a mole or lesion looks suspicious, your doctor will take a sample of skin from it and send the sample to a pathology lab. There, a biopsy can determine whether melanoma is present. Types of biopsies include:
- Shave biopsy – The doctor shaves off the top layers of the skin with a small surgical blade.
- Punch biopsy – The doctor uses a special instrument to take a deeper, cylindrical core sample of the suspicious tissue.
- Excisional biopsy – The doctor removes the entire growth.
- Incisional biopsy – The doctor removes a portion of the growth.
After the skin sample is removed for biopsy, it is examined under a microscope by a pathologist experienced in evaluating skin cancers. The pathology report will confirm whether melanoma is present.
Staging of melanoma
If melanoma is diagnosed, more tests may be done to determine the stage of the melanoma, based on how far the cancer has progressed:
Stage 0
Melanoma in situ. Cancer is present only in the outer layer of skin cells and has not spread deeper or to other sites.
Stage 1
Early stage melanoma that is less than 1 mm thick. It is localized to the primary site and has a very low potential to spread.
Stage 2
The tumor is 1mm to 2mm thick. Or it shows ulceration and is less than 1mm thick. It has a slightly higher chance of spreading.
Stage 3
The cancer has spread to nearby lymph nodes or nearby skin. Or the tumor is 2mm to 4mm thick without ulceration. It has a higher chance of spreading to distant sites.
Stage 4
The melanoma has spread to distant organs such as lungs, liver or brain. Or the tumor is thicker than 4mm with ulceration. It has a high chance of recurring after treatment and spreading to distant sites.
Knowing the stage helps determine prognosis and the type of treatment needed.
Early detection gives best chance for survival
When detected at its earliest stages, melanoma is highly treatable. The American Cancer Society estimates 5-year survival rates by stage:
- Stage 0: Nearly 100%
- Stage 1: 95%
- Stage 2: 60% to 80%
- Stage 3: 40% to 70%
- Stage 4: 15% to 20%
So examining your skin monthly and recognizing changes in moles can make a significant difference. If melanoma is found early, it can nearly always be removed with surgery before spreading through the body.
Treatment options for early melanoma
Treatments for melanoma in its earliest stages include:
Excisional surgery
The primary melanoma tumor and some surrounding normal skin are removed.
Mohs surgery
The visible tumor is removed layer by layer until only cancer-free tissue remains. This helps conserve healthy tissue.
Lymph node removal
If the melanoma has spread to nearby lymph nodes, these may be removed.
Immunotherapy medicines
Medicines can help the immune system attack any remaining cancer cells.
Targeted therapies
Drugs that target specific genes or proteins in melanoma tumors interfere with cancer growth.
Clinical trials
Research studies test new medicines and treatment combinations.
Risk factors for melanoma
These factors increase the chance of developing melanoma:
- Fair skin. Increased risk if you sunburn easily or have blonde/red hair.
- A history of tanning, sunburns or indoor tanning.
- Living closer to the equator or high altitude. Increased sun exposure.
- Excessive sun exposure. This includes recreational sunbathing.
- Weakened immune system due to certain diseases.
- Older age. Average age at diagnosis is 65.
- Male gender. Incidence rates are higher for men.
- Previous skin cancer.
- Family history. Around 10% of people with melanoma have a first-degree relative with melanoma.
You can help prevent melanoma by minimizing sun exposure, avoiding tanning beds, and performing regular skin self-exams.
Prevention tips
To lower your skin cancer risk:
- Avoid direct sun between 10 a.m. and 4 p.m. when UV rays are strongest.
- When outdoors, seek shade under trees, umbrellas or buildings.
- Wear sun protective clothing – long sleeves, long pants, wide brim hat.
- Apply broad spectrum SPF 30+ sunscreen every 2 hours when outside.
- Avoid indoor tanning beds. UV radiation increases melanoma risk.
- Examine skin monthly for signs of change.
- See a dermatologist annually for a professional skin exam.
Conclusion
Melanoma can be sneaky when it first develops. Look for the ABCDE early warning signs – asymmetry, irregular borders, varied color, large diameter and changes over time. If you notice any abnormal moles or spots, make an appointment promptly with your doctor for evaluation. Melanoma is highly treatable when detected in its earliest stages.
