Melanoma, the deadliest skin cancer, is most commonly seen on the head, neck, upper back, torso and lower legs, however, it can form anywhere on your skin including the scalp, genitals, soles of the feet and even under a nail.

Dermatologists encourage people of all skin colors to perform self-skin exams on a regular basis. Checking your skin can help you find melanoma early when it is highly treatable.

When examining your skin, you want to look for the warning signs which are called the ABCDE’s of melanoma:

• A is for Asymmetry: Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a round to oval and symmetrical common mole.
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• B is for Border: Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.

• C is for Color: Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colors red, white or blue may also appear.
• D is for Diameter or Dark: While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger. Some experts say it is also important to look for any lesion, no matter what size, that is darker than others. Rare, amelanotic melanomas are colorless.

• E is for Evolving: Any change in size, shape, color or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching or crusting, may be a warning sign of melanoma.

Melanoma may show up on your body in different ways.

Things to look for are:

• A changing  mole
• A bleeding mole
• A new red, brown, white or multi-colored spot or patch on your skin
• A changing freckle or age spot
• A dark streak under a nail
• A band of darker skin around a nail

Melanoma may develop without any pain or discomfort. For many people, the only sign is a change in the appearance of the skin or nails. However, melanoma may bleed or be itchy or painful.

Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds.

Scientists have shown that UV light from the sun and tanning beds can do two things:

• Cause melanoma on normal skin.
• Increase the risk of a mole on your skin turning into a melanoma

Scientists have also found that some people inherit genes that increase their risk of getting melanoma.

Because UV exposure is the leading cause of melanoma, you can greatly reduce your risk of getting melanoma by taking steps to prevent skin cancer.

Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light can cause melanoma to develop on normal skin and also increase the risk of a mole turning into melanoma.

Research shows that you increase your risk of getting melanoma if you:

• Use tanning beds. Using tanning beds before the age of 35 can increase your risk of melanoma by 59% and the risk increases with each use.
• Have had 5 or more blistering sunburns between ages 15 and 20. This will increase your risk of getting melanoma by 80%!
• Live close to the equator where the sun is more intense.
• Live in a sunny area such as Florida or Arizona
• Failed to protect your skin from the sun. People over the age of 65 are at greater risk for melanoma because of the greater amount of UV exposure over the course of their lives. Men older than 50 also have a higher risk of melanoma

Anyone can get melanoma. Most people who get melanoma have fair or light skin but people with darker skin can also get melanoma. 

The following factors increase the risk of melanoma:

• Fair or pale skin
• Natural red or blond hair
• Blue, green or gray eyes
• Skin that rarely tans and burns easily
• 50 or more moles
• Multiple large and/or irregular moles
• History of atypical or dysplastic moles
• A previous history of melanoma
• A history of melanoma in your family.  Scientists have found that some people inherit genes that increase their risk of getting melanoma.
• A medical condition or medication that weakens your immune system such as AIDS or a history of organ transplantation

To diagnose melanoma, a dermatologist begins by looking at a patient’s skin.  A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermoscope. This device shines light and magnifies the skin to allow the dermatologist to see color and structures in the skin.

If the dermatologist finds a spot that is suspicious for melanoma, he/she will  remove it (or part of it). This is called a biopsy and the piece of skin will be sent to the lab to be examined under a microscope. Melanoma cannot be diagnosed without a biopsy. Biopsies are quick, safe and easy for  a dermatologist to perform and the discomfort and risks are minimal.

If melanoma is diagnosed in the biopsy report, this  information will be communicated to the patient.  The report will also tell the thickness of the melanoma  (Breslow Depth) which is how deeply the cancer has grown into the skin. This piece of information is important in deciding treatment and future prognosis.

Another type of biopsy  called a sentinel lymph node biopsy  (SLNB) may also be recommended based on the depth of the melanoma.  When melanoma spreads, it often goes to the closest lymph nodes first.  A SLNB tells doctors whether the melanoma has spread to nearby lymph nodes.  For melanomas that have grown deeper in the skin or have spread to lymph nodes, additional testing including x-rays, blood work, CT scans and even PET scans may be recommended.

The type of treatment a patient receives depends on how deeply the melanoma has grown into the skin (Breslow depth), whether the melanoma has spread to other parts of the body and the patient’s health. 

The treatments most commonly used include the following:

• Surgery: When treating melanoma, doctors want to remove all of the cancer. When melanoma has not spread, it is often possible for a dermatologist to remove the cancer during an office visit and the patient is awake for the procedure. Types of surgeries include the following:
• Wide local excision: To perform this, the dermatologist numbs the skin , then surgically cuts out the melanoma with some of the normal-looking skin around the melanoma (usually ¼-1/2 inch margin of normal skin).
• Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced moes) is a surgery performed by a specialist to remove certain skin cancers. It offers the highest cure rate for early melanomas. Your dermatologist will tell you if Mohs is right for you.  With Mohs surgery, the surgeon will cut out the tumor plus a small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to determine if there are left over cancer cells. If cancer cells remain, the surgeon will continue to remove small amounts of skin and look at them under the microscope. This continues until the surgeon no longer sees cancer cells.

When caught early, removing the melanoma with one of the above surgical options may be  all the treatment a patient needs. In its earliest stage, melanoma grows only in the outer layer of the skin, called the epidermis. This is referred to as melanoma in situ. In this stage, the cure rate with surgical removal is nearly 100 %.

When melanoma grows deeper into the skin or spreads to other body parts, treatment becomes more complex.

It may begin with one of the surgeries described above but may include additional treatments such as the following:

• Lymphadenectomy or lymph node dissection: This procedure removes the lymph nodes near the melanoma.
• Immunotherapy: This treatment helps the patient’s immune system fight the cancer.
• Chemotherapy: This medicine kills the cancer cells along with some of the normal cells of the body.
• Radiation therapy: This treatment uses x-rays to kill the cancer cells along with some of the body’s normal cells.
• Targeted therapy: This treatment targets parts of the melanoma cells that make them different from normal cells and can work when chemotherapy does not.

The outcome for melanoma depends on how deeply the melanoma has grown into the skin and whether it has spread to other body parts. If the melanoma is properly treated and is in the top layer of skin, the cure rate is nearly 100%. If melanoma has grown deeper or spreads, the patient may die.

Images used with permission of the The Skin Cancer Foundation:

• American Academy of Dermatology. Stats and facts: Melanoma. Last accessed April 27, 2016.
• Agbai ON, MD, Buster K, et al. “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public.” J Am Acad Dermatol 2014;70(4):748-62.
• Gagnon, L. “Dermatologists better at detecting melanoma
  Non-dermatologists would benefit from more training in accurate pigmented lesion diagnosis.” Dermatology Times. Jan 12, 2015:
• Gloster HM and Neal K. “Skin cancer in skin of color.” J Am Acad Dermatol 2006;55(5):741-60.
• Soura E, Eliades PJ, et al. “Hereditary melanoma: Update on syndromes and management Emerging melanoma cancer complexes and genetic counseling.” J Am Acad Dermatol 2016;74:411-20.
• Tsao H, Olazagasti JM, et al. “Early detection of melanoma: Reviewing the ABCDEs.”  J Am Acad Dermatol 2015;72:717-23.
• Zwald FO and Brown M. “Skin cancer in solid organ transplant recipients: Advances in therapy and management Part I. Epidemiology of skin cancer in solid organ transplant recipients.” J Am Acad Dermatol 2011;65:253-61.