Melanoma Skin Cancer

What is melanoma skin cancer?

Melanoma skin cancer is a cancer that begins in melanocytes, the cells in the skin that make melanin (the pigment that gives skin, hair, and eyes their color). When these cells grow out of control, they can form a tumor that often looks like an unusual mole or dark spot. Melanoma is less common than other skin cancers, such as basal cell carcinoma and squamous cell carcinoma, but it is considered more serious because it is more likely to spread (metastasize) to other parts of the body if it is not found early.

Melanoma can develop anywhere on the skin, including areas that rarely see the sun, such as the soles of the feet, palms, under the nails, and inside the mouth or genital area. In people with lighter skin it most often appears on the back, chest, legs, face, and arms. In people with darker skin it is more likely to appear on the palms, soles, and nail beds, and it is sometimes found at a later stage because it is not expected.

Melanoma affects adults of all ages and is one of the more common cancers in younger adults, although the risk rises with age. It can also occur, much less often, in the eye (ocular melanoma) or in mucous membranes. This page focuses on melanoma of the skin. Understanding what melanoma skin cancer is, how it looks, and how it is treated can help you recognize warning signs and have informed conversations with your care team.

Melanoma skin cancer symptoms

The most common melanoma skin cancer symptom is a change in an existing mole or the appearance of a new pigmented spot. Many melanomas are first noticed by the person themselves or by a family member. Doctors often teach the ABCDE rule to help people spot suspicious features:

• A – Asymmetry: one half of the spot does not match the other half.
• B – Border: the edges are irregular, ragged, notched, or blurred.
• C – Color: the color is uneven, with shades of brown, black, tan, red, white, or blue.
• D – Diameter: the spot is larger than about 6 millimeters (roughly the size of a pencil eraser), although melanomas can be smaller.
• E – Evolving: the spot changes in size, shape, color, or height, or develops new symptoms such as itching or bleeding.

Other possible symptoms include:

• A mole that itches, feels tender, or becomes painful
• A spot that bleeds, oozes, or forms a crust without healing
• A sore that does not heal
• A dark streak under a fingernail or toenail that is not caused by injury
• A new firm lump on the skin, which may be pink, red, or skin-colored rather than dark
• Redness or swelling spreading beyond the border of a mole
• An “ugly duckling” spot that looks different from all your other moles

Symptoms can vary by type. Superficial spreading melanoma, the most common type, usually grows outward across the skin for a time before growing deeper, so it often looks like a flat, irregular patch. Nodular melanoma tends to grow downward more quickly and may appear as a raised bump that can be black, blue, or even pink. Lentigo maligna melanoma often develops slowly on sun-damaged skin of the face in older adults. Acral lentiginous melanoma appears on the palms, soles, or under the nails and is the most common type in people with darker skin.

In early stages, melanoma usually causes no symptoms beyond the visible change. If melanoma has spread, it may cause symptoms in other parts of the body, such as swollen lymph nodes (small glands that filter fluid), unexplained weight loss, tiredness, a persistent cough, bone pain, or headaches. These symptoms have many other causes, so they do not mean a person has melanoma, but they should be checked by a doctor.

Causes and risk factors

Melanoma skin cancer causes come down to damage to the DNA (the genetic instructions) inside melanocytes. When this damage builds up, the cells can start to grow without normal controls. The most important known cause is ultraviolet (UV) radiation, which comes from sunlight and from artificial sources such as tanning beds and sun lamps. However, melanoma can also arise in skin that has had little sun exposure, so UV light is not the only factor.

Factors that increase the risk of melanoma include:

• UV exposure and sunburns: intermittent intense exposure and a history of blistering sunburns, especially in childhood, raise risk.
• Tanning bed use: indoor tanning exposes the skin to concentrated UV radiation.
• Fair skin, light hair, and light eyes: people who burn easily and freckle have less protective melanin. Melanoma can still occur in people with darker skin.
• Many moles or unusual moles: having a large number of moles, or moles that are irregular (called atypical or dysplastic nevi), increases risk.
• Family history: having a close relative with melanoma raises risk, and a small number of families carry inherited gene changes.
• Personal history: people who have had melanoma or another skin cancer before are more likely to develop a new one.
• Weakened immune system: for example, after an organ transplant or with certain medical conditions or treatments.
• Age: risk rises with age, although melanoma also occurs in young adults.
• Rare inherited conditions: such as xeroderma pigmentosum, in which the skin cannot repair UV damage normally.

Having one or more risk factors does not mean a person will develop melanoma, and some people with melanoma have no obvious risk factors. Risk factors simply mean that regular skin checks and sun protection deserve more attention.

Melanoma skin cancer diagnosis

Melanoma skin cancer diagnosis usually begins with a skin examination. A doctor, often a dermatologist (a skin specialist), looks at the suspicious spot and the rest of your skin. They may use a dermatoscope, a handheld magnifying device with a light, to see structures below the skin surface that are not visible to the naked eye. Some clinics also take standardized photographs of the whole body to track changes in moles over time.

A skin examination alone cannot confirm melanoma. The only way to be certain is a biopsy, in which the doctor removes all or part of the suspicious area, usually under local anesthesia, and sends it to a laboratory. A pathologist (a doctor who examines tissue under a microscope) then checks whether melanoma cells are present. Where possible, doctors prefer to remove the whole lesion with a small rim of normal skin (an excisional biopsy), because this gives the most accurate information.

If melanoma is confirmed, the pathology report typically describes several features that guide treatment:

• Breslow thickness: how deep the melanoma extends into the skin, measured in millimeters. Thickness is one of the most important factors in planning care.
• Ulceration: whether the skin surface over the tumor has broken down.
• Mitotic rate: how quickly the cells appear to be dividing.
• Margins: whether any melanoma cells reach the edge of the removed tissue.

Depending on these findings, your doctor may recommend further tests to find out whether the melanoma has spread. A sentinel lymph node biopsy identifies and removes the first lymph node or nodes that drain the area of the melanoma so they can be checked for cancer cells. For thicker melanomas or when spread is suspected, imaging such as ultrasound of nearby lymph nodes, CT scans (detailed X-ray images), MRI (magnetic scans), or PET scans (which highlight areas of active cells) may be used. Blood tests are not used to diagnose melanoma, but some markers may be measured to help with staging in advanced disease. In some cases the tumor is tested for specific gene changes, such as BRAF mutations, because these can influence which medications are likely to help.

All of this information is combined into a stage, usually from 0 to IV. Stage 0 (melanoma in situ) means the cancer is confined to the top layer of skin. Stages I and II describe melanomas of increasing thickness that have not spread. Stage III means spread to nearby lymph nodes or skin, and stage IV means spread to distant organs such as the lungs, liver, or brain.

Melanoma skin cancer treatment options

Melanoma skin cancer treatment options depend mainly on the stage, the location of the tumor, the results of gene testing, and the person’s overall health and preferences. Care is often planned by a team that may include a dermatologist, a surgeon, a medical oncologist (a doctor who treats cancer with medication), a radiation oncologist, and a pathologist. Within many hospital groups, including Acibadem, systemic drug treatment for melanoma is coordinated through the Medical Oncology Department, working alongside surgical and dermatology teams.

Surgery is the main treatment for melanoma that has not spread. After a biopsy confirms the diagnosis, the surgeon usually performs a wide local excision, removing the site of the melanoma together with a margin of healthy skin. The width of the margin depends on the thickness of the tumor. Many excisions are done under local anesthesia, and the wound is closed with stitches; larger wounds may need a skin graft or flap. If the sentinel lymph node contains cancer, your doctor may discuss removing more lymph nodes or close monitoring with ultrasound, depending on current guidelines and your situation.

Immunotherapy uses medications that help the body’s own immune system recognize and attack melanoma cells. Drugs called immune checkpoint inhibitors are commonly used for melanoma that has spread and are also offered after surgery in some higher-risk stage III or stage II melanomas to reduce the chance of the cancer returning (this is called adjuvant therapy). Immunotherapy can cause side effects related to the immune system attacking healthy tissues, such as skin rashes, diarrhea, or inflammation of glands or organs, so close follow-up is needed.

Targeted therapy refers to medications that block specific gene changes driving the cancer. About half of melanomas carry a BRAF mutation, and people whose tumors test positive may be offered combinations of BRAF and MEK inhibitors, usually taken as tablets. These drugs are used for advanced melanoma and, in some cases, after surgery.

Radiation therapy uses high-energy beams to destroy cancer cells. It is not usually the first treatment for melanoma of the skin, but it may be used after lymph node surgery in selected cases, to relieve symptoms from melanoma that has spread to bones or the brain, or for people who cannot have surgery.

Chemotherapy, which uses drugs that kill rapidly dividing cells, was once the main treatment for advanced melanoma. Today it is used far less often because immunotherapy and targeted therapy tend to work better, but it may still have a role when other options are not suitable.

Observation and follow-up is part of every treatment plan. After treatment, regular skin examinations and, in some cases, imaging are scheduled to watch for recurrence or new melanomas. The frequency of visits depends on stage and usually decreases over time. Clinical trials testing new treatments or combinations may also be discussed, particularly for advanced disease.

Supportive and rehabilitative care addresses the practical and emotional effects of melanoma. This may include wound care after surgery, physical therapy if lymph node removal causes arm or leg swelling (lymphedema), management of treatment side effects, nutritional support, and psychological support or counseling.

Living with melanoma skin cancer and outlook

The outlook for melanoma varies widely and depends most on how early it is found. When melanoma is diagnosed at an early stage and removed completely, many people are treated successfully with surgery alone and go on to live normal lives, although they remain at higher risk of a new melanoma. Thicker melanomas and those that have reached the lymph nodes carry a greater chance of returning, and melanoma that has spread to distant organs is more difficult to treat. Newer medications have improved outcomes for many people with advanced melanoma, and some now live for years with the disease controlled, but responses differ from person to person and no treatment can be guaranteed to work.

Your doctor can give you a more personal picture based on your stage, pathology results, and response to treatment. Statistics describe groups of people and cannot predict what will happen to any one individual.

After treatment, most people are advised to:

• Attend all follow-up appointments and report any new or changing skin spots promptly
• Examine their own skin regularly, including hard-to-see areas, using a mirror or a partner’s help
• Protect their skin from UV light with shade, clothing, hats, sunglasses, and broad-spectrum sunscreen
• Avoid tanning beds completely
• Encourage close relatives to have their skin checked, as they may share risk

Living with a cancer diagnosis can bring anxiety about recurrence, changes in body image after surgery, and fatigue during drug treatment. Talking openly with your care team, asking for referral to a counselor or support group, and involving family or friends can help. Many people find that a clear follow-up schedule reduces uncertainty.

Frequently asked questions

What is melanoma skin cancer and how is it different from other skin cancers?

Melanoma skin cancer starts in melanocytes, the pigment-producing cells of the skin, whereas basal cell and squamous cell carcinomas start in other skin cells. Melanoma is less common but more likely to spread to lymph nodes and distant organs if not treated early, which is why doctors treat any suspicious mole seriously and why early detection matters so much.

What are the first melanoma skin cancer symptoms people usually notice?

The first sign is often a mole that changes in size, shape, or color, or a new dark spot that looks different from other moles. Some people notice itching, tenderness, or bleeding from a mole. Melanoma can also appear as a pink or skin-colored bump or as a dark streak under a nail, so any new or changing skin lesion is worth having examined.

What are the main melanoma skin cancer causes?

The main known cause is DNA damage in skin cells from ultraviolet radiation, whether from the sun or from tanning beds. Inherited factors, fair skin, many moles, a weakened immune system, and a personal or family history of melanoma also raise risk. Melanoma can still develop in skin that has had little sun exposure, so the exact cause is not always clear.

How is melanoma skin cancer diagnosis confirmed?

A doctor examines the skin, often with a dermatoscope, but the diagnosis is confirmed only by a biopsy, in which the spot is removed and examined under a microscope by a pathologist. If melanoma is found, the report describes its thickness and other features, and further tests such as a sentinel lymph node biopsy or imaging scans may be recommended to determine the stage.

What melanoma skin cancer treatment options exist if it has spread?

For melanoma that has spread to lymph nodes or other organs, treatment may include surgery where feasible, immunotherapy with checkpoint inhibitors, targeted therapy for tumors with a BRAF mutation, and radiation therapy to control symptoms. The choice depends on the extent of spread, tumor gene testing, and your general health, and clinical trials may be an option in some situations.

Can melanoma skin cancer come back after treatment?

Yes, melanoma can return at the original site, in nearby lymph nodes, or in distant organs, sometimes years after treatment. The risk is higher for thicker melanomas and those that involved lymph nodes. People who have had melanoma are also more likely to develop a new, separate melanoma, which is why lifelong skin checks and follow-up visits are usually recommended.

Can melanoma skin cancer be prevented?

Not every melanoma can be prevented, but the risk can be reduced by limiting UV exposure: seeking shade in the middle of the day, wearing protective clothing and hats, using broad-spectrum sunscreen, and never using tanning beds. Regular self-examination and professional skin checks for people at higher risk help find melanoma early, when treatment is most likely to be successful.

When to see a doctor

Any new, changing, or unusual skin spot should be examined by a doctor, particularly if you have risk factors such as fair skin, many moles, heavy sun exposure, or a family history of melanoma. Melanoma is most treatable when found early, so it is better to have a harmless mole checked than to wait. Seek medical advice promptly if you notice any of the following red-flag signs:

• A mole that has changed in size, shape, or color over weeks or months
• A spot with irregular borders, multiple colors, or asymmetry
• A mole that itches, hurts, bleeds, oozes, or crusts
• A sore on the skin that has not healed after several weeks
• A new dark streak under a fingernail or toenail that was not caused by injury
• A fast-growing raised bump on the skin, whether dark, pink, or skin-colored
• A spot that looks clearly different from all your other moles

If you have already been treated for melanoma, contact your care team if you develop a new skin lesion, a lump under the skin or in the armpit, neck, or groin, unexplained weight loss, persistent cough, bone pain, severe headaches, vision changes, or new weakness, as these may need urgent assessment. Emergency medical care is needed for sudden severe headache, confusion, seizures, difficulty breathing, or uncontrolled bleeding from a skin lesion.