Melanoma

Overview

Melanoma is a type of skin cancer that begins in melanocytes, the cells that produce melanin, the pigment that gives skin its color. Although melanoma is less common than some other skin cancers, it can be more serious because it may spread to other parts of the body if not detected and treated early.

Melanoma most often develops on the skin, but it can also occur in less visible areas, such as under the nails, in the eyes, or on mucous membranes such as the mouth or genital area. It can appear in a new spot or develop from an existing mole. People of any skin tone can develop melanoma, including those who do not burn easily.

Early recognition and medical evaluation are important. Many melanomas can be treated effectively when found at an early stage, while more advanced melanoma may require a combination of cancer treatments and long-term follow-up.

Symptoms

Melanoma may look different from person to person. A useful way to remember warning signs is the “ABCDE” approach:

• Asymmetry: One half of a mole or spot does not match the other half.

• Border: The edges are irregular, blurred, notched, or uneven.

• Color: The color is uneven or includes shades of brown, black, red, white, blue, or pink.

• Diameter: The spot is larger than usual or is increasing in size.

• Evolving: The mole or spot changes in size, shape, color, texture, or symptoms.

Other possible signs include a sore that does not heal, bleeding or crusting, itching, tenderness, or a mole that looks noticeably different from the others. Melanoma under a nail may appear as a dark streak or discoloration. In darker skin tones, melanoma can occur on the palms, soles, under nails, or other areas not commonly exposed to the sun.

Causes and Risk Factors

Melanoma develops when changes occur in the DNA of melanocytes, causing the cells to grow in an uncontrolled way. Ultraviolet radiation from the sun or tanning devices is an important risk factor, but melanoma can also occur in areas with little sun exposure.

Factors that may increase the risk of melanoma include:

• Frequent sunburns, especially severe sunburns earlier in life.

• Use of tanning beds or other artificial ultraviolet light sources.

• Having many moles or unusual-looking moles.

• A personal or family history of melanoma or certain other skin cancers.

• Fair skin, light-colored eyes, red or blond hair, or a tendency to burn easily.

• A weakened immune system.

• Living in or frequently visiting areas with intense sunlight or high altitude.

Having one or more risk factors does not mean a person will develop melanoma, and some people with melanoma have no obvious risk factors.

Diagnosis

Diagnosis begins with a medical history and a careful skin examination. A doctor may examine the suspicious spot with a special magnifying device that helps show patterns in the skin. The doctor may also check other moles and areas of the body, including less visible sites when appropriate.

If melanoma is suspected, a biopsy is usually needed. This means removing all or part of the abnormal area so it can be examined in a laboratory by a specialist. The biopsy report helps confirm whether melanoma is present and provides important details, such as how deeply it has grown.

If melanoma is confirmed, additional tests may be recommended to determine the stage. Staging describes how far the cancer has grown or spread. Depending on the situation, tests may include examination of nearby lymph nodes, imaging scans, or other laboratory tests. Staging helps the medical team plan the most appropriate treatment approach.

Treatment Options

Treatment depends on the stage of melanoma, its location, the person’s overall health, and other individual factors. A multidisciplinary cancer team may include dermatology, surgical oncology, medical oncology, radiation oncology, pathology, radiology, and supportive care specialists.

Surgery is commonly used for early melanoma. The goal is to remove the melanoma along with a margin of healthy tissue around it. In some cases, nearby lymph nodes may be evaluated to check whether cancer cells have spread.

For melanoma that has a higher risk of returning or has spread beyond the original site, additional treatments may be considered. These can include immunotherapy, which helps the immune system recognize and attack cancer cells, or targeted therapy, which is used when the melanoma has certain genetic changes. Radiation therapy may be recommended in selected cases, such as for symptom control or treatment of specific areas. Chemotherapy is used less often today but may still be considered in certain situations.

Follow-up care is an important part of melanoma management. It may include regular skin checks, monitoring for recurrence, management of treatment side effects, and guidance on reducing ultraviolet exposure. Emotional support and rehabilitation services may also help patients and families cope with the diagnosis and treatment process.

When to See a Doctor

Medical evaluation is recommended for any new, changing, or unusual mole or skin spot, especially if it follows any of the ABCDE warning signs. A doctor should also assess a sore that does not heal, a spot that bleeds or crusts without clear injury, a dark streak under a nail, or a mole that becomes painful, itchy, or noticeably different from others.

People with a personal or family history of melanoma, many moles, unusual moles, or a weakened immune system may need regular professional skin examinations. Anyone concerned about a skin change should seek medical advice rather than waiting to see if it improves. Early assessment can help ensure that suspicious changes are properly examined and, if needed, treated promptly.