A Guide to Melanoma: Warning Signs, Stages, and Treatment
Another name for melanoma is malignant melanoma.
This article will discuss early warning signs of melanoma, as well as information about melanoma diagnosis, staging, and treatment options.
Melanoma is highly treatable with early detection. This is why it is important to know the warning signs of melanoma and perform routine self-checks of your skin.
Moles are very common marks on the skin. A typical mole is even in color, which may be tan, brown, or black. It is usually present from a young age and maintains its size and shape over time.
However, moles that change in appearance in any way — including size, shape, color, or firmness — can be a warning sign of melanoma.
A mole that is new can also indicate melanoma. Up to 80% of melanomas develop on skin that appeared clear previously.
The Skin Cancer Foundation (SCF) notes that in females, melanoma is more likely to appear on the legs. In males, the trunk is a more common area for melanoma. However, melanoma can develop anywhere on the body, even areas not typically exposed to sunlight.
Talk to a dermatologist if you see any new moles develop or if an existing mole appears different or unusual in any way.
Experts recommend thinking of “ABCDE” to remember the warning signs of melanoma when examining a mole.
|Asymmetry||The mole is not even in shape, with one side different from the other.|
|Border||The edge of the mole is irregular or jagged instead of smooth and defined.|
|Color||The color of the mole is uneven, with some spots darker or lighter than others.|
|Diameter||The mole is growing or has a diameter longer than the width of a pencil eraser (6 millimeters).|
|Evolving||The mole is changing in appearance or developing new symptoms, such as bleeding.|
A mole that stands out from other moles around it may also signal melanoma. Experts refer to this type of mole as an “ugly duckling.”
Typical moles on your body should all be similar in appearance, particularly if they occur near each other in a specific area. If one mole in a group is darker, larger, or different in any way, it could be a warning sign of melanoma.
A mole that is isolated from other moles can also indicate melanoma.
When in doubt, contact your doctor for an evaluation of any mole or spot on your skin that causes you concern.
Several factors determine melanoma staging, including how much the cancer has grown and if it has spread to other body areas.
Knowing the melanoma stage helps doctors decide how to best treat the melanoma and determine a prognosis for recovery.
Doctors use the TNM staging system from the American Joint Committee on Cancer when evaluating melanoma:
- tumor size (T)
- lymph node involvement (N)
- metastasis, or spread (M)
There are five stages of melanoma: 0, 1, 2, 3, and 4. Higher stages are more advanced disease and generally have a poorer prognosis. Up to stage 2, melanoma is only in the skin and has not spread to lymph nodes.
- Stage 0: This early melanoma is isolated to the outermost layer of skin.
- Stage 1: This early melanoma is smaller than 1 millimeter (mm) and has penetrated beneath the top skin layer.
- Stage 2: This intermediate or high-risk melanoma tumor is deeper than 1 mm but has not spread, although the risk of spread is high. Thicker tumors larger than 4 mm have a higher risk of spreading.
- Stage 3: In this advanced melanoma, the cancer has spread to nearby lymph nodes or has spread more than 2 centimeters (cm) from the primary tumor.
- Stage 4: This advanced melanoma has spread to distant body areas including lymph nodes, lungs, liver, brain, bone, or digestive tract.
Melanoma staging is complex and can be confusing. Your doctor will talk through your specific diagnosis and available treatment options.
The SCF outlines the four primary types of melanoma as follows.
- superficial spreading melanoma: The most common type of melanoma, superficial spreading melanoma grows across the surface of the skin for some time before becoming invasive. These cancers are usually flat and vary in color.
- nodular melanoma: This is the most aggressive form and has usually spread by the time of diagnosis. It typically looks like a bump or dome. It is often blue-black but can also appear pink or red in rare cases.
- acral lentiginous melanoma: This type is most common in People of Color. It appears as a black or brown area. It can develop in less obvious locations, such as under the nails or on the palms of the hands and soles of the feet.
- lentigo melanoma: This type occurs more often in older adults. It is similar to superficial spreading melanoma both in appearance and in the way it grows across the surface before invading deeper. It usually appears on skin with chronic sun exposure, such as the face, ears, arms, and upper trunk.
The American Cancer Society (ACS) lists factors that could put someone at higher risk for developing melanoma. However, not everyone with risk factors will develop melanoma, and it is possible to have melanoma without any risk factors.
Risk factors for melanoma include:
- exposure to ultraviolet (UV) light, such as through sunbathing or tanning beds
- having 50 or more moles on your body, which may include dysplastic, or irregular, moles
- light or fair skin that freckles in sunlight and does not tan
- red or blonde hair
- blue or green eyes
- family history of melanoma
- personal history of melanoma or other skin cancer
- weakened immune system, due to chronic conditions or treatments that affect immunity
- age, with risk increasing as you get older
- xeroderma pigmentosum, a rare genetic condition that reduces the skin’s ability to repair DNA damage
Talk with your doctor if you have risk factors for melanoma to discuss steps you can take to lower your risk.
Performing regular skin self-exams is a first step in identifying possible melanoma early. It is also important to get annual screenings from your primary care doctor or dermatologist.
If you or your doctor identify an area of concern, your doctor will likely order a skin biopsy. This procedure involves removing a sample of tissue and testing it in a lab to determine if cancer is present.
Information from these tests also helps doctors stage the cancer and determine the appropriate course of treatment.
The goal of melanoma treatment is to remove all cancerous tissue and bring about remission of the disease.
Melanoma treatment plans are multifaceted and individualized to your age, medical history, coexisting diseases and conditions, and the type of melanoma and its stage of advancement.
Surgery to remove cancerous tissue is the primary treatment for melanoma in any stage.
Doctors will typically also remove a small area of healthy skin around the tumor to ensure removal of all cancerous cells.
If the cancerous area is large, doctors may graft a portion of skin from another area of your body onto the wound from the cancer removal.
Doctors may recommend chemotherapy following surgery to kill any remaining cancer and reduce the risk of melanoma coming back.
For some people, one option may be hyperthermic isolated limb perfusion. This is a localized type of chemotherapy that administers treatment directly into the limb where cancer is present.
For more advanced melanoma, radiation therapy can provide targeted treatment to areas where cancer has spread. Radiation can also help relieve symptoms and improve quality of life in later stages of melanoma.
Immunotherapy uses your body’s own immune system to fight cancer. Medications called biologics change the way your immune system cells interact with cancer cells.
Your doctor may recommend immunotherapy if you are unable to undergo surgery or if your melanoma has advanced.
Targeted therapy is a developing treatment type that aims to kill cancer cells while preserving healthy ones.
Traditional chemotherapy affects any type of fast-growing cell, causing side effects like hair loss or mouth sores. Targeted therapy uses medications that seek out cancer cells specifically or work to prevent the growth of new tumors.
Your doctor will review all of your treatment options, including potential benefits and risks of each.
Treatment of early stage melanoma is very effective. As melanoma progresses, the outlook becomes less positive.
Based on data from between 2011 and 2017, the ACS provides 5-year relative survival rates for melanoma stages as follows.
|Stage||5-year relative survival rate|
|localized, meaning cancer has not spread beyond original site||99%|
|regional, meaning cancer has spread to nearby lymph nodes or tissue||68%|
|distant, meaning cancer has spread to other areas of the body||30%|
|all stages combined||93%|
About 7,650 people die of melanoma annually in the United States. However, new treatment advances are improving outcomes and providing hope for people with late stage melanoma.
A relative survival rate is used to give an idea of how long someone with a specific condition may live after their diagnosis compared with someone without the condition.
For example: A 5-year survival rate of 70% means that someone with that condition is 70% as likely to live for 5 years as someone without the condition.
It is important to remember that these figures are estimates. Remember to talk with your doctor about your specific condition.
Here are some other questions people often ask about melanoma.
Is melanoma a curable cancer?
Early detection is key to curing melanoma. If treatment begins in stage 1, the 5-year survival rate is 99%. This means 99% of people who receive treatment for stage 1 melanoma are still alive 5 years after their diagnosis.
Is melanoma the deadliest cancer?
Melanoma is the most dangerous type of skin cancer because it can rapidly spread to other parts of the body.
Early warning signs of melanoma include moles that have characteristics you can remember with ABCDE: asymmetry, border irregularly, color that is uneven, diameter wider than a pencil eraser, and evolving appearance or symptoms.
Stage 1 melanoma has a cure rate of 99%, which makes early detection critical. Perform routine self-checks of your skin and schedule annual skin cancer screenings with your dermatologist to help spot symptoms when they are most treatable.