Wait, You Can Get Melanoma Where?!

That's right, protecting your skin from cancer could involve everyone from your urologist to ophthalmologist.

by Sarah Ludwig Rausch Health Writer

When it comes to skin cancer, you probably fall into one of two camps—not worrying (or thinking) about it too much or being super proactive about applying sunscreen before you head outside. Either way, it may not have occurred to you to wonder if you can get melanoma in the spots you may consider “safe.” After all, if ultraviolet (UV) rays cause skin cancer, and if certain areas of your skin aren’t exposed to them, you should be fine, right?

Wrong. Turns out, you can get melanoma anywhere on your body, our experts say. Yep, you read that right—anywhere. Even in places that never, ever see the sun. And, yes (as it may be dawning on you with some discomfort), that includes your private parts.

“It’s not just the sun-related areas—you can get melanoma anywhere that you have melanocytes, which are the cells that make pigment,” explains Ashwani Rajput, M.D., director of the Johns Hopkins Kimmel Cancer Center in Baltimore. And you have melanocytes in every crook, cranny, and crevice of your body. This brown pigment is called melanin, and it’s what gives your skin, hair, and eyes their color.

Melanoma, the deadliest form of skin cancer, occurs when your melanocytes get damaged, and they start growing like crazy. Though no one knows exactly what causes this damage, experts believe that being exposed to UV rays via the sun or tanning beds is the biggest reason. Still, the fact that it can appear in places that have had little to no sun exposure shows that UV radiation isn’t the only reason melanoma happens. We’ll explain why, and what you can do about it, here.

Surprising Spots Where Melanoma Can Appear

Melanoma is far rarer than other types of skin cancer (including basal cell and squamous cell carcinomas), accounting for just 1% of all skin cancer cases in this country. However, melanoma causes the most deaths—roughly 7,200 in the U.S. last year alone. This is because it’s a lot more likely to spread to other places in your body if left unchecked and untreated. Keep in mind that around 30% of melanomas pop up in moles people already have, according to Dr. Khetarpal, meaning the other 70% are new lesions.

The most common area for men to have melanoma is on the trunk (back, abdomen, and chest), while women tend to get it on their legs, says Shilpi Khetarpal, M.D., a dermatologist at the Cleveland Clinic in Ohio. But you can get melanoma in odd places that you probably would never think of, too.

For example, you can get melanoma in your eye, which is known as ocular melanoma. “This is something you wouldn’t see with the naked eye. Your eye doctor has to do a dilated eye exam and look at the back of your eye,” Dr. Khetarpal explains.

Another surprising area that melanoma can show up is in places with mucous membranes, including the insides of your mouth, anal canal, vagina, and digestive tract. These melanomas are often mistaken for something else. Dr. Rajput says that a melanoma in the anal canal might be confused for a hemorrhoid. Fortunately, this type of melanoma, called mucosal melanoma, is rare, making up only 1% of all melanomas.

You can also get melanoma on your palms, the soles of your feet, in between your toes, under your fingernails or toenails, behind your ears, and on your scalp underneath your hair, say both doctors. And though it’s extremely rare, Dr. Rajput notes that it’s important to look underneath the foreskin of the penis in uncircumcised men to make sure everything is clear there, too.

All these hidden places, not to mention the areas you can’t see yourself, are why your dermatologist needs to “look at every square centimeter of skin on your body,” says Dr. Rajput. Including—even if it may make you a little uncomfortable—your nether regions. That said, not every dermatologist will automatically scan your private parts. If you aren’t told to strip down to nothing underneath your gown, you may need to specifically ask for this.

It’s true that people with fair skin are at higher risk for melanoma, but it can develop in anyone, no matter how dark your skin. In fact, if you do have darker skin you’re more likely to have melanoma in one of the hidden areas that see little or no sun (eyes, under nails, or in the mucous membranes). Why? Because melanin works to protect your skin from harmful UV rays. The more you have, the more protected your skin is—so if you do develop melanoma, it’s unlikely to be from UV damage.

How to Protect Those Hidden Areas

Over the past 30 years, the incidence of melanoma has greatly increased. According to Dr. Khetarpal, if you’ve had five or more sunburns in your lifetime, your risk for developing melanoma doubles. Your risk also doubles if you’ve had just one blistering sunburn in childhood or adolescence.

There’s nothing you can do to protect yourself from melanoma that isn’t related to UV radiation, says Dr. Khetarpal. But you can still do your best to protect some of those hidden areas that could potentially be exposed to it, like your scalp, eyes, palms, soles, genital area, and under nails. Here’s how, according to our experts.

  • Stay away from direct sunlight and tanning beds. Laying out in the sun or under lamps may feel nice, but it exposes many of these unseen areas—not to mention the obvious ones—to UV radiation.

  • Wear a hat when you’re outside to protect your scalp.

  • Put on sunglasses to keep your eyes protected. Look for eyewear with a UV rating of UV400, which provides almost 100% protection from harmful ultraviolet light, blocking wavelengths up to 400 nanometers.

  • Try ultraviolet protective clothing if you don’t like how sunscreen feels.

  • Consider buying swimwear that has ultraviolet protective material to protect your genital area.

  • Finally, make sure you’re using enough sunscreen when you’re outdoors to lower your overall UV intake. “For an adult, a full-body application of sunscreen is one ounce, which is the size of a shot glass,” says Dr. Khetarpal. If you’re not using enough, you’re not getting full protection. Let’s say you’re only using about half an ounce. Dr. Khetarpal says this translates to only getting SPF 15, which is why she recommends using as high an SPF as possible.

Dr. Rajput reiterates: Yes, fair-skinned folks are most at risk for skin cancer. But it’s still important for those with darker skin to take all the above precautions, too, since anyone can get melanoma.

The Obvious (and Not-So-Obvious) Signs of Melanoma

Now that you know all the crazy places melanoma can appear, what should you watch out for? Dr. Khetarpal says the simplest way is to remember the ABCDEs of melanoma:

A - Asymmetry: If you were to cut the mole in half, does one side looks different than the other?

B - Border: Is the border of the mole irregular instead of round?

C - Color: Are there multiple shades of color?

D - Diameter: Is the mole larger than a pencil eraser?

E - Evolving: Has the mole changed shape or color or does it bleed?

Most melanomas have two or more of the above characteristics. However, if you have a mole that appears to be changing in size, shape, and/or color, or you've answered "yes" to two or more of the above, Dr. Khetarpal says you should have the mole checked.

Our experts say there are some less obvious signs to watch for too, such as:

  • Anything strange or different underneath your nails

  • Bumps on your scalp or behind your ears

  • Bleeding when you brush your hair

  • Any unusual itching, bleeding, or skin changes

As soon as you experience any of these signs, go see a dermatologist. “We do the biopsy in the office. It’s a very simple procedure. And we know for melanoma that early detection is key, so at the earliest sign of something changing, you should seek medical attention,” Dr. Khetarpal advises.

What to Know About Skin Checks

So, where do skin checks come into all this? “We recommend that people do self-skin checks monthly,” advises Dr. Khetarpal. Take a look at all your moles to make sure nothing has changed, and consider having a partner help you look, she adds. “Nobody knows your body better than you do,” points out Dr. Rajput. “You’re looking for something different or something that’s changed on your body.”

As for how often you need to have your skin thoroughly checked by a dermatologist, Dr. Khetarpal says it depends. “The majority of melanoma cases are found in people after the age of 55,” she says. “In general, for people that are fair-skinned and that have had their fair share of sun exposure, we recommend getting a baseline screening skin exam around the age of 50. That way we can assess their risk and decide how often we need to see them.”

However, if you have a first-degree relative (sibling or parent) that has been diagnosed with melanoma, Dr. Khetarpal advises starting those annual skin checks when you’re 40. (Other dermatologists recommend starting even earlier—as young as 20.) And, if you’ve had a diagnosis of melanoma yourself, you’ll have to be checked more often. How often depends on the stage of melanoma you were in when it was diagnosed, Dr. Rajput says, but it could be every three to six months.

Dr. Khetarpal notes that if you have a family history of melanoma or you’ve already had it, it’s also important to see an ophthalmologist, urologist or gynecologist, and a dentist every year. Since you’ll likely be seeing them at different times than your dermatologist, ask them to help check all those hidden places (eyes, pelvic area, and mouth) for melanoma.

And, if you have a lot of little moles (no matter what your skin type or risk level), Dr. Rajput advises that you see a dermatologist for a baseline skin exam, too, to check them out, and to give the doctor an idea of how often you need to be screened in the future.

Sarah Ludwig Rausch
Meet Our Writer
Sarah Ludwig Rausch

Sarah Ludwig Rausch is a health writer and editor whose specialties include mental health, diseases, research, medications, and chronic conditions. She’s written for The Christian Science Monitor, American Cancer Society, Cleveland Clinic, PsychologyToday.com, MedShadow Foundation, the ACT Test, and more.