Raise your hand if this has happened before: You get out of the shower, catch a glimpse of your naked body in the mirror, and think, “wait, where did that come from?” A new, unsightly mole, that seemingly appeared overnight, has taken up residence on your back. Your next thought might be, “Should I be concerned?” Or even, “Is it cancer?” Early detection is critical with melanoma moles, so use this in-depth examination to help you understand the warning signs—as well as other symptoms of this skin cancer—and get treatment, stat.
We went to top professionals in the industry to bring the most up-to-date information about signs and symptoms of melanoma.
Ellen Marmur, M.D.Associate Clinical Professor in the Departments of Dermatology and Genomics and Genetic Science
Steven Q. Wang, M.D.Mohs Surgeon and Director of Dermatological Surgery and Dermatology
Sancy Leachman, M.D.Chair of the Department of Dermatology at Oregon Health & Science University and Director of Melanoma Research Program at Knight Cancer Institute
First, Let's Recap Exactly What Melanoma Is
Melanoma is a form of skin cancer, the deadliest type. More specifically, it’s cancer of your pigment-making cells called melanocytes. The biggest cause is UV radiation from the sun or tanning beds. UV light can trigger changes in the DNA of those melanocyte cells that can lead to melanoma.
But UV isn’t the only cause. Your genetics, your skin type, and certain medical conditions, and can also put you more at risk for melanomas.
It’s true that melanoma typically presents via a mole, but even if you have a lot of ‘em, let’s start out with a reassuring stat: Most moles are not melanoma, according to a recent study published in the JAMA Dermatology. Researchers looked at over 80,000 biopsy reports from 4,700 patients and found that the majority of moles tested (77%) weren’t melanoma. Instead, the spots were a mix of things caused by UV damage, infections and viruses, and the two other types of skin cancers, squamous cell and basal cell carcinomas, which aren’t as dangerous as melanoma.
Still, the key is to be vigilant, so how are you supposed to know which spots are melanoma? The most common sign is an unusual-looking or atypical-for-you mole. What this means, logistically: Experts say it’s the ugly duckling among your moles. It'll stand out from them, appearing larger, having a different texture, or shape. It may also be a mole that you’ve had for a while, but it’s changed. Perhaps it used to be smooth, but now it’s scaly; it’s grown in size; it itches; or it’s changing in color, becoming darker all over or in just one part.
Or maybe it’s not a mole at all, but rather a new patch or growth on your skin that wasn’t there before. Melanomas can be pink or clear pimple-like bumps or flat splotches, too. In people with dark skin tones, melanomas are often dark lesions or unevenly pigmented patches, and tend to show up in areas that don’t get a lot of sun: the palms of the hands, soles of the feet, and fingernails.
I've Heard About the ABCDEs of Melanoma. Explain!
Back in 1985, dermatologists developed the ABCD guidelines for monitoring your own moles, a system still widely used by primary care physicians and dermatologists today. In 2004, researchers from NYU School of Medicine suggested the letter E be added to the list in an article published in the Journal of the American Medical Association.
Although one of these signs can indicate melanoma, not every mole that presents in this way is melanoma. These guidelines exist for you to be aware of your moles. If any lesion fits the bill with one or all of these letters, make an appointment with a dermatologist, who is trained to detect skin cancers.
Here’s what the ABCDE melanoma acronym stands for:
A is for asymmetry: If you could fold your mole in half, would the two sides match up perfectly? If not, it should be checked by your dermatologist.
B is for border: Irregular, jagged, blurred, or notched edges (read: not smooth) are red flags.
C is for color: Most moles are brown, but be on the lookout for those that are really dark or black. This can also refer to moles that are not evenly pigmented—part of the mole may be darker or lighter than the rest, or have areas of pink, white, or blue within the mole. In dark skin, melanomas are typically not pink or white, but dark and unevenly pigmented patches or lesions.
D is for diameter: Doctor say any mole larger than an eraser (1/4 inch) is suspicious. But that doesn’t mean only large moles are cause for concern. Melanomas can be detected at much smaller sizes, too.
E is for evolving: This refers to moles that are changing in size, shape, color, or texture. The spot may be itchy, oozing, or bleeding—all signs that it’s time to see a doctor.
Are There Any Other Signs of Melanoma?
The ABCDEs of melanoma work well when you have a visible, dark spot, usually on visible areas that have had a lot of sun exposure: legs, arms, back and shoulders, and face. But some melanoma signs are trickier to identify.
Here are some other less-obvious flags you should be aware of:
Colorless lesions: Not all melanomas are brown or black moles. Some don’t have any color at all, a.k.a. amelanotic melanomas. These can be raised bumps or flat splotches with a red, pink, white, or flesh-toned hue. About 5% of melanomas lack color, but because they’re harder to detect, amelanotic melanomas are usually found at later stages, which can lead to a poor prognosis.
In a study in JAMA Dermatology, researchers have identified people who are more at risk of developing amelanotic melanomas: those who lacked moles on their backs but had a lot of freckles, fair skin with an inability to tan, red hair, and light eyes. If you carry the so-called “red-haired gene,” MC1R, you’re also at risk of this type of melanoma. Your doctor may test for this gene (among others) if you have a strong family history of melanoma.
Sores: An open wound that won’t heal can be concerning. When on the foot, it could be an acral lentiginous melanoma (ALM), a type of melanoma that pops up on feet, hands, and nails. One of the identifying characteristics is an ulcer that is often mistaken for a diabetic foot ulcer. If you have a sore that won’t heal on your foot, make an appointment with a dermatologist who can determine if it’s skin cancer or another medical condition.
Nail issues: Changes to the nail can stem from subungual melanoma, a type that grows on your nail bed. The signs here include a brown or purplish vertical band on your nail that may start to expand width-wise over time. You may see blood or a nodule under the nail plate. Your affected nail may also become more brittle, and the skin around it can appear red or infected-looking. It typically affects one nail.
Changes in your eyes: Certain changes in vision can indicate ocular melanoma, which affects the inside of your eye. While the tumor is typically visible only to an eye care specialist, symptoms may include floaters (or flecks of light that float around your vision), blurry vision, loss of peripheral vision, a dark spot on your iris, and changing shape or size of your pupil (like always dilated).
Lesions in mucosal areas: While rare (1.4% of all melanomas), mucosal melanoma occurs where the sun don’t shine: in the mucus linings of your body, including inside your mouth, nose, gastrointestinal tract, the anus, and your genitals. For a woman, that’s inside the vagina. While not so common, a man may have melanoma in the mucosa of the penis (he can also have cutaneous melanoma if on the skin of his penis). You may be able to spot discoloration or a visible lesion or lump inside your mouth or genitals, but it’s tricky to detect in other hard-to-see areas. Other symptoms include bleeding, pain, and itching in these areas.
What Kind of Doctor Should I Go to With Melanoma Symptoms?
Your primary care physician is qualified to give your skin and scalp an exam, but ideally, you should see a dermatologist, who is specifically trained (and has special tools) to spot skin cancer, at least once a year. He or she can track any changes in existing moles and even take photographs. If you have a strong family history, or have had a run in with skin cancer (any type), you’ll want to bump up those visits to every three to six months. The sooner a melanoma is detected, the sooner it can be removed.
Early detection is the best cure for melanoma. Here’s how the process will work:
Your dermatologist will examine the spot (along with the rest of your body) and do a biopsy if she suspects skin cancer.
The biopsy is then sent off to a lab to be studied under a microscope.
If the mole turns out to be malignant melanoma (or another type of skin cancer), the growth will likely be removed and more tests may be ordered to see if it has spread.
If the melanoma hasa spread, you will be referred to a cancer specialist, such as a dermatologic surgeon or oncologist, for a treatment plan.
Other Experts Who Can Help Detect Melanoma
It’s not just dermatologists who should be checking for skin cancer. There are other experts and professionals who should be on the lookout, too. During appointments and routine exams, ask these pros to look for melanoma in their areas of specialty. This includes:
your dentist, who can check the inside of your mouth for any lesions
your gynecologist, who can inspect your genitals during annual exams
your manicurist, who can alert you about changes in your nails and the surrounding skin
your hairstylist, who can monitor your scalp for new or changing growths. A small 2018 study in JAMA Dermatology found that training hairdressers in being able to spot scalp and neck melanomas could be a beneficial step toward detecting these often-overlooked melanomas sooner. And in a survey done by Emory University in Atlanta, 93% of hairstylists wanted to learn more about skin cancer detection, but 40% said they rarely checked. Your stylist may not have skin cancer training, but you can at least ask her to point out any scalp moles you can’t see yourself.
What Are the Signs of Advanced Melanoma?
The vast majority of melanomas are diagnosed before the cancer spreads to other organs, which is known as metastatic melanoma, or stages III and IV—84% are diagnosed in stages I and II; 9% for stage III; and 4% for stage IV.
Metastatic melanoma commonly spreads to lymph nodes, lungs, liver, and brain, so your symptoms may go beyond the unusual or changing mole or lesion. If you have a more advanced melanoma stage, you may also be experiencing:
swollen lymph nodes
hard lumps on your body
pain in other areas of your body
breathing difficulties or a cough that won’t go away
headaches that aren’t typical for you (for example, if you usually get tension headaches or migraines, you shouldn’t necessarily be alarmed, but if you’re suddenly getting headaches that don’t disappear with medicine or rest, call your doctor)
problems with your eyesight (blurry vision, floaters, etc.)
persistent fatigue (not “I-stayed-up-too-late-binge-watching Netflix” tired—but rather, exhaustion that doesn’t get better with rest)
unexplained weight loss or loss of appetite
If you’re experiencing any of these symptoms, make an appointment with your PCP as soon as possible.
Frequently Asked QuestionsMelanoma Signs and Symptoms
I have a lot of moles. Am I more at risk for melanoma?
Research says: The more moles you have, the higher your risk of developing the potentially deadly skin cancer. And if more than 10 of your moles are considered atypical or dysplastic nevi—non-cancerous growths that look irregular under a microscope—you’re 12 times more likely to develop melanoma. While the overwhelming majority of melanomas grow as new spots, not existing ones, these atypical moles should be watched closely for any changes.
I have a suspicious spot. Now what?
Don’t panic, but you need to get it checked ASAP. As we’ve mentioned, early detection is your best chance at a cure. First step: Schedule an appointment with a board-certified dermatologist. He will examine the spot and do a biopsy, if necessary. If the mole is cancerous, you’ll likely be referred to a dermatologic surgeon or an oncologist to discuss treatment options.
I had an early melanoma removed years ago. Can it grow back in the same spot?
Yes, but it probably won’t look your original mole, and may not even be in the same place. When melanoma makes a recurrence around the initial site, it usually appears as a lump under the skin. A recurrence is more likely to happen within the first five years, but research has shown that melanoma can make a comeback even a decade or more later.
How often should I have a skin check?
You should monitor your own skin for any signs and symptoms of melanoma regularly, but you want to see a dermatologist annually for a professional check. This skin doc may take images of your moles to better track any changes. If you’ve had melanoma or other types of skin cancer, schedule that check every three to six months.
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