6th July, 202214 min read

Melanoma skin cancer: do you need a health check

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Melanomas are much less common than other types of skin cancer, making up somewhere between 1% and 7% of all cases. But they’re more serious, as they’re more likely to spread to other parts of your body.

Sometimes known as ‘malignant’ melanomas, they have a slightly scary reputation. Research shows that more than 7,000 people a year die from them in the US, and more than 2,000 people a year in the UK.

But the good news is that 75 out of 100 people who have a melanoma removed will be cured, and it won’t come back. And spotting them early is the key to getting the best treatment plan for you.

So here’s how to know if you’re at risk, what to look for, and how to get any suspicious changes checked out and treated.

What are melanomas?

Melanomas are

skin cancers
that can start from a mole you already have or a new mole. In the UK and the US, they’re the 5th most common type of cancer, in both men and women.

They can happen anywhere on your body, but they’re more likely on your legs if you’re a woman or on your back if you’re a man. They’re most common on parts of your body that are often exposed to the sun.

Are moles a sign of melanoma?

Moles in themselves aren’t a problem – it’s only if they start to change, or if a new mole appears. Most of us have dozens of moles, and it’s common to have between 20 and 50 by the time we’re adults.

But having lots of moles does increase your risk of getting a melanoma, because they can develop from an existing mole. About 1 in 3 cases of melanoma start this way.

This is why it’s a good idea to check your moles regularly – such as once a month – for any changes that could be signs of melanoma. You can use the ‘ABCDE’ rule to help you do this (which doctors also use when

diagnosing
melanoma).

Who’s more likely to get melanoma?

As with all skin cancers, the biggest risk factor for melanoma is exposure to UV light – either from the sun or a

sunbed
.

In particular, spending time in intense sunshine that causes sunburn increases your risk of melanoma (read more about sunburn and why you should avoid it).

The things listed below can also put you at higher risk. Although this can seem scary, knowing the facts means you can take steps to protect yourself – such as being extra careful in the sun and regularly checking your skin for any changes (

see below
).

You’re more at risk if you:

  • have had a melanoma before
  • are white – melanoma is more than 20 times more common in white Americans than African Americans. The lifetime risk of melanoma is about 1 in 38 for white people, 1 in 167 for Hispanic people and 1 in 1,000 for black people
  • have pale skin that burns easily, blonde or red hair, or light-coloured eyes
  • have a family history of melanoma – about 1 in 10 people who get melanoma have a family member who has had it. This is because other risk factors can be hereditary, such as light skin, having lots of moles, and having moles that are more likely to change into melanomas
  • have more than 50 moles, or a very large, hairy birthmark
  • have a lot of abnormal moles (dysplastic naevi) – these tend to be bigger and have irregular edges or colours
  • have a weakened immune system – for example, because you have HIV or you’re taking long-term immunosuppressant medication after an organ transplant

Prevention and spotting the signs early

How treatable and curable melanoma is depends very much on how early it’s diagnosed. Here’s what you need to know:

  • people with smaller, more curable melanomas that haven’t grown deep into the skin or spread to other areas live a long time after treatment, and many are completely cured
  • in England, more than 85 out of 100 people diagnosed with melanoma survive for 10 or more years
  • if the cancer has spread, it’s more difficult to cure. But newer treatments – such as immunotherapy and targeted treatments – can slow down how fast the cancer grows (
    see below
    )
  • protecting your skin from the sun is the best way of reducing your risk of melanoma – read about
    staying safe in the sun
  • it’s also vital to spot the signs of melanoma early, so you can get diagnosed and treated as soon as possible – read about how to check your skin

Different types of melanoma

There are 4 main types of melanoma, and some other rarer types. Here’s what you need to know about the main ones.

Superficial spreading melanomas (SSMs)

About 70% of melanomas are superficial spreading melanomas (SSMs). Of these, about 60% are thin and highly curable. SSMs are the type of melanoma that’s most likely to start from a mole you already have.

They tend to grow outwards at first – so if they’re caught early, they often don’t cause problems. But if they do grow deeper into your skin, they have the potential to spread to other parts of your body.

What do they look like?

SSMs can vary in appearance. They may:

  • be a coloured (usually dark) patch of skin, which can be either raised or flat
  • have an irregular border
  • be just a few millimetres or several centimetres in diameter
  • have several different colours in them – including brown, black, grey, blue and red

Nodular melanomas

These are the 2nd most common type of melanoma, making up between 15% and 30% of cases. They tend to grow faster than SSMs, and often grow on previously normal skin.

Nodular melanomas can be harder to diagnose because they tend to have a small diameter and symmetrical borders – most are more than 2mm deep by the time they’re diagnosed.

What do they look like?

Nodular melanomas can be:

  • a lump that changes
  • darkly coloured, ranging from black to red – but they can also be your normal skin colour
  • growing on stalks

Lentigo maligna melanomas

These account for 10% to 15% of melanomas. They’re most common on skin that’s been damaged by the sun over a long period – such as on older people who have spent a lot of time outdoors.

What do they look like?

Lentigo maligna melanomas can:

  • start off looking like a freckle – although they usually stand out more than a freckle
  • get bigger and darker over several years
  • begin flat and grow sideways
  • grow downwards into the deeper layers of the skin at a later stage

Acral lentiginous melanomas

Although these make up less than 5% of all melanomas, they’re the most common type in people with darker skin (but they can affect people of any skin colour).

In the US, they account for 60% to 72% of melanomas in African Americans, and 29% to 46% of cases in Asians.

What do they look like?

Acral lentiginous melanomas:

  • appear mainly on the soles of your feet, palms of your hands and under your nails
  • may first appear as dark brown/black, irregularly coloured patches of skin
  • can be raised or flat, or have some raised areas
  • sometimes open up (ulcerate) and bleed

When to see a doctor

If you think you have any of the melanoma signs or symptoms described above, see a doctor as soon as possible.

In particular, you should see a doctor urgently if you notice any of the following:

  • any of the ABCDE changes to a mole
  • a mole that bleeds, itches, oozes or crusts
  • a mole that looks different from your other moles
  • a scab that doesn’t heal

You should also see a doctor routinely if you:

  • have more than 100 moles
  • 2 or more people in your family have had melanoma
  • were born with a mole that’s bigger than 1.5cm in diameter

How is melanoma diagnosed?

Your doctor will examine your skin and ask you some questions (see below for details).

If necessary, they’ll refer you to a skin specialist (dermatologist). They can do a closer examination of your skin, using a handheld device called a dermatoscope. They may also take a small sample of your skin (

biopsy
) to check it for cancerous cells.

Preparing for your appointment

You can help your doctor by taking photographs that show how your skin or mole has changed, and having answers ready for the questions below.

Questions your doctor may ask include:

  • is it a new mole/lesion or an old one?
  • has it changed in size, shape, or colour?
  • does it bleed or itch?
  • do you have a family history of skin cancer?
  • have you used sunbeds or had excessive sun exposure?
  • have you had severe sunburn in your childhood or teenage years?
  • do you have a weakened immune system?
  • have you ever had PUVA therapy (a UV light treatment for psoriasis)?
  • which countries have you lived in?

Your doctor may also use the following tests to check your skin.

ABCDE and the ugly duckling test

One of the guides your doctor can use to help them work out if a mole might be cancerous is the ABCDE rule mentioned

above
.

They may also be on the lookout for moles that look different from others on your body – this is known as the ‘ugly duckling’ test.

Sometimes, they may want to take a photograph of your skin, to send to a dermatologist and get their opinion.

7-point scoring system

Doctors can also use a weighted 7-point checklist to assess moles or other pigmented patches of skin for cancerous changes.

Major changes are given 2 points each. These include:

  • changes in size
  • irregular border/shape
  • irregular colour

Minor changes are given 1 point each. These include:

  • diameter larger than 7mm
  • inflammation
  • oozing or crusting
  • change in sensation – including itch

A score of 3 or more suggests a greater risk of the change being skin cancer. In the UK, if there are strong concerns, any of these changes would be enough for an urgent referral to be checked for cancer.

Treatment for melanoma skin cancer

How melanoma skin cancers are treated depends on where they are on your body and what ‘stage’ they’re at.

There are 4 stages of melanoma:

  • stage 1 – it’s less than 2mm deep and only in the skin (it hasn’t spread to other parts of your body)
  • stage 2 – it’s still only in the skin, but it’s either more than 2mm deep or it’s broken the top layer of skin
  • stage 3 – it has spread either to your lymph nodes or to areas between the cancer and the lymph nodes
  • stage 4 – it has spread to other parts of your body and nearby lymph nodes

Treatment for stage 1 and 2 melanomas

Treatment for early-stage melanoma is surgery to remove the tumour and surrounding tissues. This is known as ‘wide local excision’.

If a large amount of skin needs to be removed, it may also involve a skin graft to repair your skin’s surface.

You may have a biopsy of your ‘sentinel’ lymph nodes. These are the first lymph nodes that cancer is likely to spread to, so they are sometimes removed and checked for cancer.

Treatment for stage 3 and 4 melanomas

This may have been diagnosed by a sentinel lymph node biopsy (see above). You will usually have surgery to remove the tumour.

If this surgery isn’t suitable, other options include:

  • laser surgery
  • injecting treatments directly into the tumour
  • chemotherapy
  • electrochemotherapy – where chemotherapy is injected into the tumour or your bloodstream, and an electric pulse is used to send it into the cancer cells
  • targeted therapy (see below)
  • immunotherapy (see below)
  • taking part in a clinical trial

Your doctor may also send a sample of your tumour for genetic testing, to look for variations in the ‘BRAF’ gene – which can make melanoma cells grow. Between 40% and 50% of people with melanoma have these changes.

If you do have changes, you may benefit from the following treatments, which target the gene and stop the growth of the cancer cells:

  • targeted therapies – these treatments target specific proteins, which are making the cancer grow. For example, the medicine vemurafenib targets the BRAF protein and slows it down, stopping the cancer from growing
  • immunotherapy – this treatment uses medicines that work with your immune system to find and destroy cancer cells. The medicines used for melanomas include pembrolizumab and ipilimumab

You can read more about some of these treatments in the treatment section of our article on

non-melanoma skin cancer
.

Support for dealing with melanoma

If you’re diagnosed with melanoma, it might feel shocking and scary. Going through treatment can be hard, too, and you’ll probably need time off work to recover. Or maybe someone you care about has been diagnosed, and you want to help support them?

If you’re looking for support and more information, try:

Your health questions answered

I used sunbeds in my early 20s (I’m now 29), and have had several cases of severe sunburn. I’ve noticed a new large mole on my arm, which is getting bigger and changing shape. But surely I’m too young for it to be a melanoma?

Answered by:

Dr Ann Nainan

“Although your risk of melanoma increases with age (the average age at diagnosis is 65), they can happen at any age, and aren’t uncommon in people under 30. In fact, melanomas are 1 of the most common cancers in younger people. See your doctor, who can examine you and refer you to a specialist if necessary. The earlier a melanoma is diagnosed, the higher the chance that it can be cured completely. According to figures from Cancer Research UK, the 5-year-plus survival rate for stage 1 melanoma is almost 100%, while it’s 80% for stage 2, 70% for stage 3, and about 30% for stage 4.”

I’ve heard you can get melanoma in your eye. If so, what are the symptoms?

Answered by:

Dr Ann Nainan

“Melanoma in the eye is rare: about 2,500 people are diagnosed with it in the US every year, while 500 to 600 people in the UK are affected. It’s more common in people with light-coloured eyes and pale skin, and people over 50, as well as people who have used sunbeds. The cause is unknown, but it’s thought that it’s likely to be due to a mix of genetic and environmental factors. The cancer can grow for a long time without any symptoms, and these types of melanomas are most commonly picked up during a routine

eye test
. When symptoms do happen, they can include double vision or blurred vision, irritation, seeing flashing light or wavy lines, and losing vision. Other symptoms include redness and bulging of the eye, and seeing ‘floaters’ (a sensation similar to seeing a fleck of dust in your eye). If you have any of these symptoms, see your doctor, who can examine you and arrange specialist tests if needed. Treatment options depend on the stage of the cancer, but include surgery, radiotherapy and chemotherapy.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.