1 in 35 men and 1 in 41 women will be diagnosed with melanoma - the most serious form of skin cancer. Rates are rising faster than any other cancer in Britain and it is one of the biggest killing cancers in the 15-34 age group. Awareness, prevention and early diagnosis are key to combatting the disease and saving lives.
Skin cancer is the only cancer we can physically see developing in its early stages and the good news is that if detected and diagnosed early, almost all cases are successfully treatable. However, if left untreated melanoma can spread to other sites and organs, become difficult to treat and potentially life-threatening.
It is therefore not only important to know how to spot the early signs and symptoms of the various forms of melanoma, but to get to know your skin and conduct thorough, monthly self-examinations.
The advice and images provided are intended to help you spot the early warning signs of the various types of melanoma. However, it’s important to acknowledge that skin cancers can vary dramatically in size, shape, colour, surface characteristics and symptoms. Therefore, if you spot any new, unusual or changing moles or skin lesions, it is extremely important to visit your GP or dermatologist as soon as possible for professional clinical assessment.
The literal translation of melanoma is ‘black tumour’. It is the most serious, potentially life-threatening form of skin cancer. Melanoma begins in melanocytes – the cells that produce the pigment melanin that colours the skin, hair and eyes. Melanocytes also form moles, where melanoma often, but not always develops. These cancerous growths develop when unrepaired DNA damage to skin cells trigger mutations that lead the skin cells to multiply rapidly and form malignant tumours.
As with all skin cancers, melanoma can often be seen on the skin, making it easier to detect in its early stages. But, if left undetected, melanoma can spread to distant sites or organs. Once melanoma has spread to other parts of the body it is referred to as ‘metastatic melanoma’ – at this stage it becomes very difficult to treat and prognosis is poor, so early detection, diagnosis and treatment is vital.
Melanoma often arises from otherwise normal appearing skin (about 75%) or from within a mole or freckle, which starts to grow larger and change in appearance or sensation. There are 6 main types of melanoma that can vary dramatically in appearance and grow at variable rates. The information and images below will help you guide you in getting to know your skin and spotting potential abnormalities that could indicate the early warning signs.
The 6 main types of melanoma skin cancer are:
Superficial spreading melanoma is the most common type of melanoma accounting for around 70% of all cases. They most commonly appear as a new mole or within an existing mole or freckle that changes in appearance. This type of melanoma is most frequently found on the trunk in men and legs in women, but it can appear anywhere on the skin. It is therefore important to conduct regular full-body skin examinations and to seek prompt professional assessment of any new, unusual or changing moles.
The ‘ABCDE’ OF MELANOMA is a common screening tool used to compare the characteristics of normal moles versus melanoma. These photographs show examples of superficial spreading melanoma and should help you to identify a melanoma from a normal/healthy mole.
A = ASYMMETRY
When one half of the mole does not match or look like the other half of the mole.
B = BORDER
When the borders of the mole are uneven, irregular, ragged or have blurred, undefined edges.
C = COLOUR
When the colour changes or varies throughout with no uniform pigmentation. Red, blue and black colourations are particularly serious signs.
D = DIAMETER
When the largest diameter of the mole is greater than 6mm – however they can also appear much smaller.
E = EVOLVING
When changes occur to the mole’s appearance and/or sensation is the biggest indictor of a melanoma.
! ADDITIONAL WARNING SIGNS:
Melanoma can be very small; they are often dark / almost black in appearance – they can be as small as a pen tip and the ABCDE warning signs may be difficult to detect with the naked eye.
Melanoma can also lack pigmentation and appear red, or skin coloured, which could indicate an amelanotic melanoma.
Although much rarer in dark or black skin, melanoma can arise and signs and symptoms can be harder to detect, so extra vigilance when conducting self-examinations is key.
Nodular melanoma is a particularly aggressive form of the disease, found in around 20% of cases. This type of skin cancer does not follow the ABCDE rule as they are generally more even in shape and colour. Nodular melanomas tend to grow fast and become quickly invasive, so early detection, diagnosis and treatment is vital.
Nodular melanoma are usually black, but can also appear blue, grey, white, brown, tan or skin tone. The following images provide some examples but if you detect any lump or bump on the skin that’s growing quickly, you must seek professional assessment immediately. Because nodular melanoma has very different and distinctive characteristics to more common forms of melanoma, the EFG screening tool is useful to remember when conducting your skin examinations:
E = ELEVATED
Look out for an elevated lump or bump – these are usually uniform in colour, but variations may be visible.
F = FIRM TO TOUCH
Nodular melanoma are firm to touch and generally more even in shape than other forms of melanoma, although irregular borders can sometimes form.
G = GROWING
Any lump or bump that is growing persistently should be checked out immediately by your GP and/or dermatologist.
! ADDITIONAL WARNING SIGNS:
Nodular melanoma can be more difficult to detect on dark or black skin and may be confused with a normal mole. Vigilance is key to detect any new, firm lumps or bumps that are growing.
Whilst in the majority of cases nodular melanoma appear dark or black, they can, in rarer cases lack pigmentation, appearing red, pink or flesh-toned indicating a potential amelanotic nodular melanoma.
Lentigo maligna (which is sometimes called hutchinson’s melanotic freckle), is an early form of melanoma in which the malignant cells are confined to the outer layer of the skin (epidermis) which is why it is often reported as melanoma ‘in situ’. It grows slowly in diameter over 5 to 20 years or longer, often occurring on chronically sun-damaged skin, particularly the head and neck, in the elderly.
Lentigo maligna presents as a long-standing or changing patch of discoloured skin that often resembles common freckles or brown marks, often referred to as sun spots or age spots.
They generally have a smooth surface, an irregular shape and are commonly a shade of brown, which can develop darker areas. They are generally larger than other types of melanoma (more than 6mm) and can grow to several centimetres.
Lentigo maligna are usually slow growing and can be harmless, but if melanoma does develop it can spread aggressively. It is often hard to distinguish a lentigo maligna from a lentigo maligna melanoma, it is therefore important to pay special attention to lesions of this nature for signs of change.
To help identify a lentigo maligna and signs that could indicate the development of an invasisve melanoma, use the ABCDE screening tool, in addition to changes in sensation and surface characteristics:
THE ‘ABCDE’ TOOL: Asymmetric / Border irregularity / Colour variation / Diameter > 6mm / Evolution
SENSATION: Be aware of any changes in sensation, such as becoming itchy and/or stinging.
BEHAVIOUR: Changes to the behaviour – becoming hard, lumpy, bleeding, oozing, crusting.
Unlike other types of melanoma, Acral Lentiginous Melanoma (ALM) develops on the palms of the hands and more commonly on the soles of the feet. ALM can appear as a new mole, patch of discoloured skin OR a changing spot in or connected to an existing mole. Acral lentiginous melanoma often advance faster than other types of melanoma, becoming quickly invasive. As people with skin of colour are less prone to other forms of melanoma, ALM is the most common melanoma diagnosed in people of colour (POC) particularly in black skin.
ALM often appear as a black discolouration, but signs can be very subtle such as an ill-defined patch of light brown-grey, discoloured skin that can look like a stain or a bruise (that’s not caused by trauma / won’t heal).
As with other forms of melanoma, in rarer cases ALM can also lack pigmentation (amelanotic acral lentiginous melanoma) which may appear as a reddish and/or orange patch of skin or non-healing ulcer.
To help identify acral lentiginous melanoma use the ABCDE screening tool (above) in addition to discolouration and changes to surface characteristics:
THE ‘ABCDE’ TOOL: Asymmetric / Border irregularity / Colour variation / Diameter > 6mm / Evolution
DISCOLOURATION: An ill-defined patch with single or variable pigmentation (brown, blue-grey, black and red) may be very subtle and can appear like a stain or bruise that won’t heal.
SURFACE: ALM often have a smooth surface at first, later becoming thicker with an irregular surface that may be dry or warty, the lesion may ulcerate or bleed.
Subungual melanoma begins in the nail matrix – part of the nail bed that protects the skin beneath. It is very uncommon, accounting for approximately 0.7 percent to 3.5 percent of all malignant melanomas worldwide. Whilst rare, this form of melanoma occurs in all racial groups, with around 30-40 percent of cases appearing in skin of colour.
Signs and symptoms of subungual melanoma include:
Amelanotic melanoma often go undetected due to the fact they lack melanin, the dark pigment that gives most moles and other forms of melanoma their colour. They can also mimic signs and symptoms of non-melanoma skin cancers such as basal or squamous cell carcinoma or may be mistaken for scars or cysts. Whilst amelanotic melanoma is relatively uncommon fatality rates tend to be higher because they often go undetected for longer and are therefore commonly diagnosed at later stages.
Any subtype of melanoma can be amelanotic, so both the ‘ABCDE’ and ‘EFG’ tools apply. They can appear flat and irregular, indicating an amelanotic superficial spreading melanoma, or elevated and firm to touch, indicating an amelanotic nodular melanoma. Amelanotic melanoma can also appear like an ulcer or non-healing sore (despite therapy).
Due to the lack of pigment, whilst amelanotic melanoma are classically described as skin-coloured, a substantial proportion appear as red or pink.
Whilst the majority of melanoma develop on the skin, making early detection easier, it can also develop in places that are more difficult to detect or cannot be seen, such as the mucus membranes (mucosal melanoma) or in the eye (uveal melanoma or ocular melanoma).
Mucosal melanoma is very rare, accounting for 1 percent of all melanomas. This type of melanoma is not associated with UV exposure, with underlying causes still unknown.
Mucosal melanoma develops internally in the mucus membranes that line various parts of the body. This includes the head and neck region, the anus, the vagina and vulva, and the gastrointestinal tract. Signs and symptoms vary based on the location of the tumour – for example:
Signs and symptoms of mucosal melanoma in the head and neck region may include mouth ulcers, nose bleeds, or a lump in the neck, jaw or mouth.
Signs of mucosal melanoma in the anus may include pain in the area, diarrhoea, constipation or bleeding.
Signs of mucosal melanoma of the vagina and vulva may include changes in the colour of the vulva, itching, bleeding and/or a lump or open sore.
Also known as uveal melanoma or ocular melanoma, eye melanoma can affect different parts of the eyes. Regular eye health screenings are an essential part of our overall health programme but if you notice any of the following signs or symptoms, seek immediate examination:
Diagnosis of melanoma is relatively uncommon and can only be confirmed after a full professional assessment, appropriate biopsy, histological examination and specialist interpretation. If your dermatologist or skin specialist suspects a melanoma they may remove the mole (excision biopsy) and send it for examination by a histopathologist (a specialist who examines tissue) to check whether it is cancerous.
A biopsy is usually carried out under local anaesthetic. If a melanoma is confirmed another operation is usually required, most often performed by a plastic surgeon or dermatologist to remove a wider area of skin.
‘Staging’ is the process of determining the size / depth of the melanoma and if / how far it has spread. It is used to determine how serious the cancer is and how best to treat it. When the melanoma is removed, the depth of the tumour will be examined. This is the depth (measured in mm) from the surface of the skin at which the cancer cells are present at the time of surgical excision.
The earliest stage melanomas are stage 0 (melanoma in situ) and then range from stages I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread and the higher the number, the more the cancer has spread. Within a stage, an earlier letter means a lower stage. Most melanoma are less than 1mm thick and are less likely to grow back or require further treatment.
Further tests will be carried out if there is a concern the cancer has spread into other organs, bones or bloodstream. Patients with melanoma will be cared for by a team of specialists that should include: a dermatologist, a plastic surgeon, an oncologist, a pathologist and a specialist nurse.
When helping patients decide on their treatment, the team will consider: the type of cancer, the stage of the cancer and the patient’s general health. The team will then recommend what they believe to be the best treatment option.
Install the Skcin app on your mobile device to access all the tools and resources you need to confidently perform full-body skin examinations, set monthly reminders, and track lesions for signs of change using close-up photography.
The Skcin app is a comprehensive, educational, and self-management tool dedicated to the prevention and early detection of skin cancer. The app comprises six key service areas to help you learn more and take charge of your skin health and surveillance.
