Skin melanoma diagnosis and treatment

Melanoma is one of the most serious types of skin cancer because it can spread to other parts of the body quickly. In the U.S., about 200,340 new cases were diagnosed in 2024, and rates continue to rise, especially in areas with high sun exposure, where cases have nearly doubled every decade.

Melanoma begins when melanocytes (skin pigment cells) grow abnormally and form a malignant tumor. While many melanomas are black or brown, they can also appear red, purple, multicolored or even colorless. Most develop on normal-appearing skin, particularly in sun-exposed areas, though some start from existing moles.

Routine skin exams help dermatologists spot concerning areas early. Catching melanoma early usually makes it highly treatable.

Late-stage melanoma causes more than 8,400 deaths annually in the U.S., showing why regular skin checks matter.

Who Gets Melanoma?

Skin cancer can be found in people of any age and is one of the more common cancers to find in those younger than 30. The risk of being diagnosed with melanoma increases with age and the average age for it to be found is 61. Those with lighter skin are much more likely to get melanoma than those with darker skin. A major risk factor for most melanomas is exposure to UV rays from sunlight or tanning beds. This is why proper sun protection is so important. Besides damaging rays from the sun, family history could also be a contributing factor to developing melanoma.

What is melanoma?

Melanoma is a type of skin cancer that begins in melanocytes, cells that give your skin its color. It can grow quickly and spread to other parts of the body, which is why noticing changes early is so important.

What is a malignant melanoma?

Malignant melanoma refers to a melanoma that has the potential to invade deeper layers of skin and metastasize (spread) to other organs. Not all melanomas become malignant, but medical evaluation is needed to determine the risk.

What melanoma looks like

Melanoma can look like a flat, dark patch or a raised, multicolored spot. Patients should monitor for:

• Changes in moles
• New growths
• Any lesion that looks different from the surrounding skin

How serious is melanoma?

Melanoma is serious because it can spread beyond the skin to the lymph nodes and organs. Early-stage melanoma is highly treatable, but advanced melanoma can be life-threatening.

The key to better outcomes is early detection and timely treatment.

Risk factors for Melanoma

Who gets melanoma?

Skin cancer can occur at any age and is more common in people under 30 than in many other cancers. Risk increases with age, and the average age at diagnosis is 61.

While having light skin increases risk, melanoma can develop in anyone. Other contributing factors include UV exposure, family history and certain skin or immune conditions.

Even with these risk factors, many people do not develop melanoma. It can occur without any known risk factor.

Sun protection and regular skin checks are your best prevention.

Skin type and sensitivity to the sun

People with fair or easily burned skin are at a higher risk. Fair skin offers less natural protection from ultraviolet (UV) radiation, which can damage DNA in skin cells and contribute to melanoma.

Moles and freckles

Having multiple moles or freckles (especially if they are atypical or “dysplastic”) can signal a higher risk. Melanoma does not always start in a mole. It can also develop on normal skin. Features that indicate a higher risk in atypical moles include:

• Large size
• Varied color
• Irregular borders

Large congenital moles may also carry a higher risk. Removal is sometimes considered, but cosmetic concerns can make this impractical.

Personal history of melanoma

If you’ve had melanoma before, your risk of another lesion increases (up to 25 percent of patients may experience a second melanoma).

Positive family history

Approximately one in ten melanoma patients has a family member with the disease.

Risk is highest for first-degree relatives under age 50, though second-degree relatives also contribute to risk.

Weak immune system

The immune system helps protect your body from abnormal cells, including cancer cells. When weakened, the body is less able to fight melanoma. People with a weakened immune system (due to HIV, chemotherapy or organ transplant) are at higher risk for melanoma and other skin cancers.

Certain skin cancers, including basal cell carcinoma, squamous cell carcinoma and melanoma, are more common in people with immune suppression.

Some rare genetic conditions, like Xeroderma pigmentosum, which affect the skin’s ability to repair DNA damage, also increase melanoma risk. The National Cancer Institute booklet What You Need To Know About™ Melanoma has more information about risk factors for this disease.

Not everyone who has dysplastic nevi or other risk factors for melanoma gets the disease. In fact, most do not. About half the people who develop melanoma do not have dysplastic nevi and they may not have any other known risk factor for the disease.

At this time, no one can explain why one person gets melanoma while others do not. Research has shown that sun exposure, especially excessive exposure that leads to bad, blistering sunburns, is an important and avoidable risk factor. Scientists are continuing their studies of risk factors for melanoma.

UV exposure and tanning beds

A major risk factor for most melanomas is exposure to UV rays from the sun or from tanning beds. Protecting your skin from UV radiation is very important.

Studies show that too much sun, especially when it causes painful, blistering sunburns, significantly increases the risk of melanoma, but this is a risk you can reduce.

Sunburns during early childhood may be the most critical melanoma risk, though total lifetime sun exposure also matters. Both UVA and UVB rays can contribute to melanoma, and tanning beds expose your skin to similar harmful rays, increasing your risk.

How fast melanoma can spread

Melanoma can grow slowly or spread quickly, depending on its type and thickness. Early detection is crucial, as treatment is more effective before the cancer spreads.

Causes of melanoma

Genetic and hereditary factors

Melanoma can develop due to one or more genetic factors, such as:

• Familial melanoma
  About 10% of melanomas run in families. Having a first-degree relative with melanoma increases a person’s risk by ten times.
• Atypical (“dysplastic”) moles
  Having multiple or unusual moles increases risk, especially among those with a family history of skin cancer.
• Multiple melanomas or nevi
  Having several melanomas or many moles may indicate a stronger genetic predisposition.
• Genetic mutations
  Up to 25% of familial cases involve the CDKN2A gene. Only about 1 percent of isolated melanomas have this mutation.

Genetic testing may be considered if two or more family members have melanoma, melanoma occurs at a young age or there’s a history of pancreatic cancer. Testing should be discussed with your physician and a genetic counselor.

Suspicious lesions and biopsy If a mole or spot looks unusual, it is typically removed surgically for examination (biopsy):

• Excisional biopsy
  The entire mole is removed. This is the preferred method to ensure no cancer cells remain at the edges.
• Incisional biopsy
  Only part of a large or hard-to-reach lesion is removed for evaluation and diagnosis, with a full removal done later (if needed).
• Microscopic analysis
  Confirms melanoma and distinguishes it from other pigmented lesions
• Atypical/dysplastic lesions
  Not melanoma, but higher risk. These require removal and monitoring.

UV radiation and DNA damage

Ultraviolet (UV) rays from the sun or tanning beds can damage the DNA in skin cells. This damage can lead to mutations that increase the risk of melanoma and other skin cancers. Protecting your skin with clothing, sunscreen and shade helps reduce this risk.

Early Detection of Melanoma

How to detect melanoma

Because melanoma usually begins on the surface of the skin, it often can be detected at an early stage with a total skin examination by a trained health care worker. Checking the skin regularly for any signs of the disease increases the chance of finding melanoma early.

A monthly skin self-exam is very important for people with known risk factors, but doing regular skin self-exams is a good idea for everyone. Self-screening was shown in studies to reduce the frequency of advanced lesions in patients with melanoma.

Here is how to do a skin self-exam:

After a bath or shower, stand in front of a full-length mirror in a well-lit room. Use a handheld mirror to examine hard-to-see areas.

• Start at the top
  Check your face and scalp, then work downward, examining the neck, shoulders, back, chest, arms and legs. Don’t forget to check the front, back and sides of each limb. Also, check the groin, the palms, fingernails, soles of the feet, toenails and the spaces between the toes.
• Check hard-to-see areas
  A friend or relative may be able to help inspect hard-to-see areas, like the scalp and neck. Using a comb or a hair dryer can make the scalp easier to see.
• Know your moles
  Regular skin checks help you recognize your mole’s usual size, shape and color. Look for any signs of change, particularly new dark spots, changes in outline, shape, size, color or texture. Also, note any new, unusual or “ugly-looking” moles. If your doctor has taken photos of your skin, compare them to how your skin looks during self-examination.
• Pay attention to hormone changes
  Moles can change during hormone changes, such as adolescence, pregnancy and menopause, so check carefully during these times.

It may help to record the dates of your skin exams and note how your skin looks. If you find anything unusual, see your doctor right away. Remember, the earlier a melanoma is found, the better the chance for a cure.

In addition to doing routine skin self-exams, people should have their skin checked regularly by a doctor or nurse specialist. A doctor can do a skin exam during regular checkups. People who think they have dysplastic nevi should point them out without delay to the doctor. It is also important to tell the doctor about any new, changing or “ugly-looking” moles.

A medical skin check may be preferable in certain high-risk settings, such as a history of sunburn, the presence of other cutaneous malignancies or melanoma in the past or a positive family history of melanoma, to see a specialized dermatologist for regular skin inspections.

Early detection of melanoma may not be easy in individuals with pigmented skin. Although a degree of skin pigmentation is protective against melanoma, the risk is not zero. In such cases, melanoma develops especially on the hands, feet or nails, but can arise on any other part of the body and on mucosal surfaces. The patients are encouraged to perform monthly skin self-checks and to be aware of the criteria used to assess moles. Consulting with a dermatologist specializing in pigmented skin lesions and in the detection technique called “dermoscopy” is advisable. Caution is recommended for patients with pigmented skin, as melanoma, although less frequent, may be more aggressive and present at an advanced stage.

When to see a dermatologist for a suspicious mole

See a dermatologist if you notice:

• a new mole
• changes in an existing mole
• any lesion that looks unusual, dark or “ugly”

Prompt evaluation is especially important for those with many moles, a personal or family history of melanoma or other risk factors. Early professional assessment can catch melanoma at its most treatable stage.

Distinguishing Benign Moles from Melanoma

According to recent research, certain moles are at higher risk of developing into malignant melanoma. Moles that are present at birth and atypical moles have a greater chance of becoming malignant. Frequently, melanomas arise as single lesions. Occasionally, one spot may stand out as looking most atypical, and such lesions would be of particular concern.

Recognizing changes in your moles is crucial in detecting malignant melanoma at its earliest stage. Melanomas vary greatly in appearance. Some melanomas may exhibit all ABCD characteristics, while others may show changes in only one or two characteristics. Always consult your physician for a diagnosis.

While the ABCDE system was designed to enable healthcare professionals to detect melanoma, other tools have been developed recently.

ABCDE’s of melanoma detection

A simple checklist can help you spot potential melanomas. Even one of the following warning signs should prompt a visit to a medical professional:

• A – Asymmetry
  One half of the mole or lesion does not match the other half.
• B – Border
  Edges are irregular, notched or blurred.
• C – Color
  The color is uneven, with shades of brown, black, tan, red or blue.
• D – Diameter
  Larger than 6–7 millimeters (about the size of a pencil eraser), though smaller lesions can still be concerning.
• E – Evolving
  Any change in size, shape, color, elevation or new symptoms such as bleeding, crusting or itching.

Other warning signs include a new bump or vertical growth over a mole, and pain, inflammation or changes in sensation in the area. These changes are reasons to seek early evaluation, as early detection greatly improves treatment outcomes.

Warning signs that a mole is changing

If you notice a suspicious mole or changes from the ABCDE checklist, a dermatologist can provide a professional evaluation. They may use:

• Dermoscopy
  A magnifying tool with a light source that lets doctors see details not visible to the naked eye. This improves early detection and helps avoid unnecessary biopsies.
• Total body mole mapping
  Photos of your moles over time allow comparison and help track new or changing lesions, especially for people with many moles or high-risk spots.

Based on what is found, a doctor may:

• Monitor a mole closely for changes.
• Remove it through a biopsy for lab examination. This quick, in-office procedure uses local anesthesia, may require a few stitches and leaves a small scar.

Pathologists examine the tissue to determine if the mole is typical, atypical or melanoma, guiding further treatment if needed.

Types of Melanoma

Superficial spreading melanoma

The most common type of melanoma is encountered in almost three-quarters of cases. This subtype originates “in situ,” meaning it develops and extends in the most superficial portion of the skin before growing deeper (“vertical growth”). Commonly, the lesion appears as a discolored patch with suspicious features, such as increasing size, irregular borders or a change in color, such as black, round, red, blue or unstained patches.

It is more common in young individuals. Because the superficial pattern of growth may last for up to a few years, this lesion can be diagnosed early, before a “vertical growth phase” develops, which carries the risk of systemic metastases.

Nodular melanoma

The only subtype that is usually deeply invasive at presentation. It is considered a more aggressive variant, and making the diagnosis can be difficult because of several factors. Some of these lesions lack pigmentation (may be white or skin-colored) and may be located on the scalp. This variant is commonly encountered in older adults.

Lentigo maligna melanoma

Lentigo maligna, a rare subtype, arises from superficial lesions and commonly maintains a noninvasive pattern of spread for a relatively long period before progressing to deep invasion. It tends to originate in sun-damaged skin, mainly on the head and neck and frequently appears as a brown or black lesion, that is flat or slightly prominent relative to the surrounding skin. The deeply penetrating advanced form is known as lentigo maligna melanoma.

Acral lentiginous melanoma

A rare subtype but frequently encountered in African American and Asian patients. It also spreads superficially at the beginning. The initial lesion usually occurs as a dark spot on the palms and soles, or under the nails.

How melanoma is diagnosed

Dermoscopy and skin examination

A dermatologist examines your skin using a magnifying tool called a dermatoscope. This helps spot suspicious moles that aren’t visible to the naked eye.

Melanoma biopsy

If a mole looks unusual, the doctor may remove it with a quick in-office procedure called a biopsy. The tissue is examined under a microscope to confirm whether it is melanoma.

Imaging tests for advanced cases

If melanoma is diagnosed and there’s concern it may have spread, imaging tests such as CT, MRI or PET scans may be used to check other parts of the body.

Stages of Melanoma

Stage Ia

Consists of a very thin tumor (< 1 mm) without ulceration.

Stage Ib

Consists of the same thickness of a tumor but having ulceration or invading to a Clark level III or IV, or a thin tumor (1.01 – 2 mm) without ulceration.

Stage IIa

Comprises thin tumors (1.01 – 2 mm) with ulceration and intermediate thickness tumors (2.01 – 4 mm) without ulceration.

Stage IIb

Comprises intermediate thickness tumors (2.01 – 4 mm) with ulceration, or thick melanomas (> 4 mm) without ulceration.

Stage IIc

Consists of thick lesions (> 4 mm) with ulceration.

Stage III

Melanoma is diagnosed when the tumor was found inside the lymph nodes that drain the territory of the melanoma lesion, either as:

• Micrometastases (can only be seen by examination under the microscope)
• Macrometastases (can be appreciated by manual palpation during a clinical exam)
• Other deposits of melanoma are found along the trajectory of lymphatic channels (“in-transit metastases” or “satellites”).

Stage IV

Stage IV melanoma occurs when the cancer has spread (metastasized) to distant parts of the body. This can include:

• Lymph nodes, skin or under the skin (Stage M1a)
• Lungs (Stage M1b)
• Other distant organs (Stage M1c)

Several factors influence the prognosis, or the likelihood of melanoma progressing and becoming life-threatening:

• Tumor thickness (Breslow depth)
  Thicker melanomas are generally associated with a higher stage and a less favorable prognosis. Breslow depth measures tumor depth in millimeters.
• Clark level
  This describes how deeply the melanoma has invaded the skin:
  • Level I – Confined to the epidermis (outermost layer of skin)
  • Level II – Invades the papillary dermis (just below the epidermis)
  • Level III – Reaches but does not invade the reticular dermis (deeper layer of the dermis)
  • Level IV – Invades the reticular dermis
  • Level V – Reaches the subcutaneous tissue (fat layer under the skin)
    Higher Clark levels indicate deeper invasion and a less favorable prognosis.
• Spread to lymph nodes or other organs
  The involvement of these areas increases the severity of the disease.
• Patient factors
  Older age and male sex have been linked to a less favorable outcome.

Once Melanoma Has Been Diagnosed

After melanoma is diagnosed, your doctor will assess whether the lymph nodes are affected. The approach depends on the characteristics of the skin lesion:

• Palpable lymph nodes
  If lymph nodes are large enough to be felt during a physical exam, your doctor may refer you to a surgeon for complete removal of the affected nodes.
• Non-palpable lymph nodes with high-risk melanoma
  If nodes aren’t detectable but your melanoma has certain high-risk features, a sentinel lymph node biopsy may be recommended. This procedure involves injecting a small amount of dye and a radioactive tracer near the primary tumor. The first lymph node that absorbs the tracer (“sentinel node”) is removed and examined for cancer cells.
  If melanoma is found in the sentinel node, additional lymph nodes in the same region may need to be removed. This targeted approach reduces complications such as chronic swelling (lymphedema) compared with removing all lymph nodes initially.

A medical dermatology team (e.g., dermatologist, medical oncologist and surgeon) usually determines the best course of action for each patient.

Assessing the rest of the body:

Depending on the risk of melanoma spreading, your doctor may recommend imaging tests such as:

• Chest X-rays
• CT scans
• MRI scans
• PET scans

These tests, combined with regular physical exams, help monitor for the spread of melanoma. Over time, the frequency of these tests usually decreases. Patients should promptly report any new symptoms, including:

• Shortness of breath or cough
• Weakness in any part of the body
• Seizures or changes in thinking/perception
• Unexplained pain

Surgical removal of the primary melanoma:

The tumor is removed along with a margin of normal skin to ensure no cancer cells remain. Margin size depends on the thickness of the melanoma:

• In-situ (very superficial): 5 mm margin
• 0–1 mm thick: 1 cm margin
• 1–2 mm thick: 1–2 cm margin
• Greater than 2 mm: 2 cm margin

Larger margins used in the past did not improve outcomes but left bigger scars. Margin size may also depend on the tumor’s location and cosmetic considerations. Melanomas on the lips, nose, ears, eyelids, hands or feet may require referral to a plastic surgeon for the best functional and cosmetic outcomes.

Your care team will discuss the plan, answer questions and guide you through the procedure to ensure the safest and most effective treatment.

Melanoma treatment options

Treating melanoma can feel overwhelming, but there are several options your doctor can recommend based on the type, stage and location of the melanoma. The goal is always to remove the cancer and reduce the risk of it coming back, while keeping you as comfortable and healthy as possible.

Melanoma surgery

Surgery is usually the first step. The doctor removes the melanoma along with a small margin of healthy skin to make sure all cancer cells are gone.

Melanoma removal techniques

How the melanoma is removed depends on its size and location. This could be a simple excision, Mohs surgery for precise removal or a skin graft if needed.

Immunotherapy treatments

Immunotherapy helps your immune system recognize and fight melanoma cells. It is often recommended for melanomas that are more advanced or at higher risk of recurrence.

Targeted therapy options

Some melanomas have genetic changes that drive their growth. Targeted therapy uses medications to block these changes and slow or stop the cancer from growing.

Adjuvant treatment

Additional treatment after surgery may be suggested to reduce the chance of melanoma coming back.

Treatment for metastatic disease

If melanoma has spread, treatment may include surgery, immunotherapy, targeted therapy and sometimes radiation or chemotherapy to help control the disease and improve outcomes.

Prevention of Melanoma

The number of people diagnosed with melanoma is rising each year. In the United States, cases have more than doubled over the past 20 years. Experts believe much of this increase is linked to more time spent in the sun.

Ultraviolet (UV) radiation from sunlight, tanning beds and sunlamps can damage the skin and increase the risk of melanoma and other skin cancers. Everyone, especially those with dysplastic nevi (atypical moles) or other risk factors, should take steps to protect their skin. UV radiation is strongest during summer, particularly in the middle of the day. A simple rule is to seek shade or cover up whenever your shadow is shorter than you are.

Tips to reduce melanoma risk:

• Use broad-spectrum sunscreen with at least SPF 30 on all exposed skin
• Wear protective clothing, hats and sunglasses
• Avoid tanning beds and sunlamps
• Check frequently overlooked areas such as the scalp, ears, feet and between the toes
• Be especially cautious during peak sun hours
• Perform regular skin self-exams and see a doctor for suspicious changes

Knowledge of the above information, along with a few simple changes in behavior and lifestyle, can help prevent skin cancer.

Sun protection and sunscreen use

Protecting your skin from UV radiation is one of the most important steps to reduce melanoma risk. Key tips include:

• Use sunscreen regularly
  Choose a broad-spectrum sunscreen that protects against both UVA and UVB rays, with an SPF of 30 or higher. Apply generously to all exposed skin, including face, neck, ears and hands. Reapply every two hours or after swimming or sweating.
• Wear protective clothing
  Hats, long sleeves and UV-blocking sunglasses help shield the skin and eyes. Pay special attention to areas often overlooked, such as the scalp, neck and the backs of hands.
• Avoid peak sun hours
  UV rays are strongest between 10 a.m. and 4 p.m., especially in summer. Seek shade or plan outdoor activities for early morning or late afternoon.
• Special considerations for high-risk individuals:
  People with a family history of melanoma, many atypical moles (dysplastic nevi) or fair, sun-sensitive skin should be extra cautious and see a dermatologist regularly.

Seeking medical advice

When to consult a melanoma dermatologist

Sometimes it is necessary to see a specialist. A dermatologist (skin doctor) has the most training in diseases of the skin. Our doctors at Advanced Dermatology P.C. are participants in the AAD annual melanoma screening sessions. They are often cited in the media for their expertise in skin cancer prevention and treatment.

A specialist can perform thorough skin exams and monitor high-risk moles. Those with more than 100 moles or a family history of melanoma may need checkups every six months.

• Mole removal guidance
  Most moles do not turn into melanoma, so routine removal is not necessary. Only moles that appear abnormal, change in appearance or are both new and unusual typically need to be removed. Cosmetic or psychological concerns may also guide removal decisions.
• Why early treatment matters
  Detecting melanoma early allows for simpler treatment, fewer complications and significantly better survival rates.

Frequently Asked Questions