Symptoms and Signs of Melanoma

Even though it is only responsible for 5% of skin cancer diagnoses, melanoma is the cause of most skin cancer deaths. Knowing the symptoms of this type of cancer can help you identify it earlier.

Risk factors for melanoma include excess sun exposure, having fair skin, and having a family history of melanoma. Despite these risk factors, many people who develop the disease do not have any risk factors, and even those without risk factors should be alert to the signs and symptoms and contact their healthcare provider if they note anything abnormal on their skin. Some people have a genetic predisposition to melanoma, and it's thought that up to 72% of melanomas have a genetic component.

Melanoma is most treatable when detected early. Moles or other spots on the skin should be self-examined each month. Look for any changes in the existing areas and look for new moles.

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Signs and Symptoms of Melanoma

A melanoma may begin as a new spot on the skin, or as a change in an existing mole. Note that even if you have had a mole as long as you can remember, any change should be carefully examined and evaluated. As you read through these possible signs, note the mnemonic ABCDE. 

Possible signs and symptoms of a melanoma include:

“A” for asymmetry: An unevenness of a mole—when one half doesn’t match the other half—may be a sign of melanoma.

“B” for border: Unlike benign (noncancerous) moles, melanomas often have an irregular border or edge.

“C” for color: Melanomas tend to be "more colorful" than regular moles, with colors varying from the color of your skin to the typical dark brown or black of a mole to red. Different colors occurring in the same mole are also of concern, and some melanomas have a classic tarry black appearance, while others are brown, red, white, or sometimes blue in appearance.

“D” for diameter: Melanomas tend to be larger than normal moles (but certainly not always.) Any mole that has a diameter which is the same or larger than the diameter of a pencil eraser should be evaluated.

“E” for elevation: Instead of being flat, a mole may be elevated off the skin, or different parts of the mole may have different elevations.

“E” for evolving: “E” can also stand for evolving, which can refer to any component of the mole. For example, it could be changing in size, in color, in shape, or in degree of elevation. The mole may also change in texture, such as becoming scaly.

“F” for funny looking: Some healthcare providers add an extra letter to the mnemonic and include "F," for funny looking. Many melanomas simply don't look like normal moles.

Itching/other sensations: Often overlooked is the presence of symptoms in a mole, rather than being devoid of specific sensations as most moles are. Melanomas may sometimes cause itching, and they can break down and scab if you scratch them, making them more difficult to evaluate.

Sores on the skin that do not heal: If a sore on your skin does not heal after a period of two weeks, you should have your healthcare provider examine you for the possibility of melanoma.

Bleeding or oozing from a mole: If bleeding or oozing comes from a mole or spot, it needs to be examined by a medical professional. This is often indicative of advanced melanoma and needs to be evaluated.

Late symptoms: If a melanoma grows large and spreads to other regions of the body, it may cause symptoms related to that spread. For example, a melanoma that has spread to the liver may cause jaundice, a yellowish discoloration of the skin. Cancers that have spread may also cause systemic symptoms, symptoms throughout the body,  such as fatigue, unintentional weight loss, and weakness.

Self-Exams for Melanoma and the ABCDE Mnemonic

When doing a self-examination, you need to look at all areas of your body. It helps to have a mirror to view difficult-to-see areas. Look for any changes to color, shape, and size to any freckle, mole, blemish or reddened areas.

A quick review of the ABCDEs of melanoma to watch include:

• A: Asymmetry
• B: Border
• C: Color
• D: Diameter
• E: Elevation

When doing your exam, keep in mind that melanoma can occur anywhere on the skin, including areas that are never exposed to the sun. It may also occur under nail beds or even in the eye (ocular melanoma.) People with dark skin can get melanoma, and due to similarities in color between skin and the mole, these can be more difficult to diagnose. 

Even people without any risk factors or who have had very little sun exposure can get melanoma. If you have been very careful about using sunscreen, you could still get melanoma. In fact, researchers are uncertain whether sunscreen actually prevents melanoma (though it can clearly reduce the risk of other skin cancers.)

Preventing Melanoma

While it's impossible to prevent melanoma, you may be able to reduce your risk. Since exposure to ultraviolet (UV) rays is a risk factor, avoid tanning beds and sunlamps, and practice caution in the sun. Sunscreen is recommended, though it is uncertain whether the use of sunscreen decreases the risk of melanoma. 

Being smart in the sun is the ideal way to lower risk. This includes avoiding the sun during midday (especially from 10 a.m. to 2 p.m.) using protective clothing to cover your skin, and wearing a hat or using an umbrella and seeking shade to reduce exposure. 

It's important to state again: Don't rely on sunscreen but practice other sun safety practices.

At the same time, a deficiency in vitamin D from the sun may be a risk factor for melanoma. Ask your healthcare provider to check your vitamin D level and ask for recommendations if your level is low. Many people are deficient in this vitamin (which acts like a hormone), and a deficiency may raise the risk of other cancers as well. Finally, eating a healthy diet and getting exercise is important for cancer prevention in general.