In most cases, melanoma is easy to self-detect at an early stage while it is curable by simple surgical excision. Although the visual appearance of a skin lesion (a growth or mark) is often an indication of melanoma, you cannot always rely on this alone. You should also be aware of the history of your skin lesions—any changes that occur in them, as well the onset of any new ones. The only way to develop this awareness is by regular self-examination of your skin. We recommend a complete self-skin exam once every month.
WARNING SIGNS OF MELANOMA Any of these should prompt an immediate visit to a dermatologist or plastic surgeon:
Any change in a mole, blemish, freckle, birthmark, or pigmented area
A new mole or freckle that appears out of the blue or is growing rapidly, especially if you don't have many moles, or the new mole or freckle looks different from those you do have
A change in surface texture or in the way a mole feels to the touch
A new "freckle" that is dark, dry, or scaly
A pigmented area or splotch that is new or that you don't remember seeing before
A new spot that is black, even if very small
A mole or other spot that looks or behaves differently than those around it, even if it seems otherwise normal
A mole or other spot that itches and/or bleeds
Redness, other color, or shadow extending into the surrounding skin
There are two types of melanoma: radial and nodular. Radial melanomas are easier to self-detect because they grow in diameter near the skin surface before growing downward through the skin. Radial melanomas usually have two or more of the ABCD properties, as shown below.
Please note these photos show only a few of many different ways melanomas may appear; read this entire page to learn about other possible warning signs.
ABCD Properties of Radial Melanomas
A = ASYMMETRY
B = BORDER
Radial melanomas are often unsymmetrical; an imaginary line through the middle does not
The borders of radial melanomas may be uneven, fuzzy, or have notched
or scalloped edges. (Dermnet.com)
C = COLOR
D = DIAMETER
Radial melanomas often begin to show color changes in areas, with shades of black, brown, tan, and sometimes other colors. (Dermnet.com)
Unlike normal or atypical moles, radial melanomas often grow larger than the width
of a pencil eraser. (Dermnet.com)
SIMULATED PROGRESSION OF AN ATYPICAL MOLE TO RADIAL MELANOMA
In the animation above, the earliest signs of an atypical mole changing into a radial melanoma are 1) the increase in size, and 2) the shape becoming more irregular. This is the time to act. As the melanoma continues to grow, its color becomes darker and less uniform, black bumps begin to appear, and in the late stages, most of the melanoma has become black and lumpy. The initial appearance of bumps often signals the last chance to act before a melanoma spreads internally.
This represents just one of many different ways a mole can change. Usually these changes occur over a period of several weeks, or more typically, months. Although not all changes will turn out to be melanoma, don't take any chances, and above all, don't make the mistake of trying to be your own doctor.
The Deadly E Change
In addition to the ABCD properties, there is an E change to watch for, and if you see it you should act immediately. E equals elevation. The beginning of a bump or thickness increase in a mole, freckle, blemish, or birthmark—even if the increase is small—often signifies a melanoma that is entering a dangerous phase. Elevation changes are critical because, when the thickness of a melanoma exceeds 1 mm, the chance of internal spread increases. When the thickness reaches 3 mm, curability is only about 50 percent and quickly decreases as the thickness increases further.
The animation above shows a radial melanoma growing into the skin. Radial melanomas start in the thin outer layer of the skin (the epidermis) and at first usually undergo a surface growth phase that is noninvasive and completely curable. As the melanoma grows and reaches the middle layer of the skin (the dermis), it begins an "invasive radial" growth phase. Still, curability is about 90 percent at this point. As it penetrates further into the dermis, however, it begins an "invasive vertical" growth phase, becoming less curable as downward growth progresses into the loose connective tissue beneath the dermis (the subcutaneous layer). Malignant cells may be released into lymph and blood vessels, spreading to other parts of the body.
In short, a lump or elevation increase above the surface of the skin is a warning sign of vertical growth beneath the surface.
This elevated melanoma started in a mole that grew darker and larger, then developed a bump on the left side. At this stage, it was destined to be fatal. If it had been removed while it was flat, or even when the bump first started developing, it likely would have been curable. (National Cancer Institute)
EFG Properties of Nodular Melanomas
About 20 percent of melanomas begin the dangerous vertical growth phase with little or no radial growth first. For these nodular melanomas the ABCD properties do not apply; instead they have three combined EFG properties.
E = ELEVATED
Early elevation above the skin surface
F = FIRM
Firm to the touch, not flabby
G = GROWING
Continues growing more than two to three weeks
Any of the following warning signs may indicate a nodular melanoma:
The start of a new bump in a mole, freckle, blemish, or birthmark.
The start of a thickness increase in a previously flat or slightly raised mole.
In otherwise clear skin, the beginning of a bump that looks like a blood blister, bubble, or pimple that continues to grow after two to three weeks, especially if you don't ordinarily have pimples and haven't injured yourself at the site of the blood blister.
(From left: Rebecca C. Tung, M.D./Cleveland Clinic; Dermnet.com;
Jeffrey L. Melton, M.D./
Loyola University; University of Michigan Comprehensive Cancer Center)
Although a nodular melanoma can arise in a pre-existing mole, it is more common for one to develop spontaneously from normal skin, as in the four photos above. All of these were fatal. The colors of nodular melanomas are usually black, blue-black, dark brown, or brown-red. However, occasionally they are red (third photo from left), pink, grey, flesh-tone, or light to medium brown (far right photo, from the ankle of a 12-year-old boy). Nodular melanomas are typically dome-shaped and lacking in the ABCD properties, making visual diagnosis more difficult than with radial melanomas.
SIMULATED DEVELOPMENT OF NODULAR MELANOMA ON CLEAR SKIN
How Much Time Do You Have to Act?
Nodular melanomas can spread internally in as little as three months.
Most radial melanomas can spread internally within 6 to 18 months from the first noticeable change of a pre-existing mole or appearance of a new mole.
Radial melanomas that develop from age or liver spots (which typically occur in people 70 or older) can take as long as 10 to 15 years to spread internally.