Home > Finding Melanoma Early: Appearance Limitations

Appearance alone is not always enough to detect early melanomas; you also need to know the history of your skin lesions, including any changes in lesions and any new lesions.

Three melanomas with appearance limitations

Above, the photo at left shows a mole on the toe of an adult that lacked the usual ABCD features. Ordinarily, it would not have been cause for concern, but the patient noticed it was growing larger and insisted on having it removed. It was an early melanoma. In the middle photo, the black mark under the thumbnail could easily have been attributed to an injury or a nail fungus, but the patient recalled no injury and had no history of nail fungus. It too was an early melanoma. The red lesion in the photo at right had no resemblance to a typical melanoma and might have been dismissed; however, the dermatologist recommended biopsy, which identified it as an early stage amelanotic melanoma (a melanoma lacking pigmentation).

Patient Descriptions of Melanomas in Their Own Words

No matter how many photos are included on this website, some melanomas will look different. Ginger Richardson, a melanoma survivor from Huron, Ohio, surveyed melanoma patients on the MRF Bulletin Board, asking them what their melanomas looked like when first discovered. The descriptions below portray a wide variety of appearances.

"Dusty gray blotch."
"Pale flat spot that sometimes itched and would flake off when scratched."
"Flesh-colored on the crown of head, started by looking like tip of an eraser then got itchy, tingled, and became more irregular."
"Pale, flat spot… had since a child, irregular borders, lighter than other freckles."
"Perfectly round, flat, and evenly-colored brown. No itching, bleeding, or scab."
"Dry patch of skin that was quite itchy."
"Flat light brown freckles… started to merge."
"Mole got larger and lighter in color. Sort of greyish. Looked like a snake about to molt."
"Little round black spot… under direct sunlight one could see various colors."
"Mole that was colorless; same as color of skin. Developed a red circle around it. Over a couple of years the scar seemed to spread out into a circle. Began to itch."
"Small, even-colored brown mole… appeared quickly and grew quickly… started itching… skin around it was red… started oozing and [became] crusty and black [in areas]… started bleeding."
"Freckle that grew and looked like clover with hole in middle."
"Looked exactly like a wart—so much that not much attention was paid to it until it started bleeding."
"Smallish pink circle, flat, looked like a burn mark. No bigger than 5 mm diameter. Grew off an old, very small mole that was also pink."
"Reddish-brown, on nose, seemed like a pimple, never completely healed… not concerned until it bled."
"A pimple… had it as a child."
"Small, perfectly round red bump [that] looked like a pimple."
"Size/shape/texture of a large mosquito bite but was dark brown [and] did not itch like a bug bite."
"Flesh-colored and regular in shape… looked like a pencil eraser… raised."
  "Like a scab, irregular borders and itchy, on the exact site of a [longtime] double-sized freckle."  

Melanomas Without Identifiable Primary Sites

About five to ten percent of melanomas are first detected in lymph nodes or internal organs without any obvious signs of primary sites on the skin. Some dermatologists believe these originate from 1) moles or misdiagnosed melanomas that were incompletely removed, or 2) "regressed" melanomas in which the immune system eradicated cancerous cells on the skin, but not before the cells were released into lymph or blood vessels.

Melanoma with partial regression

Any mole that is changing should be examined by a dermatologist or plastic surgeon immediately. Although most malignant changes involve increasing size and darkening color, some cancerous moles can actually decrease in size, become lighter, and even disappear. The rate of decreasing size and fading color is important; a very gradual change over a period of years is often benign, while a rapid change over a period of weeks or months is often malignant. Even though a cancerous mole can fade from the skin's surface, it can still grow deep enough below the surface to release melanoma cells into the lymph fluid or bloodstream.

Melanoma Mimics

Six melanoma mimics

Many skin growths that look ominous turn out to be harmless. The six skin lesions in the photos above may look like melanomas to viewers untrained in dermatology. However, all were benign.