Melanoma can often be found early. Everyone can do things to find this cancer early, when it is most curable.
Self exams
It's important to check your own skin about once a month. You should know the pattern of moles, freckles, and other marks on your skin so that you'll notice any changes. Self-exam is best done in front of a full-length mirror. A hand-held mirror can be used for places that are hard to see. A family member can check your lower back or the back of your thighs.
Spots on the skin that change in size, shape, or color should be seen by a doctor right away. Any unusual sore, lump, blemish, marking, or change in the way an area of the skin looks or feels should also be checked by a doctor. It is sometimes hard to tell the difference between melanoma and a normal mole, so it is important to show your doctor any mole that you are unsure of. (For more details about skin self-exam, see our documents called Skin Cancer: Prevention and Early Detection and Why You Should Know About Melanoma)
What to look for
Normal moles
A normal mole is most often an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised. It can be round or oval. Moles are usually less than 1/4 inch across, or about the width of a pencil eraser. Moles can be present at birth or they can appear later. Several moles can appear at the same time.
Once a mole has developed, it will most often stay the same size, shape, and color for many years. Some moles may fade away over time.
Most people have moles, and almost all moles are harmless. But it is important to notice changes in a mole – such as its size, shape, or color – that suggest a melanoma may be starting.
Possible signs and symptoms of melanoma
The most important warning sign for melanoma is a new spot on the skin or a spot that is changing in size, shape, or color. A spot that looks different from all of the other spots on your skin can also be a warning. If you have any of these warning signs, have your skin checked by a doctor.
The ABCD rule can help you tell a normal mole from an abnormal mole. Moles that have any of these signs should be checked by a doctor. ABCD stands for the following:
A is for Asymmetry: One half of a mole or birthmark does not match the other.
B is for Border: The edges are irregular, ragged, notched, or blurred.
C is for Color: The color is not the same all over and may include shades of brown or black, or there may be patches of pink, red, white, or blue.
D is for Diameter: The spot is larger than about ¼ inch (the size of a pencil eraser), but melanomas can be smaller than this.
Still, some melanomas do not fit the "rules" above. It may be hard to tell if the mole is normal or not, so you should show your doctor anything that you are unsure of.
Other warning signs are:
- A sore that does not heal
- Spread of color from the border of a spot to the skin around it
- Redness or a new swelling beyond the border
- Itchiness, tenderness, or pain
- Change in the surface of a mole – scaliness, oozing, bleeding, or a new bump or nodule
Exam by a health professional
Part of a routine cancer check-up should include a skin exam by a doctor or trained health professional. If there is any reason to suspect that you have a melanoma, your doctor will do more exams and tests to find out if it is melanoma or something else.
Medical history and physical exam
The doctor will likely ask about your symptoms and risk factors. This will include your age, when you first saw the mark on your skin, and whether it has changed in size or the way it looks and if it has caused any symptoms (pain, itching, bleeding, etc.). You may also be asked about whether anyone in your family has had skin cancer and about past UV light exposure.
During the exam, the doctor will note the size, shape, color, and texture of the area of concern, and whether there is bleeding or scaling. The rest of your body will be checked for other spots and moles. The doctor may also check nearby lymph nodes, like those in the groin, underarm, or neck. Enlarged lymph nodes might suggest the spread of a melanoma.
You may be referred to a doctor who is an expert in skin diseases (a dermatologist). The doctor might use a special magnifying lens and light source held near the skin. Sometimes a thin layer of oil is put on the skin. A picture of the spot may be taken. These tests, when used by a doctor who has experience with them, can improve the chances in finding melanomas early. They also often show that an area of concern is not cancer, so no more testing is needed.
Skin biopsy
If the doctor thinks a spot might be a melanoma, he or she will take a sample of the skin to look at under a microscope. This is called a biopsy. There are different ways to do a skin biopsy. The choice depends on the size of the area of concern and where it is found on the body. All methods are likely to leave at least a small scar. Since different methods leave different types of scars, you should ask the doctor about this before the biopsy is done.
The skin around the area of the biopsy will be numbed before the biopsy. You will feel a little stinging as the medicine goes in, but you should not feel any pain during the biopsy.
Shave biopsy: After numbing the area, the doctor "shaves" off the top layers of the skin. A shave biopsy is useful for many types of skin diseases and in treating benign moles. But it is not often used if a melanoma is suspected. This is because the sample removed may not be thick enough to find out how deep the cancer goes into the skin.
Punch biopsy: In a punch biopsy a deeper sample of skin is removed. The doctor uses a tool that looks like a tiny round cookie cutter. Once the skin is numbed, the doctor rotates the tool on the surface of the skin until it cuts through all the layers of the skin and takes out a sample of tissue.
Incisional and excisional biopsies: If the doctor has to look at a tumor in the deeper layers of the skin, an incisional or excisional biopsy will be done. The skin will be numbed before the biopsy. A surgical knife is used to cut through the full thickness of skin. A wedge of skin is removed, and the edges of the wound are sewn together.
An incisional biopsy removes only part of the tumor. If the whole tumor is removed, it is called an excisional biopsy. Excisional biopsy is most often done.
After a biopsy, the skin sample is sent to a lab to be looked at under a microscope. The sample may also be sent to a doctor with special training in making diagnoses from skin samples (a dermatopathologist).
Biopsies of melanoma that may have spread
Melanoma that has spread to other parts of the body (called metastatic melanoma) may not be found until long after the first melanoma was removed from the skin. Rarely, some melanomas spread so fast that a person could have a lot of cancer in the lymph nodes, lungs, brain, or other places while the first skin melanoma is still small.
Sometimes these tumors are found before the skin lesion is found. In other cases they may be found long after a skin melanoma has been removed, so it's not clear whether it is the same cancer. In still other cases, metastatic melanoma may be found without ever finding a skin lesion. This may be because some skin lesions go away on their own (without any treatment) after some of their cells have spread to other parts of the body.
Melanoma can also start in internal organs, but this is quite rare. If melanoma has spread widely throughout the body, it may not be possible to tell which tumor was the first one. When this happens, melanoma in those organs might be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a cancer that starts in the lung. There are special tests that can be done on biopsy samples to tell whether it is a melanoma or some other kind of cancer. This is important because different treatments are used for different cancers.
Fine needle aspiration biopsy (FNA): This kind of biopsy can sometimes be used if the doctor thinks the melanoma has spread to organs like the lung or liver. A thin, hollow needle is used to remove very small tissue samples from the tumor. The test rarely causes much discomfort and does not leave a scar. The FNA is not used to diagnose a suspicious mole, but it may be used to biopsy large lymph nodes near a melanoma to find out if it has spread.
Surgical (excisional) lymph node biopsy: For this type of biopsy a swollen lymph node is removed through a small cut (incision). It is often done if a lymph node's size suggests spread of melanoma but either an FNA was not done or it did not show any cancer cells.
Sentinel lymph node biopsy: If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy is often done to find out if the cancer has spread to nearby lymph nodes. This test can find the lymph nodes that drain lymph fluid from the area of the skin where the melanoma started.
To find the sentinel lymph nodes, the surgeon injects a radioactive liquid (and sometimes a blue dye) into the area of the melanoma. The lymph nodes are then checked for radioactivity to find which ones are the first to drain fluid from the skin near the melanoma. These are the sentinel lymph nodes, called that because they "stand watch," so to speak, over the tumor. A small cut is made in the identified lymph node area. The lymph nodes are then checked to find which one(s) turned blue. When these lymph nodes have been found, they are taken out and looked at under a microscope. If cancer cells are found, the rest of the lymph nodes in this area are removed, too. If the sentinel nodes do not contain cancer cells, further lymph node surgery is not needed.
If a lymph node near a melanoma is very large, this test may not be needed. The enlarged node is simply biopsied.
Imaging tests
Imaging tests are done to make pictures of the inside of the body. They are used to look for the spread of melanoma. They are not needed for people with very early melanoma which is not likely to have spread. These tests may also be done to help find out how well treatment is working or to look for signs that the cancer has come back after treatment.
Chest x-ray: This test may be done to see if the cancer has spread to the lungs.
CT (computed tomography) scan: If there is any reason to suspect that the melanoma has spread to the liver or other organs, the doctor might order CT scans. These can also spot spread to the lungs better than a standard chest x-ray. CT scans use many x-ray images that are combined by a computer to give a detailed, cross-sectional view of the body. You may get a kind of dye put into your vein, which helps better outline structures in your body. You may also be asked to drink 1 to 2 pints of a special liquid. This helps outline the intestines.
CT scans take longer than regular x-rays and you usually need to lie still on a table while they are being done. You might feel a bit confined by the ring in the table moves through when the pictures are being taken. Spiral CT is now used in many places. This type of CT scan uses a faster machine with a lower dose of radiation that gives more detailed pictures.
CT scans can also be used to guide the needle during a biopsy. For this, you will stay on the CT scanning table while a biopsy needle is moved through the skin and toward the mass.
MRI (magnetic resonance imaging): This is like a CT scan except that it uses radio waves and strong magnets to make a picture of your insides. MRI scans are very helpful in looking at the brain and spinal cord. They take longer than CT scans – often up to an hour. You may have to lie inside a narrow tube, which is confining and can upset some people. Newer, open MRI machines can sometimes be used instead. The MRI machine also makes loud buzzing and thumping noises that may bother some people. Some places provide headphones to block this out.
PET (positron emission tomography) scan: In this test, a special kind of radioactive sugar is put into a vein. The sugar collects in areas that have cancer and a scanner can spot these areas. This test is useful when the doctor thinks the cancer has spread but doesn’t know where. Doctors find it most useful in people with advanced stages of melanoma. It is not very helpful in people with early stage melanoma. Some newer machines do PET scans and CT scans at the same time.
Bone scan: A bone scan is used to look for cancer that has spread to the bones. It is rarely used for melanoma. It is only done when other test results or symptoms suggest that the cancer may have spread to the bones. For a bone scan, a radioactive chemical is put into a vein. The substance collects in the bones where the cancer has spread, which can be seen with a special camera. These areas may be biopsied to see if they contain melanoma.
To learn more about these imaging tests, see our document called Imaging (Radiology) Tests.
Lab tests
Tests of biopsy samples: Samples from any biopsies you have will be sent to a lab, where a pathologist (a doctor with special training) will look at them under a microscope for melanoma cells. If the samples do contain melanoma, the pathologist will look at certain features such as the tumor thickness and mitotic rate (the portion of cells that are actively dividing). These features help tell the stage of the cancer, which in turn affects treatment options and prognosis (outlook).
Blood tests: Blood tests aren't used to find melanoma, but some tests may be done before or during treatment, especially for more advanced melanomas. Some tests of blood cell counts and blood chemistry levels may be done in a person who has advanced melanoma to see how well the bone marrow, liver, and kidneys are working during treatment.
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