Melanoma can often be found early. Everyone can do things to find this cancer early, when it is 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.

Exam by a health professional

Part of a routine cancer check-up should include a skin exam by a doctor or trained health professional.

What to look for

Normal moles

It's important to know the difference between melanoma and a harmless mole. 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. Moles may fade away in older people.

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 ABCD rule can help you tell a normal mole from an abnormal mole. Moles that have any of these signs should be checked by your doctor. ABCD stands for the following:

• Asymmetry: One half of the mole does not match the other half.

• Border irregularity: The edges of the mole are irregular or not smooth. They may look ragged, blurred, or notched.

• Color: The color over the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of pink, red, blue, or white.

• Diameter: The mole is larger than about ¼ inch-- about the size of a pencil eraser-- although sometimes melanomas can be smaller.

Another important sign of melanoma is a mole that is growing or changing in shape or color. 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.

How melanoma is found

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 really a 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. 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 skin doctor (dermatologist).

The doctor might use a special magnifying lens and light source held near the skin. Sometimes a thin layer of oil is used with this instrument. 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 you might have a melanoma, they 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 a 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.

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.

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 tissues.

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.

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 diagnosing from skin samples (a dermatopathologist).

Biopsies of melanoma that has spread

Melanoma that has spread to other parts of the body 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. 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 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 an abnormally large lymph node is removed through a small incision. It is often done if a lymph node's size suggests spread of melanoma but FNA did not find any cancer cells.

Sentinel lymph node biopsy: This has become a common way to find out if the cancer has spread to nearby lymph nodes. It can find the lymph nodes that drain lymph fluid from the area of the skin where the melanoma started. A surgeon injects a radioactive liquid and 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 incision 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 might not be needed.

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.

Chest X-rays: This test may be done to see if the cancer has spread to the lungs.

CT (computed tomography) scans: 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 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 an injection of a kind of "dye" 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 you have to lie in when the pictures are being taken. But CT scans are getting faster all the time.

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.

MR (magnetic resonance imaging) 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 help with this if needed. The MRI machine makes loud buzzing and thumping noises that may bother some people. Some places provide headphones to block this out.

PET (positron emission tomography) scans: In this test, a special kind of radioactive sugar is injected 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 (see below) 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 scans: A bone scan is used to look for cancer that has spread to the bones. It is rarely used for melanoma. In this test a radioactive chemical is injected into a vein. The substance collects in the bones where the cancer has spread. These areas may be biopsied to see if they contain melanoma.

Last Medical Review: 07/01/2008
Last Revised: 05/06/2009