Melanoma Signs And Symptoms
Melanoma skin cancer is much more serious than basal cell carcinoma and squamous cell carcinoma. It can spread quickly to other organs and causes the vast majority of skin cancer deaths in the United States. Usually melanomas develop in or around an existing mole.
Appearance
Signs and symptoms of melanoma vary depending on the exact type and may include:
- A flat or slightly raised, discolored patch with irregular borders and possible areas of tan, brown, black, red, blue or white
- A firm bump, often black but occasionally blue, gray, white, brown, tan, red or your usual skin tone
- A flat or slightly raised mottled tan, brown or dark brown discoloration
- A black or brown discoloration, usually under the nails, on the palms or on the soles of the feet
See more pictures and get details about different types of melanoma in our dedicated melanoma section.
Merkel Cell Carcinoma: A Rare Skin Cancer On The Rise
Merkel cell carcinoma is a rare type of skin cancer that affects about 2,000 people in the United States each year.
Though its an uncommon skin cancer, cases of Merkel cell carcinoma have increased rapidly in the last couple of decades.
This type of cancer starts when cells in the skin, called Merkel cells, start to grow out of control.
Merkel cell carcinomas typically grow quickly and can be difficult to treat if they spread.
They can start anywhere on the body, but Merkel cell carcinomas commonly affect areas exposed to the sun, such as the face, neck, and arms.
They may look like pink, red, or purple lumps that are firm when you touch them. Sometimes, they can open up as ulcers or sores.
Risk factors include:
Skin Cancer Of The Head And Neck Treatment
Many early-stage small basal cell cancers or squamous cell cancers can be removed by Mohs surgery, a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Tumors with nerve involvement, lymph node involvement or of a large size are not suitable for Mohs surgery. They require a multimodality approach to treatment, with formal surgical resection and adjuvant radiation or chemotherapy.
Melanoma is more likely to spread, and aggressive surgical resection with wide margins is required, in addition to radiation and/or chemotherapy.
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Basal Cell Carcinoma: The Most Common Skin Cancer
Basal cell carcinoma, which is also called basal cell skin cancer, is the most common form of skin cancer, accounting for about 80 percent of all cases.
Rates of basal cell carcinoma have been increasing. Experts believe this is due to more sun exposure, longer lives, and better skin cancer detection methods.
This type of cancer begins in the skins basal cells, which are found in the outermost layer, the epidermis. They usually develop on areas that are exposed to the sun, like the face, head, and neck.
Basal cell carcinomas may look like:
- A flesh-colored, round growth
- A pinkish patch of skin
- A bleeding or scabbing sore that heals and then comes back
They typically grow slowly and dont spread to other areas of the body. But, if these cancers arent treated, they can expand deeper and penetrate into nerves and bones.
Though its rare, basal cell carcinoma can be life-threatening. Experts believe that about 2,000 people in the United States die each year from basal cell carcinoma or squamous cell carcinoma.
Some risk factors that increase your chances of having a basal cell carcinoma include:
- Being exposed to the sun or indoor tanning
- Having a history of skin cancer
- Being over age 50
- Having chronic infections, skin inflammation, or a weakened immune system
- Being exposed to industrial compounds, radiation, coal tar, or arsenic
- Having an inherited disorder, such as nevoid basal cell carcinoma syndrome or xeroderma pigmentosum
How Are Moles Evaluated
If you find a mole or spot that has any ABCDE’s of melanoma — or one that’s tender, itching, oozing, scaly, doesn’t heal or has redness or swelling beyond the mole — see a doctor. Your doctor may want to remove a tissue sample from the mole and biopsy it. If found to be cancerous, the entire mole and a rim of normal skin around it will be removed and the wound stitched closed. Additional treatment may be needed.
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Amelanotic Melanoma: It Doesnt Look Like Other Melanomas
Odds are, if you have spent time on SkinCancer.org, you know the classic ABCDE warning signs of melanoma: Asymmetry, Border irregularity, Color variations, Diameter over ¼ inch or Dark in color, and Evolution or change. But did you know that some melanomas have very different features?
For example, certain melanomas may have no color at all. Physicians refer to these as amelanotic melanomas, because they are conspicuously missing melanin, the dark pigment that gives most moles and melanomas their color. These unpigmented melanomas may be pinkish-looking, reddish, purple, normal skin color or essentially clear and colorless.
- An example of a flat, amelanotic, superficial spreading melanoma on the leg.
- A nodular melanoma developing within an amelanotic melanoma in situ on the scalp.
While these melanomas lack pigment, they may have other melanoma warning signs to stay on the lookout for, such as asymmetry and an irregular border. In addition, more and more physicians today stress the importance of the E in the ABCDEs evolution or change. The Skin Cancer Foundation recommends that you examine your skin head to toe every month, especially looking for any new mole or any sign of change in an existing mole. If you spot any change that you consider suspicious, see a skin specialist without delay.
To help you spot unusual melanomas, you can also use early recognition strategies beyond the ABCDEs, such as the Ugly Duckling sign.
Who Gets Skin Cancer And Why
Sun exposure is the biggest cause of skin cancer. But it doesn’t explain skin cancers that develop on skin not ordinarily exposed to sunlight. Exposure to environmental hazards, radiation treatment, and even heredity may play a role. Although anyone can get skin cancer, the risk is greatest for people who have:
- Fair skin or light-colored eyes
- An abundance of large and irregularly-shaped moles
- A family history of skin cancer
- A history of excessive sun exposure or blistering sunburns
- Lived at high altitudes or with year-round sunshine
- Received radiation treatments
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Each Type Of Skin Cancer Looks A Little Different
According to Dr. Wofford, Most people think of melanoma, which typically looks like a dark spot on the skin, but actually, there are many different types of skin cancer. Each type looks a little different, so in addition to understanding how to tell the difference between benign skin spots and cancerous lesions, it may be beneficial to learn a little more about the appearance of each type of skin cancer.
What Are The Abcdes Of Melanoma
Dermatologists use the ABCDE criteria to analyze moles and check for warning signs that may indicate a melanoma.
A – asymmetry
Normal moles are symmetrical in shape, meaning if you were to draw a line down the middle, both halves would look the same. Asymmetrical moles are abnormal and should be checked by a doctor.
The image on the left is an example of a symmetrical, benign mole. The image on the right shows what an asymmetrical mole looks like. The two sides of the mole do not match.
B – borders
Blurred, jagged, or irregular borders are a sign that the mole could be cancerous. If the edges of your mole are uneven, it is good to have it checked out by a doctor.
The image on the left shows a mole with defined borders while the mole image on the right has irregular and uneven borders.
C – colours
Colour can help distinguish a normal mole from an abnormal one. Healthy moles usually have one even colour, while irregular moles can contain multiple shades of colour. It is also important to make note of any blue or white colours that may be present in your moles, as this is a sign that the mole may be cancerous. If your mole has multiple colours or shades, you should speak with your doctor.
The mole in the left image is monotone and is healthy. The image on the right contains multiple shades of red and is cancerous.
D – diameter
The image on the right is larger than 6 mm and is cancerous.
E – evolution
Definition
Signs
Superficial BCC
Clinical Image
Clinical Image
Clinical Image
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How To Check Your Skin
- Make sure you check your entire body, as skin cancers can sometimes occur on parts of the body that are not exposed to the sun, such as the soles of the feet, between fingers and toes and under nails.
- Undress completely and make sure you have good light.
- Use a mirror to check hard to see spots, like your back and scalp, or get a family member, partner or friend to check for you.
What Is A Melanocyte
Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes in the melanocytes, resulting in uncontrolled cellular growth.
About Melanin
Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not. Thats why people with darker skin are at lower risk for developing melanoma than fair-skinned people who, due to lack of eumelanin, are more susceptible to sun damage, burning and skin cancer.
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What Are The Signs Of Melanoma
Knowing how to spot melanoma is important because early melanomas are highly treatable. Melanoma can appear as moles, scaly patches, open sores or raised bumps.
Use the American Academy of Dermatology’s “ABCDE” memory device to learn the warning signs that a spot on your skin may be melanoma:
- Asymmetry: One half does not match the other half.
- Border: The edges are not smooth.
- Color: The color is mottled and uneven, with shades of brown, black, gray, red or white.
- Diameter: The spot is greater than the tip of a pencil eraser .
- Evolving: The spot is new or changing in size, shape or color.
Some melanomas don’t fit the ABCDE rule, so tell your doctor about any sores that won’t go away, unusual bumps or rashes or changes in your skin or in any existing moles.
Another tool to recognize melanoma is the ugly duckling sign. If one of your moles looks different from the others, its the ugly duckling and should be seen by a dermatologist.
Melanomas That Could Be Mistaken For A Common Skin Problem
Melanoma that looks like a bruise
Melanoma can develop anywhere on the skin, including the bottom of the foot, where it can look like a bruise as shown here.
Melanoma that looks like a cyst
This reddish nodule looks a lot like a cyst, but testing proved that it was a melanoma.
Dark spot
In people of African descent, melanoma tends to develop on the palm, bottom of the foot, or under or around a nail.
Did you spot the asymmetry, uneven border, varied color, and diameter larger than that of a pencil eraser?
Dark line beneath a nail
Melanoma can develop under a fingernail or toenail, looking like a brown line as shown here.
While this line is thin, some are much thicker. The lines can also be much darker.
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What Are The Signs And Symptoms Of Skin Cancer
Skin Cancer Symptoms
If a spot on your skin looks suspicious to you, theres one cardinal rule: Get to a doctor to have it checked out. Thats because all three of the most common skin cancers including the most dangerous, melanoma are 99 percent curable if diagnosed and removed early, according to the Skin Cancer Foundation .
Thats why a regular regimen of self-checks, as well as establishing a relationship with a dermatologist, is important in spotting skin cancer symptoms and treating skin cancer early and effectively.
The SCF recommends scheduling an appointment once a year with a dermatologist for a full-body skin check to screen for skin cancer.
If youre in a higher risk group, such as you have a history of atypical moles, your dermatologist may suggest coming in more often.
In advance of your appointment, you should examine your own body in order to start a conversation with your doctor about any skin changes. Avoid nail polish and makeup and keep your hair down so that you dont inadvertently keep any suspect moles hidden.
What Are Skin Metastases
Skin metastases are secondary breast cancers that form on or just below the skin.
Secondary breast cancer happens when cancer cells spread from the breast to other parts of the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system.
The most common sites affected are the areas near where the original breast cancer was for example the skin of the chest wall or around the surgical scar. Less commonly, skin metastases can occur on other areas of skin, such as on the scalp, neck, abdomen, back and upper limbs.
About a fifth of people with secondary breast cancer will develop skin metastases.
This is not the same as having cancer that starts in the skin. The cells that have spread to the skin are breast cancer cells.
Its also different to local recurrence, which is when primary breast cancer has come back in the chest or breast area, or in the skin near the original site or scar.
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Squamous Cell Skin Cancers
Squamous cell skin cancers can vary in how they look. They usually occur on areas of skin exposed to the sun like the scalp or ear.
Thanks to Dr Charlotte Proby for her permission and the photography.
You should see your doctor if you have:
- a spot or sore that doesn’t heal within 4 weeks
- a spot or sore that hurts, is itchy, crusty, scabs over, or bleeds for more than 4 weeks
- areas where the skin has broken down and doesn’t heal within 4 weeks, and you can’t think of a reason for this change
Your doctor can decide whether you need any tests.
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Cancer and its management J Tobias and D HochhauserBlackwell, 2015
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Cancer: Principles and Practice of Oncology VT De Vita, TS Lawrence and SA RosenbergWolters Kluwer, 2018
When To See A Doctor About Skin Cancer
Many people, especially those who have fair coloring or have had extensive sun exposure, should periodically check their entire body for suggestive moles and lesions.
Have your primary healthcare professional or a skin specialist check any moles or spots that concern you.
See your healthcare professional to check your skin if you notice any changes in the size, shape, color, or texture of pigmented areas .
If you have skin cancer, your skin specialist or cancer specialist will talk to you about symptoms of metastatic disease that might require care in a hospital.
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Dark Stipe Under Nail
Skin cancer doesn’t just show up in obvious placesit can also be more hidden. Although rare, acral-lentiginous melanoma can show up as a narrow, dark streak under your nail, whether that’s your fingers or toes. According to the Mayo Clinic, it’s something that happens more commonly in African Americans or anyone with darker skin, but it’s something for everyone to be aware of.
Melanoma: The Deadliest Skin Cancer
Melanoma is the most serious type of skin cancer, because it tends to spread if its not treated early.
This cancer starts in the melanocytes cells in the epidermis that make pigment.
About 100,350 new melanomas are diagnosed each year.
Risk factors for melanoma include:
- Having fair skin, light eyes, freckles, or red or blond hair
- Having a history of blistering sunburns
- Being exposed to sunlight or tanning beds
- Living closer to the equator or at a higher elevation
- Having a family history of melanoma
- Having many moles or unusual-looking moles
- Having a weakened immune system
Melanoma can develop within a mole that you already have, or it can pop up as a new dark spot on your skin.
This cancer can form anywhere on your body, but it most often affects areas that have had sun exposure, such as the back, legs, arms, and face. Melanomas can also develop on the soles of your feet, palms of your hands, or fingernail beds.
Signs to watch out for include:
- A mole that changes in color, size, or how it feels
- A mole that bleeds
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Warning Signs Of Basal Cell Carcinoma That You Could Mistake As Harmless
Warning sign: A pink or reddish growth that dips in the centerCan be mistaken for: A skin injury or acne scar
A pink or reddish growth that dips in the center
The BCC on this patients cheek could be mistaken for a minor skin injury.
Warning sign: A growth or scaly patch of skin on or near the earCan be mistaken for: Scaly, dry skin, minor injury, or scar
A growth or scaly patch of skin on or near the ear
BCC often develops on or near an ear, and this one could be mistaken for a minor skin injury.
Warning sign: A sore that doesn’t heal and may bleed, ooze, or crust overCan be mistaken for: Sore or pimple
A sore that doesn’t heal, or heals and returns
This patient mistook the BCC on his nose for a non-healing pimple.
Warning sign: A scaly, slightly raised patch of irritated skin, which could be red, pink, or another colorCan be mistaken for: Dry, irritated skin, especially if it’s red or pink
A scaly, slightly raised patch of irritated skin
This BCC could be mistaken for a patch of dry, irritated skin.
Warning sign: A round growth that may be pink, red, brown, black, tan, or the same color as your skinCan be mistaken for: A mole, wart, or other harmless growth.
A round growth that may be same color as your skin
Would you recognize this as a skin cancer, or would you dismiss it as a harmless growth on your face?