Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 12, 2016

Melanoma is the most serious type of skin cancer. It begins in the melanocytes, which is a type of cell that produces melanin, a pigment that darkens the skin. Melanoma is curable in most cases when it is caught early.


Definition & Facts

The most common type of melanoma occurs on areas of the skin that have been exposed to the sun. This is because the melanocytes darken to protect the deeper layers of the skin from the adverse effects that the sun can have. Melanoma is often found on the neck or face though it is also commonly found on the chest, back, and legs. A rarer type of melanoma has been reported on patient's eyes (ocular melanoma), mouth, or vagina (mucosal melanoma).

Symptoms & Complaints

Melanoma can sometimes be difficult for patients to identify without the help of a physician. It often will just appear to be a mole. But physicians will usually apply the ABCDE method to assess symptoms with each letter of the acronym representing a common symptom:

  • Asymmetry. Moles that are not cancerous will be symmetrical. This means that if one draws a line through the middle of it, both sides will be identical. However, asymmetry in the the mole is a possible symptom of melanoma.
  • Border. The mole will have uneven shapes or borders. The edges may be notched.
  • Color. A benign mole will be represented by a single shade of brown. Melanoma, on the other hand, could host multiple colors, including tan, black, brown, or even red and blue.
  • Diameter. Moles are usually pretty small in diameter. But melanoma will usually exceed ¼ inch, or 6mm (although melanoma may be smaller).
  • Evolving. A benign mole does not evolve or grow. Melanoma does. Over the course of time, the patient will report that it is growing larger, evolving.

Other symptoms may include lesions that do not heal, swollen skin, pain, or itchiness.


Melanoma is caused by the out-of-control growth of melanocytes. This rapid, abnormal growth is caused by DNA damage initiated most often by exposure to UV light radiation. Those with fairer skin are more at risk of developing melanoma as are those who have family members who have been diagnosed with melanoma. There is a strong genetic factor with scientists discovering a defect in the gene, BRAF as triggering nearly half of all melanoma cases.

Diagnosis & Tests

Suspicious moles can often be detected on sight. Most patients are familiar enough with their body to know what an abnormality looks like. Many physicians recommend that patients conduct routine analysis of their skin from head to toe, using mirrors to look at their back and their shoulders. They also recommend patients have a doctor analyze their skin during a physical examination particularly if the patient believes that they might have a suspicious mole.

Beyond that, doctors will perform tests to accurately diagnose their patient with melanoma. These tests are known as biopsies, in which part or all of the mole is analyzed. Biopsies can come in different forms. First, there is a punch biopsy. The doctor will use a tool with a circular blade and punch through multiple layers of skin from the epidermis, dermis, all the way into the subcutaneous fat, removing a sample. Second, there is the incisional biopsy. This occurs when the doctor removes just a part of the suspicious mole for testing. Third, there is the excisional biopsy, wherein the entire mole is removed for testing.

Treatment & Therapy

Methods of treatment will usually vary from patient to patient and will depend on their physical health as well as their personal choices. If melanoma is caught early, treatment is often as simple as a minor surgery to remove the mole. After surgery, the patient will consider themselves free of cancer.

In some cases, though, this is not an option because the cancer has spread or metastasized too far. Sometimes the physician will need to remove the affected lymph nodes. They may put the patient on chemotherapy so as to destroy the cancer. Physicians may also treat melanoma with radiation therapy, which uses X-rays to kill cancerous cells.

Alternatively, they may engage in biological therapy which strengthens the body's immune system to fight the cancer. Finally, doctors may put their patients on targeted therapy, which will identify and target weaknesses in cancerous cells.

Prevention & Prophylaxis

Since the most common hypothesis for the cause of melanoma is over-exposure to UV light, prevention entails protecting oneself from UV light. The solutions include avoiding tanning beds, wearing sunscreen or staying out of the sun. Physicians also recommend patients to familiarize themselves with their own skin and to get regular checkups.

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