Melanoma Skin Cancer: Causes, Symptoms, & Treatment Options

Melanoma is a type of skin cancer that develops in melanocytes, the cells responsible for producing melanin—the pigment that gives skin its color. Unlike more common skin cancers like basal cell carcinoma or squamous cell carcinoma, melanoma has a greater tendency to grow quickly and spread to other parts of the body if not caught early.

It can appear anywhere on the skin, even in areas not typically exposed to the sun, such as the soles of the feet, under fingernails, or in the mucous membranes. Often, it begins as a new mole or changes in an existing mole, showing irregular borders, varied colors, or asymmetry. 

These characteristics make self-monitoring important. For example, someone might notice a small dark spot on their shoulder that starts growing unevenly and becomes multicolored—this could be an early warning sign of melanoma.

Why Is Melanoma Considered Dangerous?

Melanoma is considered more dangerous than many other types of skin cancer due to its potential to metastasize—or spread—beyond the skin. When melanoma cells enter the bloodstream or lymphatic system, they can travel to vital organs such as the lungs, liver, brain, or bones. This is why early detection and treatment are key.

In its early stages, melanoma is often highly treatable, usually with surgical removal. However, once it has spread, treatment becomes more complex and the prognosis can worsen. 

For instance, while stage I melanoma may be successfully treated with outpatient surgery, stage IV cases often require a combination of immunotherapy, targeted treatments, or even clinical trials.

Who Is At Risk?

Anyone can develop melanoma, but some individuals carry a higher risk. People with fair skin, light-colored eyes, or red or blonde hair are more susceptible due to lower levels of melanin, which offers some natural protection from UV radiation. 

However, it's a misconception that darker-skinned individuals are immune. Although less common, melanoma in people with darker skin often appears in less visible places, like the palms of the hands or soles of the feet, and is frequently diagnosed at later stages.

Other risk factors include having a high number of moles, a history of severe sunburns, or living in sunny climates. For example, outdoor workers, swimmers, and those who frequently engage in recreational activities under direct sunlight without adequate protection may face an increased risk.

Causes and Risk Factors

Family History

Having a family history of melanoma—especially among first-degree relatives like parents, siblings, or children—can significantly increase your risk. 

While about 10% of melanoma cases occur in people with a family history, only 1% to 2% are considered “familial melanoma,” where two or more close relatives are affected. In such cases, the hereditary risk can be 30 to 70 times higher than average. Most melanomas, however, are sporadic and not inherited.

Genetic and Environmental Triggers

In addition to genetic predispositions, environmental exposures play a major role in developing melanoma. Some individuals inherit gene mutations that make their skin cells more prone to developing cancer. For example, mutations in the CDKN2A or BRAF gene can significantly raise melanoma risk.

When it comes to repeated exposure to ultraviolet (UV) radiation, whether from sunlight or artificial sources, is the primary environmental factor. UV rays can damage the DNA in skin cells, and over time, these damaged cells may become cancerous.

UV Exposure and Tanning Beds

Ultraviolet exposure is a leading cause of melanoma. This includes natural sunlight and artificial sources like tanning beds. Tanning, especially during adolescence, can dramatically increase the risk. Studies have shown that using tanning beds before age 35 can raise melanoma risk by up to 75%.

People often underestimate how much sun they receive during everyday activities—gardening, walking a dog, or driving with the windows down. The danger lies not just in long beach vacations, but in routine exposure without sun protection. 

Wearing broad-spectrum sunscreen, seeking shade, and covering up with clothing and hats are essential protective steps.

Skin Type Influence

Certain skin types are more vulnerable. People with Fitzpatrick skin types I and II—those who burn easily and tan poorly—face a higher likelihood of developing melanoma. Also, individuals with many atypical moles (dysplastic nevi) should be extra cautious, as these can serve as precursors to melanoma.

Early Symptoms and Warning Signs

ABCDE Rule for Spotting Melanoma

One of the most effective tools for identifying melanoma in its early stages is the ABCDE rule. This guideline helps people differentiate between harmless moles and those that may be cancerous:

• A – Asymmetry: One half of the mole doesn't match the other half in shape.
• B – Border: The edges are irregular, scalloped, or poorly defined.
• C – Color: Varies from one area to another; may include shades of tan, brown, black, and sometimes white, red, or blue.
• D – Diameter: Larger than 6 millimeters (about the size of a pencil eraser), although melanomas can be smaller.
• E – Evolving: Any change in size, shape, color, elevation, or another trait—or new symptoms such as bleeding, itching, or crusting.
  
  

For example, if someone notices a mole on their arm that begins to change color and grows over a few months, it’s wise to have it examined by a healthcare provider. Early recognition can make a significant difference in treatment outcomes.

Is Melanoma Raised or Flat?

Melanoma may appear as a new lesion or as visible changes in an existing mole, often following the ABCDE pattern (Asymmetry, Border irregularity, Color variation, Diameter over 6mm, and Evolving features). This variability in how melanoma presents can make it tricky to detect.

Early melanomas are often flat or slightly raised and may resemble a harmless freckle or mole. Because they can appear subtle—especially in less visible areas—they’re easy to overlook.

As melanoma progresses, it may become more elevated. Nodular melanoma, a more aggressive subtype, typically appears as a raised bump that may be firm and dome-shaped, often blue-black or red in color. It tends to grow quickly and may bleed or ooze.

Because of this range in appearance, it’s essential to focus on changes over time rather than relying solely on whether a spot is raised or flat. 

Visual Guide to Common Presentations

Melanoma does not have one standard appearance. It can show up as:

• A dark spot that looks different from others on the body.
• A pink or red patch that resembles eczema.
• A lesion with multiple colors and irregular edges.
• A black streak under a nail (especially common in acral lentiginous melanoma, which occurs more often in people with darker skin tones).
• A new growth on skin that previously appeared clear.
  
  

Due to this variability, regular skin checks—either self-exams or by a healthcare provider—are vital. People should take note of new or changing marks, especially those that don't resemble other moles on their body.

Diagnosis and Staging

Clinical Exams and Biopsies

When a suspicious lesion is found, a healthcare provider will begin with a physical examination and a detailed history. They may use a dermatoscope, a specialized tool that allows for closer inspection of skin features.

If melanoma is suspected, the next step is typically a skin biopsy. This involves removing part or all of the abnormal area for laboratory testing. Common biopsy types include:

• Excisional biopsy (removing the entire lesion)
• Incisional biopsy (removing part of the lesion)
• Punch biopsy (using a circular blade to remove a small sample)
  
  

The biopsy helps confirm whether the lesion is melanoma and, if so, what type and how deeply it has penetrated the skin.

Understanding the TNM Staging System

Once melanoma is diagnosed, it is staged using the TNM system:

• T (Tumor): Measures the thickness and ulceration status of the tumor.
• N (Nodes): Indicates whether the cancer has spread to nearby lymph nodes.
• M (Metastasis): Determines if the cancer has spread to distant parts of the body.
  
  

Stages range from Stage 0 (in situ melanoma), where the cancer is only in the top layer of skin, to Stage IV, where it has spread to distant organs. For example, a Stage II melanoma may be more than 2mm thick and ulcerated but not yet spread, while Stage III may involve nearby lymph nodes.

Accurate staging is essential to selecting the most appropriate treatment plan and understanding the potential prognosis.

How Melanoma Spreads in the Body

First Organs Affected by Metastasis

When melanoma spreads beyond the skin, it often follows a predictable path, starting with nearby lymph nodes. These nodes act as filters, and once melanoma cells reach them, the risk of further spread increases.

From there, melanoma typically metastasizes to organs such as:

• Lungs – This is one of the most common sites for distant metastasis. Patients might experience symptoms like persistent cough or shortness of breath.
• Liver – When melanoma spreads to the liver, it may cause fatigue, weight loss, or abdominal pain.
• Brain – Melanoma can form tumors in the brain, leading to headaches, seizures, or changes in behavior.
• Bones – This may result in pain, fractures, or elevated calcium levels in the blood.
  
  

Not all patients experience symptoms immediately, which is why imaging studies—like CT scans or PET scans—are often used to monitor disease progression.

How Quickly Does Melanoma Spread?

Melanoma can progress rapidly, particularly aggressive subtypes like nodular melanoma or acral lentiginous melanoma. Some forms may grow deeply into the skin within a few weeks or months, increasing the risk of spread.

However, not all melanomas spread quickly. Superficial spreading melanoma, the most common type, may develop slowly over years before invading deeper layers.

Factors influencing the rate of spread include:

• Tumor thickness (Breslow depth) – Thicker melanomas tend to spread faster.
• Ulceration – Indicates the skin over the tumor is broken, a sign of more aggressive behavior.
• Mitotic rate – Refers to how quickly the cancer cells are dividing.

Because of this variability, even small or seemingly harmless lesions should be evaluated early. Early intervention drastically improves the chance of successful treatment.

Can You Have Melanoma for 2 Years and Not Know?

Yes, it is possible to have melanoma for an extended period without realizing it. Early-stage melanomas can grow slowly and remain asymptomatic, especially in areas not easily seen—like the back, scalp, or under the nails. 

In some cases, people dismiss changes in moles as harmless or confuse them with benign skin conditions.

There have been cases where individuals unknowingly lived with melanoma for over a year before seeking medical advice. 

Unfortunately, this delay can allow the cancer to progress to more advanced stages, making treatment more complicated. This underscores the importance of routine skin checks and consulting a healthcare provider if something looks or feels unusual.

Treatment Options for Melanoma

Surgery

Ideally, confirmed melanoma should be surgically removed within a few weeks. Timely excision helps prevent deeper invasion or spread.

There are different surgical approaches based on the stage of the melanoma:

• Wide local excision – Removes the melanoma and a border of normal skin.
• Sentinel lymph node biopsy – Determines if the cancer has spread to the lymph nodes.
• Lymph node dissection – May be performed if the sentinel node is positive.
  
  

While wide local excision is the standard surgical approach for most melanomas, Mohs micrographic surgery may be considered in select cases—typically for melanoma in situ (such as lentigo maligna) located on cosmetically sensitive areas like the face.

This technique involves the precise removal of cancerous tissue layer by layer, with each layer examined under a microscope in real time. It allows for complete margin control while preserving as much healthy tissue as possible.

Immunotherapy and Targeted Therapy

In more advanced stages, particularly when melanoma has spread, systemic treatments are considered.

Immunotherapy uses the body’s immune system to fight cancer. Drugs like nivolumab and pembrolizumab (known as checkpoint inhibitors) help activate immune cells that attack melanoma cells. These have significantly improved survival rates, even in Stage IV patients.

Targeted therapy works by interfering with specific genetic mutations in melanoma cells, such as the BRAF mutation. Medications like vemurafenib or dabrafenib, often combined with MEK inhibitors, are effective for patients who test positive for these mutations.

These treatments are typically given orally or intravenously and may be used alone or alongside other therapies.

Radiation and Chemotherapy

Radiation therapy is generally used for palliative purposes—helping relieve symptoms when melanoma has spread to areas like the brain or bones. It can shrink tumors and reduce pain or pressure.

Chemotherapy, once a mainstay, is now less commonly used due to the success of immunotherapy and targeted treatments. However, it may still be employed in certain cases where other treatments have failed. 

Agents like dacarbazine or temozolomide may be used, but their effectiveness is limited compared to newer options.

How Quickly Should Melanoma Be Removed?

Melanoma should be treated without unnecessary delay once diagnosed. Prompt surgical removal is strongly recommended, as early excision helps reduce the risk of the cancer growing deeper or spreading to other parts of the body.

The specific timing of surgery can depend on several clinical factors, including the tumor’s thickness, location, subtype, and overall health of the patient. In general, healthcare guidelines support aiming for excision within a few weeks of diagnosis, when feasible.

There is no strict timeframe, as the need for surgery may be adjusted based on the case’s urgency, surgical availability, and patient-specific risks.

Prevention and Early Detection

Sun Safety Tips

Preventing melanoma begins with protecting your skin from harmful UV rays. Practical sun safety habits include:

• Applying sunscreen 15–30 minutes before going outdoors and reapplying every two hours, or after swimming or sweating.
• Wearing sun-protective clothing, like long sleeves and wide-brimmed hats.
• Seeking shade, especially during midday hours.
• Avoiding intentional tanning, both outdoors and in salons.

Even small, repeated sunburns in childhood can increase melanoma risk later in life, so sun safety should be practiced consistently from a young age.

Self-Exams and Professional Screenings'

Routine self-exams can help detect melanoma early. Use a mirror to examine your skin from head to toe monthly, and keep an eye out for any new moles or changes in existing ones. The “ugly duckling” rule—where a mole looks different from others on your body—is another simple but effective screening method.

In addition to self-checks, regular dermatologic exams are vital, especially for those with a family history of melanoma or many moles. A dermatologist can use tools like dermatoscopy to examine lesions more closely and decide if a biopsy is needed.

Considerations for People of Color

Melanoma can occur in all skin tones, though it is less common in people with darker complexions. Unfortunately, it is often diagnosed at later stages in these populations, which contributes to worse outcomes.

In people of color, melanoma frequently appears in less sun-exposed areas, such as:

• Soles of the feet
• Palms of the hands
• Under fingernails or toenails
• Inside the mouth or genital areas

Because these sites are not usually included in routine sun checks, it's crucial to inspect them regularly and bring any unusual changes to a doctor’s attention.

What Are the Odds of Dying from Melanoma?

Melanoma’s mortality risk varies significantly depending on how early it is diagnosed. The five-year survival rate for localized melanoma (Stage I or II) is around 99%, but this number drops sharply as the cancer advances. 

For Stage III melanoma, where the cancer has spread to nearby lymph nodes, the five-year survival is approximately 68%. Stage IV, involving distant organs, carries a much lower survival rate—around 30% or less.

These statistics highlight the importance of early detection and timely treatment. Modern therapies, especially immunotherapy, have improved survival even for advanced melanoma, but outcomes remain best when the disease is caught early.

Long-Term Survival by Stage

Here’s a general breakdown of survival rates by melanoma stage:

• Stage 0 (in situ): Nearly 100%
• Stage I: 98–99%
• Stage II: 80–90%, depending on depth and ulceration
• Stage III or Regional melanoma: 60–70%, influenced by number of affected lymph nodes
• Stage IV or Metastatic Melanoma: Around 15–30%, depending on response to treatment and metastasis location
  
  

It’s important to remember that these figures are averages and individual outcomes can vary. Factors like age, overall health, and access to timely treatment all influence prognosis.

Has Anyone Been Cured of Stage 4 Melanoma?

Yes, although rare, there are documented cases of individuals with Stage 4 melanoma achieving complete remission. These cases are typically linked to breakthroughs in immunotherapy, such as in the case of Bradley Evans.

Bob Hofferman, who was referred to the National Institutes of Health also had success with an immunotherapy clinical trial.

While not every Stage 4 patient will experience the same outcome, these success stories underscore the potential of newer therapies and the value of clinical trials in offering hope.

Living With Melanoma

A melanoma diagnosis can be emotionally overwhelming. Patients often experience a mix of fear, anxiety, sadness, and uncertainty about their future. This emotional toll can affect decision-making, adherence to treatment, and overall quality of life.

Seeking psychological support is an important part of managing melanoma. Options include:

• Counseling or therapy to help process the diagnosis and treatment journey.
• Support groups, where patients can share experiences, challenges, and encouragement.
• Mindfulness and stress-reduction techniques, such as meditation or guided breathing, which have shown benefits in reducing anxiety and improving coping skills.

Family members and caregivers also play a vital role. Providing open communication, practical support, and emotional encouragement can help patients feel less isolated during treatment.

Lifestyle Adjustments and What to Avoid

After a melanoma diagnosis, making certain lifestyle changes can help manage the condition and reduce the risk of recurrence:

• Avoid excessive sun exposure, especially between 10 a.m. and 4 p.m., when UV rays are strongest.
• Use broad-spectrum sunscreen with SPF 30 or higher, even on cloudy days.
• Wear protective clothing, including hats and sunglasses, when outdoors.
• Avoid tanning beds, which emit concentrated UV radiation.
  
  

Beyond sun protection, maintaining overall health is important. Eating a balanced diet, staying active, and managing stress may support recovery and general well-being. Alcohol and tobacco should be limited or avoided, as they can impair the body’s healing and immune function.

Can Your Body Fight Melanoma on Its Own?

The immune system can sometimes detect and destroy abnormal cells, including those that become cancerous. However, melanoma has evolved ways to evade immune detection, which is why it often progresses without noticeable symptoms.

In rare cases, the immune system may spontaneously attack and shrink melanoma tumors. Still, this response is typically not strong or consistent enough to eliminate the cancer entirely. 

That’s why immunotherapy—treatments that enhance the body’s immune response—is a cornerstone of advanced melanoma care. These therapies aim to give the immune system the boost it needs to recognize and target melanoma cells effectively.

Final Thoughts on Melanoma Awareness and Action Steps

Melanoma is a serious but increasingly manageable form of skin cancer—especially when caught early and treated properly. With May being Melanoma Awareness Month, now is the time to shine a spotlight on the importance of early detection, knowing your risk factors, and taking preventive steps that could ultimately save lives.

If you or a loved one is facing a melanoma diagnosis, know that you’re not alone. Staying informed, exploring all treatment options, and even seeking a second opinion can make a meaningful difference in your care journey.

FAQs

Can you live with melanoma long-term?

Yes, especially when diagnosed early, many people live long, healthy lives after treatment. Ongoing monitoring and skin protection are essential to reduce the risk of recurrence.

How do I know if a mole is cancerous?

A mole may be cancerous if it changes in size, shape, or color, or if it looks noticeably different from others on your body. Using the ABCDE rule can help you spot suspicious features.

Can melanoma return after treatment?

Yes, melanoma can recur even after successful treatment, especially within the first few years. Regular follow-up visits and skin checks are critical to catching any recurrence early.

What should I ask my doctor after a diagnosis?

Ask about your cancer stage, treatment options, potential side effects, and what to expect during recovery. You should also inquire about lifestyle changes and follow-up care.

How is melanoma different from other skin cancers?

Melanoma is more likely to spread to other parts of the body compared to basal cell or squamous cell carcinoma. It's considered the most aggressive form of skin cancer if not caught early.

Can melanoma be inherited?

Yes, a family history can increase your risk of melanoma. Inherited genetic mutations like CDKN2A can predispose individuals to developing the disease.