Melanoma
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Melanoma
Key questions about melanoma
Melanoma is a type of skin cancer. It develops in the skin cells called melanocytes.
Melanoma most often develops in areas that have been exposed to the sun. It can also start in areas that don’t receive much sun, such as the eye (uveal or ocular melanoma); nasal passages, mouth and genitals (mucosal melanoma); and the soles of the feet or palms of the hands, and under the nails (acral melanoma).
Other types of skin cancer include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). These are known as non-melanoma skin cancers or keratinocyte cancers, and they are far more common than melanoma. However, melanoma is considered the most serious form of skin cancer because it is more likely to spread to other parts of the body, especially if not found early. The earlier melanoma is found, the more successful treatment is likely to be.
Australia and New Zealand have the highest rates of melanoma in the world. Melanoma is the second most common cancer in men and the third most common cancer in women (excluding non-melanoma skin cancers). Every year in Australia, about 17,800 people are diagnosed with melanoma that has spread into the dermis (known as invasive melanoma). About 27,500 people are diagnosed each year with melanoma that is confined to the epidermis (melanoma in situ).
How melanoma looks can vary greatly. If you have lots of moles, a melanoma usually stands out and looks different from other moles. The first sign of melanoma is often a new spot or a change in an existing mole.
Signs of melanoma
ABCD signs
Asymmetry – Are the halves of each spot different?
Border – Are the edges uneven, scalloped or notched?
Colour – Are there differing shades and colour patches?
Diameter – Is the spot greater than 6 mm across, or is it smaller than 6 mm but growing larger?
EFG signs
Some types of melanoma, such as nodular and desmoplastic melanomas, don’t fit the ABCD guidelines.
Elevated – Is it raised?
Firm – Is it firm to touch?
Growing – Is it growing quickly?
New moles mostly appear during childhood and through to the 30s and 40s. However, adults of any age can develop new or changing spots. It is important to get to know your skin and check it regularly.
In a room with good light, undress completely and use a full-length mirror to check your whole body. For areas that are hard to see, use a handheld mirror or ask someone to help. It is also a good idea to take a photograph of your moles and spots so that you can compare them to an older image if you notice one has changed.
Look for spots that are new, different from other spots, or raised, firm and growing. Even if your doctor has said a spot is benign in the past, check for any changes in shape, size or colour. If you notice a new or changing spot, get it checked as soon as possible by your doctor.
Exposure to ultraviolet (UV) radiation is the cause of most types of skin cancer. If unprotected skin is exposed to the sun when the UV index is 3 or above or to other UV radiation, the structure and behaviour of the cells can change. This can permanently damage the skin, and the damage builds up every time a person spends time unprotected in the sun.
UV radiation most often comes from the sun, but it can also come from artificial sources such as solariums (also known as tanning beds or sun lamps). Solariums are now banned for commercial use in Australia because research shows that people who use solariums have a much greater risk of developing melanoma.
Anyone can develop melanoma. The risk is higher for people who have:
- unprotected exposure to UV radiation when the UV index is 3 or above, particularly a pattern of short, intense periods of sun exposure and sunburn, such as on weekends and holidays
- lots of moles (naevi), especially if the moles have an irregular shape and uneven colour
- pale or freckled skin, especially if it burns easily and doesn’t tan
- fair or red hair, and blue or green eyes
- a previous melanoma or other type of skin cancer
- a strong family history of melanoma
- a weakened immune system from using immunosuppressive medicines for a long time.
Family history of melanoma
Sometimes the risk of melanoma runs in families. Often, this is because family members have a similar skin type or a similar pattern of sun exposure in childhood.
About 2% of melanomas are linked to an inherited faulty gene. You may have an inherited faulty gene if 2 or more close relatives (parent, sibling or child) have been diagnosed with melanoma, particularly if they were diagnosed with more than one melanoma, or if they were diagnosed with melanoma before the age of 40.
People with a strong family history of melanoma should use sun protection and check their skin carefully for new moles or skin spots. From their early 20s, they should consider having a professional skin check by a doctor. This may be every year. Discuss the frequency with your doctor.
If you are concerned about your family risk factors, talk to your doctor about referral to a family cancer clinic. Visit the Centre for Genetics Education to find a family cancer clinic near you. To learn more, call Cancer Council 13 11 20.
What are the main types of melanoma?
Melanoma of the skin is known as cutaneous melanoma. The main subtypes of cutaneous melanoma are listed below. Some rarer types of melanoma start in other parts of the body. Mucosal melanoma can start in the tissues in the mouth, anus, urethra, vagina or nasal passages. Ocular melanoma can start inside the eye. Melanoma can also start in the central nervous system.
Superficial Spreading Melanoma
| How common is it? | Makes up 55–60% of melanomas. |
|---|---|
| Who gets it? | Most common type of melanoma in people under 40, but can occur at any age. |
| What does it look like? | Can start as a new brown or black spot that grows on the skin, or as an existing spot, freckle or mole that changes size, colour or shape. |
| Where is it found? | Can develop on any part of the body but especially the area between the shoulders and hip (trunk). |
| How does it grow? | Often grows slowly and becomes more dangerous when it invades the lower layer of the skin (dermis). |
Nodular Melanoma
| How common is it? | Makes up 10–15% of melanomas. |
|---|---|
| Who gets it? | Most commonly found in people over 65. |
| What does it look like? | Usually appears as a round, raised lump (nodule) on the skin that is pink, red, brown or black and feels firm to touch; may develop a crusty surface that bleeds easily. |
| Where is it found? | Usually found on sun-damaged skin. |
| How does it grow? | Fast-growing form of melanoma, spreading quickly into the lower layer of the skin (dermis). |
Lentigo Maligna Melanoma
| How common is it? | Makes up 10–15% of melanomas. |
|---|---|
| Who gets it? | Most people with this subtype are over 40. |
| What does it look like? | Begins as an enlarging pigmented spot. |
| Where is it found? | Mostly found on sun-damaged skin on the face, ears, neck or head. |
| How does it grow? | May grow slowly and superficially over many years before it grows deeper into the skin. |
Acral Lentiginous Melanoma
| How common is it? | Makes up 1–2% of melanomas. |
|---|---|
| Who gets it? | Mostly affects people over 40 with dark skin such as those of African, Asian and Hispanic backgrounds. |
| What does it look like? | Often appears as a colourless or lightly coloured area, may be mistaken for a stain, bruise or unusual wart; in the nails, can look like a long streak of pigment. |
| Where is it found? | Most commonly found on the palms of the hands, on the soles of the feet, or under the fingernails or toenails. |
| How does it grow? | Tends to grow slowly until it invades the lower layer of the skin (dermis). |
Desmoplastic Melanoma
| How common is it? | Makes up 1–2% of melanomas. |
|---|---|
| Who gets it? | Mostly affects people over 60. |
| What does it look like? | Starts as a firm, growing lump, often the same colour as your skin; may be mistaken for a scar and can be difficult to diagnose. |
| Where is it found? | Mostly found on sun-damaged skin on the head or neck, including the lips, nose and ears. |
| How does it grow? | Tends to be slower to spread than other subtypes, but often diagnosed later; sometimes can invade or spread via nerves. |
Which health professionals will I see?
You will probably start by seeing your general practitioner (GP). If a GP diagnoses or suspects melanoma, they may remove the spot (excision biopsy) or refer you to another doctor, such as a dermatologist or surgeon, for the biopsy. A pathologist will examine the biopsy specimen to confirm a melanoma diagnosis. Your doctors can arrange further tests and suggest ways to treat the melanoma. These options may be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. Some people choose to see a doctor at a skin cancer clinic. These are usually staffed by GPs with a specific interest in skin cancer.
Visiting a melanoma unit
Management and treatment for advanced melanoma is complex.
People with a melanoma thicker than 1 mm or less than 1 mm but with high-risk features, or a melanoma that has spread, may benefit from having treatment in a cancer treatment centre that has doctors who specialise in the treatment of advanced melanoma. These are located at hospitals in major cities around Australia. You will be able to see a range of health professionals who specialise in different aspects of your care.
To find a multidisciplinary melanoma unit near you, check with your doctor or call Cancer Council 13 11 20. Melanoma Patients Australia also provides a list of major melanoma units.
Most people with early melanoma do not need to go to one of these multidisciplinary melanoma units.
Health professionals you may see
| GP | checks skin for suspicious spots, may remove potential skin cancers and refer you to specialists |
|---|---|
| dermatologist | diagnoses, treats and manages skin conditions, including skin cancer |
| general surgeon | performs surgery to remove early melanoma and lymph nodes, and to reconstruct the skin |
| reconstructive (plastic) surgeon | performs surgery that restores, repairs or reconstructs the body’s appearance and function; may also remove lymph nodes |
| surgical oncologist | performs surgery to remove melanoma and conducts more complex surgery on the lymph nodes and other organs; can be a general surgeon or a reconstructive surgeon |
| medical oncologist | treats melanoma with drug therapies such as targeted therapy and immunotherapy |
| radiation oncologist | plans and delivers radiation therapy |
| cancer care coordinator | coordinates care, liaises with MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical nurse consultant (CNC) or clinical nurse specialist (CNS) |
| counsellor, social worker, psychologist | help you manage your emotional response to diagnosis and treatment |
| physiotherapist, occupational therapist | assist with physical and practical issues, including restoring movement and mobility after treatment and recommending aids and equipment |
| palliative care specialist and nurse | work closely with the GP and cancer team to help control symptoms and maintain quality of life |
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This information is reviewed by
This information was last reviewed March 2023 by the following expert content reviewers: Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland, Diamantina Institute, and Consultant, Dermatology Department, Princess Alexandra Hospital, QLD; A/Prof Matteo Carlino, Medical Oncologist, Blacktown and Westmead Hospitals, Melanoma Institute Australia and The University of Sydney, NSW; Prof Anne Cust, Deputy Director, The Daffodil Centre, The University of Sydney and Cancer Council NSW, Chair, National Skin Cancer Committee, Cancer Council and faculty member, Melanoma Institute Australia; Prof Diona Damian, Dermatologist, Head of Department, Dermatology, The University of Sydney at Royal Prince Alfred Hospital, NSW, and Melanoma Institute Australia; A/Prof Paul Fishburn, General Practitioner – Skin Cancer, Norwest Skin Cancer Clinic, NSW and The University of Queensland; Claire Kelly, National Support Manager, and Emma Zurawel, Telehealth Nurse, Melanoma Patients Australia; Prof John Kelly, Consultant Dermatologist, Victorian Melanoma Service, The Alfred Melbourne and Monash University, VIC; Liz King, Manager, Skin Cancer Prevention Unit, Cancer Council NSW; Lee-Ann Lovegrove, Consumer; Lynda McKinley, 13 11 20 Consultant, Cancer Council Queensland; Angelica Miller, Melanoma Community Support Nurse, Melanoma Institute Australia incorporating melanomaWA, and Cancer Wellness Centre, WA; Dr Amelia Smit, Research Fellow, Melanoma and Skin Cancer, The Daffodil Centre, The University of Sydney and Cancer Council NSW; Prof Andrew Spillane, Professor of Surgical Oncology, The University of Sydney, The Mater and Royal North Shore Hospitals, NSW, and Melanoma Institute Australia; Kylie Tilley, Consumer; A/Prof Tim Wang, Radiation Oncologist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW.