Melanoma

What is melanoma?

Melanoma, also called malignant melanoma, is a cancer that usually starts in the skin. It can start in a mole or in normal-looking skin.

Melanoma develops from skin cells called melanocytes. These cells make melanin which gives our skin its colour.

UV radiation from sunlight, sunbeds or sunlamps can build up and damage the DNA (genetic material) in melanocytes. They then start to grow and divide more quickly than usual and can develop into melanoma.

There are 4 main types of skin melanoma.

Superficial spreading melanoma

This is the most common type of melanoma. It is most often found on the arms, legs, chest and back. The melanoma cells usually grow slowly at first and spread out across the surface of the skin.
Nodular melanoma

This is the second most common type of melanoma. It can grow more quickly than other melanomas. It is also more likely to lose its colour when growing – becoming red rather than black. It is more commonly found on the chest, back, head or neck.
Lentigo maligna melanoma

This type of melanoma is less common. It is usually found in older people, in areas of skin that have had a lot of sun exposure, such as the face and neck. It develops from a slow-growing, pre-cancerous condition called a lentigo maligna. Lentigo maligna is only in the upper layer of skin called the epidermis. It is sometimes called an insitu melanoma.

Lentigo maligna usually looks flat, like a stain or large freckle on the skin. It is sometimes called a Hutchinson’s freckle.

If it spreads into deeper layers of skin, it is no longer pre-cancerous and is called lentigo maligna melanoma. Even when it becomes a lentigo maligna melanoma, it is still usually slow-growing.
Acral lentiginous melanoma

This type of melanoma is rare. It is usually found on the palms of the hands, soles of the feet, or under fingernails or toenails. It is more common in people with black or brown skin. It is not thought to be caused by sun exposure.

If you have darker skin because of your ethnicity, it is important to check your skin for any dark spots or changes in these areas.
Other rare types of melanoma
Other rare types of melanoma include:

desmoplastic melanoma

amelanotic melanoma

spitzoid melanoma

malignant blue naevus.

We have more information about:

melanoma that comes back in the same area – this is called recurrent melanoma
melanoma that has spread to other parts of the body – this is called advanced melanoma

Rarely, melanoma can start in parts of the body that are not skin. We have separate information about melanoma that starts in:

the eye – called ocular melanoma
the anus and rectum (back passage) – called anorectal melanoma.

Related pages

What is cancer?

Symptoms of melanoma

The first symptom of melanoma skin cancer is usually a change in the shape, colour or size of a mole. It can be difficult to tell the difference between melanoma and a normal mole. We have more detail in our information about the signs and symptoms of melanoma.

Related pages

Do I have cancer?

Causes of melanoma

The biggest risk factor for melanoma is exposure to ultraviolet light (UV light). This can be through sunlight or sunbeds.

In the UK there are about 16,700 people diagnosed with melanoma each year. The numbers of people diagnosed with melanoma is rising.

Like most cancers it is more common in older people. But melanoma is more common in younger people in their teens and 20s than some other cancers.

We have more information about this, and other melanoma causes and risk factors.

Tests and diagnosis for melanoma

If you have any signs of a change in a mole or develop a new mole, you usually begin by seeing your GP. Your GP will check your mole and ask about any family history of cancer. If they think you may have a melanoma, they will refer you to a doctor who specialises in skin conditions called a dermatologist.

You should be seen at the hospital within 2 weeks.

At the hospital

The dermatologist uses a dermatoscope. This looks like a small magnifying glass, to look at your mole. They also check the rest of your skin and will ask you about any other skin changes or if you have any other unusual moles. They may also check the lymph nodes (glands) closest to the mole. This is to see if they look or feel swollen.

If you have an unusual mole, your dermatologist may advise checking it regularly rather than removing it. These moles are sometimes called dysplastic naevi. Your dermatologist may ask you to come back in a few months to check if the mole has changed. Or they may arrange for you to come back regularly to have photographs taken of the unusual mole.

If you have symptoms of melanoma, your mole will need to be removed so the specialist doctor can find out what it is. This is called an excision biopsy.

Waiting for tests results can be a difficult time, we have more information that can help.

Related pages

Tests to check your lymph nodes

If tests show the mole is melanoma, your doctor may suggest tests to check the lymph nodes nearby.

Not everyone needs these tests. It depends on how deep the melanoma is and if the lymph nodes look or feel swollen. Lymph node tests include:

Sentinel lymph node biopsy (SLNB)

A sentinel lymph node biopsy checks the lymph nodes closest to the melanoma. You may have this test even if your lymph nodes do not look or feel swollen. It can help to find very tiny amounts of melanoma that have spread to the lymph nodes.
Ultrasound

An ultrasound scan uses sound waves to make up a picture of an area of the body. The person doing the ultrasound spreads gel over the area where the lymph nodes are. They pass a small probe device, which makes sound waves, over this area. A computer changes the sound waves into a picture
Fine needle aspiration (FNA)

If the ultrasound scan of the lymph nodes is abnormal, the doctor will do a fine needle aspiration. The doctor puts a very fine needle into the lymph node and withdraws a sample of cells into the syringe. The sample is sent to the laboratory and examined under a microscope for melanoma cells.

Further tests

If the melanoma has spread to the lymph nodes, you may have the following tests to check if melanoma has spread anywhere else in the body:

CT scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.
PET-CT scan

A PET-CT scan is a combination of a CT scan and a PET scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.

Tests on the melanoma cells

Your doctor may arrange tests to look for certain gene changes (mutations) in the melanoma cells. The results of this type of testing tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you if you should need them.

Related pages

Stages of melanoma

The results of your tests help your doctors find out more about the size and position of the melanoma and whether it has spread. This is called staging.

Knowing the stage of the melanoma helps doctors decide on the best treatment for you.

Treatment for melanoma

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Most people will have surgery to remove more tissue from the area where the mole was removed. This is called a wide local excision. The aim is to remove all the cancer cells. For early melanoma this is often the only treatment you will need. Early melanoma means the cancer cells are only in the skin and have not spread from where the mole started.

Related pages

If melanoma has spread to nearby lymph nodes

If tests show the melanoma has spread to nearby lymph nodes, your doctor will talk to you about the best way of treating this.

You and your doctor may decide that having regular ultrasounds of your lymph nodes is the best option for you. These ultrasounds check if the cancer is growing in that area and if you need treatment.

Or your doctor may talk to you about having further treatment with targeted or immunotherapy drugs. This is called adjuvant treatment. It aims to reduce the risk of the melanoma coming back.

Sometimes your doctor may talk to you about having surgery to remove all the nearby lymph nodes. This may depend on the risk of the melanoma causing symptoms in that area.

Adjuvant treatment

Your doctor may offer you further treatment to reduce the risk of melanoma coming back after surgery. This is called adjuvant treatment. It is an option if there are factors that increases the risk the of melanoma coming back. It may be used for the following:

Stage 2 melanoma – you may have a type of immunotherapy drug called pembrolizumab.
Stage 3 melanoma – if tests show a BRAF gene mutation in the melanoma cells, you may have a combination of 2 targeted therapy drugs. These drugs are called dabrafenib and trametinib. If tests do not find a BRAF gene mutation, you may have one or, sometimes, a combination of immunotherapy drugs. These drugs are called Ipilimumab, pembrolizumab and nivolumab.

You usually have adjuvant treatment for up to 12 months. Your doctor and nurse will talk to you about the possible benefits and risks of having it. It is important to think about all these and how treatment and possible side effects may affect your daily life.

Sometimes your doctor may suggest not having treatment straightaway. They may do this if the risks of treatment outweigh the benefits. Instead your doctor may advise having regular appointments and tests.

Your specialist doctor or nurse will talk to you about the different treatment options and things to think about when making treatment decisions. You can then decide together what treatment is best for you. You may be offered some treatments as part of a clinical trial.

We have more information about treatment for melanoma.

Treatment for melanoma that has spread

Sometimes melanoma cannot be removed with surgery or tests show that the cancer cells have spread to other areas of the body. Your doctor and nurse will talk to you about the best way of managing this. If you need treatment this usually involves having targeted therapy or immunotherapy drugs. We have more in our information about advanced melanoma.

After melanoma treatment

Follow-up

After your treatment, your doctor or specialist nurse will explain the follow-up appointments you need. This depends on the stage of the melanoma.

If you had surgery to remove a melanoma in situ (stage 0), you may have one follow-up appointment. You will not need ongoing appointments. For other stages of melanoma, you may have regular appointments over several years. Some people will be offered regular scans if there is a higher risk of melanoma coming back and needing treatment.

At the appointments your doctor or nurse will examine your skin carefully. This is because after a melanoma, you have a higher risk of getting another one. They may take photographs of your skin and measure some of your moles. This is a way of checking for any changes in your skin.

They will also check areas where melanoma was removed for signs of it coming back in the same place. They will check your scar and the surrounding area. They will check your lymph nodes closest to where the melanoma was. If you had surgery to remove these, they may also check lymph nodes elsewhere in your body.

Getting support

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line for free on 0808 808 00 00.
Chat to our specialists online.
Visit our melanoma forum to talk with people who have been affected by melanoma, share your experience, and ask an expert your questions.

The following organisations also offer information and support:

Melanoma Focus

Melanoma Focus provides information, guidance and support for patients, carers and healthcare professionals. It has a free helpline answered by expert skin nurses. It also has a Melanoma TrialFinder for melanoma trials in the UK.
Melanoma UK

Melanoma UK provides support and information for patients, carers and healthcare professionals. It provides a skin check toolkit.

Checking your skin and sun skincare

It is important to check yourself for any signs of melanoma at least once a month. If another melanoma develops, there is a better chance of a cure if it is found early. If you have symptoms, contact your specialist doctor or nurse. Remember, you can contact them between your follow-up appointments.

Your specialist doctor or nurse will ask you to check:

your scar and the surrounding area
the skin, on all over your body, for any new or changing moles.

It can be helpful to stand in front of a mirror to check your skin. Ask your doctor or nurse if you are not sure how to check. The ABCDE check list helps you to know what to look for.

They may also ask you to check your lymph nodes after your treatment. A good time to do this is in the shower or bath. The British Association of Dermatologists produces a leaflet with advice about how to check your lymph nodes.

You can also reduce your risk of another melanoma by protecting your skin from the sun. Your doctor or nurse will give you advice about this. We have more information about skincare in the sun after melanoma.

Body image after melanoma

Doctors try to minimise the effects of skin cancer treatments on your appearance. Many people have only minor scarring after treatment, but for others it may be more obvious.

If scars after surgery bother you or make you feel self-conscious. Some skin clinics have a make-up specialist who can give you advice on the best way to cover up scars.

Sex, fertility and pregnancy after treatment

Cancer and its treatment can cause physical and emotional changes that may affect your sex life. You can read more about coping with these and things that may help in our information on cancer and sex.

Some cancer drugs can affect your fertility. If you are thinking of getting pregnant or making someone pregnant , after melanoma treatment, talk to your specialist nurse or doctor first. They can give you more information that may help you plan a pregnancy. This will depend on the melanoma treatment you had and any follow up tests you need. You may also find our information about pregnancy and cancer helpful.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

Related pages

Finishing cancer treatment

About our information

References

Below is a sample of the sources used in our melanoma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Michielin O, van Akkooi ACJ, Ascierto PA, et al. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019; 30, 12, 1884-1901 [accessed May 2022].

Michielin O, van Akkooi ACJ, Ascierto PA, et al. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Annals of Oncology. 2020; 31, 11, 1449-1461 [accessed May 2022].

Peach H, Board R, Cook M, et al. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73, 1, 36-42 [accessed May 2022].

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Samra Turajlic, Consultant Medical Oncologist.

With thanks to: Dr Stephanie Arnold, Consultant; Kerry Jane Bate, Advanced Nurse Practitioner; Dr Philippa Closier, Clinical Oncologist; Sharon Cowell-Smith, Macmillan Advanced Nurse Practitioner Skin Cancers; and Dr Benjamin Shum, Medical Oncologist.

Thanks also to the other professionals and people affected by cancer who reviewed this edition, and to those who shared their stories.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.