Melanoma Symptoms

The ABCDE checklist

This is the standard way of looking at a flat or slightly raised mole:

A is for asymmetry. If you imagine folding it in half, the two halves would not match.

B is for border. The edges are uneven, notched, blurred, or scalloped rather than smooth and clearly defined.

C is for color. More than one color within the same mole, or color spread unevenly. Shades of brown, black, tan, red, white, or blue-grey mixed together.

D is for diameter. Larger than about a quarter of an inch, roughly the width of a pencil eraser, although smaller ones can matter too.

E is for evolving. Any change at all in size, shape, color, height, or how it feels. This is the most important letter of the five. A mole that is doing something new deserves a look regardless of everything else.

The ugly duckling

Most people's moles look broadly like one another, in the way siblings resemble each other. A mole that stands out as clearly different from the rest of yours is worth showing to someone, even if it passes the ABCDE checklist. This one idea catches a great deal.

Raised lumps that ABCDE can miss

Some melanomas grow as a raised lump rather than as a spreading patch, and these can look neat and even, which makes the standard checklist less useful. A simpler rule fits them better:

Elevated, firm, and growing steadily for more than a month.

These can also be pink, red, or skin colored rather than dark, and are often mistaken for a spot, a cyst, or an insect bite that will not settle. Anything that keeps growing for over a month is worth showing to someone.

Other changes worth mentioning

A mole that itches, tingles, or has become tender.

A mole that bleeds, weeps, crusts, or repeatedly scabs and reopens.

A new pigmented spot appearing after the age of forty.

A sore anywhere on the skin that has not healed in a month.

The places people never think to look

Palms, soles, and between the toes. A new dark spot or streak in these areas is worth showing to a doctor. This form is unrelated to sun exposure and occurs across all skin tones, including in people who never burn.

Under the nails. A dark stripe running the length of a fingernail or toenail, particularly one in a single nail, one that is widening, or one where the pigment extends onto the surrounding skin or cuticle.

Scalp, ears, behind the ears, between the buttocks, and the genital area. These are the places most often missed simply because they are hard to see. This is where a partner, a friend, or a hairdresser can genuinely help.

Your eyes. New floaters, flashes of light, blurred or lost side vision, a dark spot on the colored part of the eye, or a change in pupil shape. Melanoma can occur in the eye, and a routine eye examination checks for it.

Contact a doctor within a few days if you notice:

• A mole that has changed noticeably over recent weeks
• Any lump that is raised, firm, and has been growing for more than a month
• A mole that is bleeding, crusting, or will not heal
• A new dark spot or streak on a palm, sole, or under a nail
• A mole that looks clearly different from all your others
• New flashes, floaters, or vision changes in one eye

Most skin changes are caused by something other than melanoma:

• Ordinary moles, which can darken, lighten, or slowly change over a lifetime
• Seborrheic keratoses, very common warty brown growths that look stuck on and appear with age
• Skin tags
• Cherry angiomas, small bright red spots that are entirely harmless
• Freckles and sun spots, which darken with sun exposure
• Dermatofibromas, firm small lumps that often follow an insect bite or minor injury
• Cysts, which can be firm and grow slowly
• Bruising under a nail, from a knock you may not remember, which grows out over months

Getting checked is not overreacting. Most people who go in with a worrying mole are reassured within a single appointment, often in a few minutes.

• Sunburn, particularly blistering sunburn in childhood
• Using sunbeds or tanning beds at any age
• Fair skin, light eyes, red or blonde hair, or skin that burns easily
• Having many moles, or moles that are large or unusual in appearance
• A parent, sibling, or child who has had melanoma
• A previous melanoma or other skin cancer
• A weakened immune system
• Living or holidaying in places with strong sun

Two points are worth stating plainly. Melanoma occurs in people of every skin tone, and in darker skin it appears more often on the palms, soles, and under the nails, so those areas are worth checking regardless of how easily you burn. And sun protection genuinely works, which makes this one of the most preventable cancers there is.

Book an appointment with a primary care doctor or a dermatologist. Say that you have a mole that has changed. That phrase gets an examination.

Photograph it today. This is the single most useful thing you can do. Take a clear, well-lit photograph with something for scale beside it, such as a coin or a ruler. A dated photograph showing change over time carries real weight with any doctor.

Write things down before you go. Bring:

• When you first noticed the mole or the change
• Exactly what has changed, and over what period
• Any itching, bleeding, or tenderness
• Whether it is new or has been there for years
• Your history of sunburn and sunbed use
• Family history of melanoma or skin cancer

Do not try to remove it yourself, and avoid picking or scratching at it. It genuinely makes examination harder.

Knowing what a thorough look involves helps you understand where you are in the process:

• A close examination of the mole, ideally with a dermatoscope, a magnifying instrument with a light that shows structures invisible to the naked eye
• A full skin examination, looking at your whole body rather than only the spot you pointed out
• Photography, so that any change can be compared accurately at follow-up
• Removal and examination of the mole if anything is uncertain, which is a short procedure under local anesthetic

The point most worth knowing is this: a dermatoscope makes a real difference, and not every doctor uses one. If you were examined with the naked eye alone and you remain concerned, asking to see a dermatologist is entirely reasonable.

It is also worth asking for a full skin check rather than only the mole that worried you. People commonly present with one mole while a different one turns out to be the more interesting finding.

A good question to ask is: "Could you look at the rest of my skin as well, including my back, scalp, and feet?"

Being told the mole looks fine is genuinely good news, and it is also completely reasonable to want another set of eyes when something has continued to change since you were seen. You live in your body every day. Nobody knows your normal better than you do.

You do not need a diagnosis in order to ask for a specialist opinion. If you have been evaluated by a primary care doctor and something still does not sit right, you can ask for a referral to a dermatologist, or to a medical oncologist who focuses specifically on melanoma. Many centers also accept requests for a second opinion directly, without a referral, and most insurance plans cover one.

When you ask, keep it simple and warm. Something like: "I was told this mole looks fine and I am relieved. It has kept growing over the last two months and I have photographs showing the difference, so I would feel more settled having a dermatologist look at it. Could you send a referral?" Good doctors hear that as thoroughness, not as doubt.

Bring your photographs with you, in date order. They are often more persuasive than any description, and they are something only you can provide.

You can find a list of top melanoma medical oncologists here: Top Melanoma Doctors

Lead with the change and the timeframe, and show your photographs:

"I have had this mole on my back for years, but over the last three months it has got noticeably bigger and there is now a darker area at one edge that was not there before. It has started itching. I have photographs from March and from last week. I would like it examined with a dermatoscope, and I would like a full skin check while I am here."

• "Could you examine this with a dermatoscope?"
• "Could you check the rest of my skin, including my back, scalp, and the soles of my feet?"
• "Given that it is still changing, would removing it be reasonable?"
• "If we are monitoring instead, when should I come back, and what would prompt an earlier visit?"
• "How often should someone with my skin type and history be checked?"

Skin examination with a dermatoscope. A handheld magnifier with a light, held against the skin. Painless, and it takes seconds per mole.

Full body skin check. A systematic look over your whole skin, usually taking ten to fifteen minutes. You will undress to your underwear and be covered where possible.

Total body photography. Some clinics photograph the whole skin surface so that new or changing moles can be identified at future visits. Particularly useful for people with many moles.

Excision biopsy. The mole is removed entirely with a small margin of skin, under local anesthetic. It takes fifteen to thirty minutes, you are awake but feel nothing beyond the initial injection, and you go home immediately with a few stitches. This is what gives a definite answer.

Melanoma is perhaps the clearest example of a field transformed by research. Immunotherapy and targeted treatments have changed what is possible so substantially that a specialist who has kept pace will approach it very differently from someone who has not. Testing for specific molecular features, particularly BRAF, guides which treatments apply, and that testing should be part of the initial workup.

Surgical judgment matters too, since how much margin to take and whether to sample the nearby lymph nodes are decisions with real consequences. A specialist will read the pathology in detail, including thickness and other features that shape everything afterward, and will bring your case to a team of dermatologists, surgeons, medical oncologists, radiation oncologists, and pathologists before any plan is set. Cancerify helps you find top melanoma specialists and centers near you, filtered by location and insurance, completely free.