Change in size, shape, color, or feel in a mole is often the first warning sign of melanoma. Melanoma can appear anywhere on the body, even on areas that are not exposed to the sun. The most frequent locations for melanoma are the trunk (torso), legs, and arms. Melanoma can also develop under the fingernails or toenails; on the palms, soles, or tips of fingers and toes; or on mucous membranes (such as skin that lines the mouth, nose, vagina, and anus).

Melanoma can appear in a number of different ways. Most melanomas are dark brown/black and are often described as “ugly looking.” Bleeding is a sign of more advanced melanoma.

Changes can occur in an existing mole, or melanoma may appear as a new or abnormal-looking mole. The "ABCDE" rule can be used to help remember the warning signs:

Asymmetry: The shape of one half of the mole does not match the other.

Border: The edges are ragged, notched, uneven, or blurred.

Color: Shades of black, brown, and tan may be present. Areas of white, gray, red, or blue may also be seen.

Diameter: The diameter is usually larger than 6 millimeters (mm) (1/4 inch; the size of a pencil eraser) or has grown in size. Melanoma may be smaller when first detected.

Evolving: The mole has been changing in size, shape, color, or appearance, or growing in an area of previously normal skin. Also, when melanoma develops in an existing mole, the texture of the mole may change and become hard or lumpy. Although the skin may feel different and may itch, ooze, or bleed, melanoma usually does not cause pain.

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis [2]. This may include how long you've been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

Early detection of melanoma

Earlier detection and recognition of melanoma is the key to improving the chance for successful treatment and overall survival. Recognizing early warning signs of melanoma and doing regular self-examinations of a person's skin will help find melanoma early when the disease is highly curable.

Self-examination of skin. Self-examinations should be performed in front of a full-length mirror in a brightly lit room. It helps to have another person check the scalp and back of the neck. Include the following steps in a skin self-examination:

• Examine the front and back of the entire body in a mirror, then the right and left sides, with arms raised.
• Bend the elbows and look carefully at the outer and inner forearms, upper arms (especially the hard-to-see back portion), and hands.
• Look at the front, sides, and back of the legs and feet, including the soles and the spaces between the toes.
• Part the hair to lift it, and examine the back of the neck and scalp with a hand mirror.
• Check the back, genital area, and buttocks with a hand mirror.

Talk with your doctor if you find any of the following:

• A growth on the skin that matches any feature on the ABCDE rule list, see above
• New growth on the skin
• A suspicious change in an existing mole or spot
• An unusual sensation in a mole, such as itching or tingling

Medical tests for early detection. A medical technique being used for early detection of melanoma is epiluminescence microscopy, or dermoscopy, which evaluates patterns of size, shape, and pigmentation in pigmented skin lesions. Among trained, experienced medical professionals, the use of dermoscopy may reduce the number of biopsies (see Diagnosis [2]) of pigmented lesions to rule out melanoma, although more research is needed. Meanwhile, confocal scanning laser microscopy is another new technology to better examine possible melanoma lesions, but it is only available in a few major facilities.

Melanoma risk calculator. As noted above, melanoma that is found early has a much higher chance of being cured. A melanoma risk calculator has been developed and piloted by the American Joint Committee on Cancer Melanoma Task Force for use by health care professionals to estimate a person's prognosis (chance of recovery) at the time of diagnosis of melanoma that has not yet spread to other parts of the body (see Staging [3]). Your doctor can help you understand this tool, which is available at www.melanomaprognosis.org [4].