Melanoma: Symptoms and Early Diagnosis

What is melanoma?

Melanoma is a malignant skin tumor that develops from melanocytes, the cells that give skin its color.

It is not the most common type of skin cancer; however, because it has a higher potential to spread compared to many other skin cancers, early diagnosis is particularly important.

However, a melanoma diagnosis:

“"A disease that will definitely have bad consequences."”

That doesn't mean anything.

Especially in melanoma detected at an early stage, the chances of completely controlling the disease with surgical treatment are quite high. (American Academy of Dermatology)

Briefly, what you need to know

Melanoma is a type of skin cancer.

Not every dark mole is melanoma.

Not all melanomas develop from pre-existing moles.

A newly appearing lesion could also be melanoma.

Melanoma doesn't always have to be black or brown.

Dermoscopy is an important tool in diagnostic evaluation.

The definitive diagnosis is made through histopathological examination.

It is not correct to destroy a suspicious lesion with laser or other destructive methods without first making a diagnosis.

Early diagnosis significantly alters the prognosis.

Does melanoma always develop from a mole?

No.

This is a very important misconception.

Melanoma can develop on a pre-existing melanocytic nevus; however, a significant proportion of melanomas arise as new lesions on seemingly normal skin where there were no previous moles.

The Turkish Dermatology Association states that melanoma mostly appears as a new formation in patient data. (Turkish Dermatology Association)

Therefore, in skin examination only:

“"Have my old selves changed?"”

not,

“"Has a new lesion appeared that wasn't there before?"”

That question is also important.

What does melanoma look like?

There is no single melanoma image.

Melanoma:

a flat pigmented spot,

a raised formation on the skin,

brown or black lesion,

lesion containing more than one color,

sometimes pink, red or skin-colored formation

It can be seen in this way.

Because:

“"If it's not black, it's not melanoma."”

That's wrong.

There are also amelanotic melanomas that contain no pigment or very little pigment.

ABCDE rule

This is one of the practical methods used to detect suspicious pigmented lesions:

A — Asymmetry: The two halves of the lesion do not resemble each other.

B — Border Irregularity: Indented, protruding, or irregular borders.

C — Color/Color difference: The presence of different colors within the same lesion.

D — Diameter / Large diameter may attract attention.

E — Evolution / Change: A change over time in the size, shape, color, or other characteristics of a lesion.

However, ABCDE is not a diagnostic test.

There may be small melanomas, and some melanomas may not show the classic ABCDE appearance.

Therefore, the letter E — Evolution, meaning new development or change, is a particularly important warning sign.

“What is the "ugly duckling" finding?

A person's moles usually show a general pattern of similarities.

Among these moles:

“"Unlike any of the others"”

The presence of a lesion may be noteworthy.

This is called the ugly duckling sign.

This is a particularly useful approach in evaluating individuals with a large number of moles.

Does melanoma itch or bleed?

It could be.

A melanoma:

it may itch,

may crust over,

It may bleed.,

It can ulcerate.

However, none of these are essential for melanoma.

Similarly, ordinary benign lesions can also bleed as a result of trauma.

Because:

“"It's not bleeding, so it's not cancer."”

or

“"It's itchy, definitely melanoma."”

The decision is not made in this way.

Who is at higher risk of melanoma?

Risk factors include:

numerous melanocytic nevi,

atypical nevi,

personal history of melanoma,

family history of melanoma,

fair skin and UV-sensitive phenotype,

intense or intermittent high UV exposure,

especially sunburns,

solarium use

It may be included.

However, the absence of risk factors does not completely rule out melanoma.

Does the sun cause melanoma?

Ultraviolet radiation is an important and modifiable risk factor for melanoma.

Intense, intermittent UV exposure and sunburns are particularly important.

Therefore, in terms of protection:

shadow,

protective clothing,

hat,

suitable sunscreen,

Avoiding tanning beds

They should be considered together.

Using sunscreen:

“"Now I can stay in the sun for as long as I want."”

That doesn't mean anything.

How is melanoma diagnosed?

The first step is a dermatological examination.

Suspicious lesions are evaluated with dermoscopy.

The 2025 European consensus guidelines explicitly recommend the use of dermoscopy in lesions clinically suspected of melanoma, and histopathological examination in cases of suspected melanoma. In high-risk patients, serial digital dermoscopy and total body photography can also aid in early melanoma detection.

However:

Dermoscopy is not a pathology test.

Definitive diagnosis is based on histopathological examination.

How is a suspicious mole biopsied?

In a lesion suspected of being melanoma, the goal is for the pathologist to:

tumor type,

invasion characteristics,

tumor thickness,

other important histopathological parameters

The goal is to obtain a suitable sample that will enable accurate evaluation.

Excisional biopsy, in which the entire suspected lesion is removed with appropriate surgical margins, is preferred whenever possible.

However, different biopsy techniques may be required due to factors such as anatomical location or lesion size. The AAD guidelines also emphasize the importance of the biopsy method providing sufficient histopathological information for subsequent staging and treatment. (American Academy of Dermatology)

If a mole is touched by a knife, can melanoma spread?

No.

We will correct this misconception on both the Moles and Melanoma pages.

The Turkish Dermatology Association's patient information document clearly states that removing a suspicious mole does not cause cancer; on the contrary, it allows for early diagnosis. (Turkish Dermatology Association)

“"If a biopsy is done, the cancer will spread."”

That is not scientifically accurate.

Can a suspicious mole be removed with a laser?

It is not advisable to destroy a pigmented lesion that may be melanoma with laser, plasma, radiofrequency, or any other destructive method without first diagnosing it.

The issue here is not whether the device is good or bad.

The problem is that when the lesion is destroyed, tissue may be lost for histopathological diagnosis.

Therefore, our approach is:

First, diagnosis → pathology if necessary → then appropriate treatment.

Cosmetic purposes do not outweigh oncological safety.

What is examined after a melanoma diagnosis?

One of the most important factors determining melanoma treatment is how deep the tumor has penetrated the skin.

Breslow thickness is particularly important in the pathology report.

In addition:

ulceration,

surgical margins,

other histopathological features,

Lymph node status when necessary

It can affect the staging.

The current European guidelines stage melanoma according to the AJCC 8th edition staging system.

What is Breslow's thickness?

Breslow's thickness is the thickness of an invasive melanoma tumor measured under a microscope and expressed in millimeters.

Roughly:

The thinner the tumor and the earlier it is detected, the better the prognosis generally.

However, we don't evaluate a patient's condition based solely on a single number; staging is done using all pathological and clinical information.

Is a PET or CT scan performed on everyone who has melanoma?

No.

This is an important patient question.

Routine advanced imaging is not necessary for every patient with early and thin melanomas.

According to the 2025 European consensus, routine advanced imaging is not required for melanomas as thin as 0.8 mm; ultrasound and more advanced imaging techniques become relevant as the disease stage progresses.

Well:

“"I've been diagnosed with cancer → I need a PET scan immediately."”

There is no such automated algorithm.

The examination is chosen according to the stage of the melanoma.

What is a sentinel lymph node biopsy?

Sentinel lymph nodes are the first lymph node or nodes that lymphatic drainage from the tumor site reaches.

In certain types of melanoma, a sentinel lymph node biopsy may be performed to assess whether the disease has spread microscopically to the lymph nodes.

Current European guidelines generally recommend evaluating this in patients with tumor thickness ≥1 mm, and also in those with certain additional histological risk factors for tumors of 0.8 mm and above.

This procedure is not performed on every melanoma patient.

How is melanoma treated?

Treatment varies entirely depending on the stage of the disease.

Early melanoma

The primary treatment is surgery.

Melanoma is completely removed with an appropriate safety margin.

Current European guidelines use a 1–2 cm confidence interval for primary cutaneous melanoma, depending on tumor characteristics.

In early melanoma, surgery alone may be sufficient. (American Academy of Dermatology)

Treatment of advanced melanoma

Melanoma treatment has changed significantly in recent years.

In addition to surgery, now:

Immunotherapies

Immunotherapies, particularly those targeting the PD-1 pathway, are an important component of melanoma treatment.

Targeted therapies

Some melanomas may contain BRAF V600 mutations.

In suitable patients, therapies that target both the BRAF and MEK pathways can be used.

The 2025 European guidelines consider adjuvant anti-PD-1 therapies in certain high-risk stages with fully isolated lesions, and BRAF/MEK-targeted therapy as options in some stage III patients with BRAF V600 mutations.

Key point:

Melanoma is now a disease that has modern treatments that target its molecular characteristics and the immune system, and are not limited to surgery alone.

What is the BRAF test?

BRAF is one of the key genes that can be altered in melanoma cells.

Especially in advanced or certain high-risk melanomas, knowing the presence of a BRAF V600 mutation can alter treatment options.

Current European guidelines recommend mutation testing, particularly BRAF V600 assessment, for stages IIB/C and above.

Not every mole or every suspected early melanoma is diagnosed with a BRAF test.

Is melanoma treatable?

Yes.

Surgical treatment can be extremely effective, especially when caught in the early stages.

As the disease progresses, treatment becomes more complex; however, immunotherapy and targeted therapies have significantly changed the treatment of advanced melanoma compared to the past. (American Academy of Dermatology)

“Melanoma = death” → false and frightening.

“Now that there are medications, it doesn’t matter” → equally wrong.

The correct message:

Early diagnosis remains critical in melanoma.

Do I need follow-up after having melanoma?

Yes.

In patients with a history of melanoma, follow-up is important to monitor for both disease recurrence and the development of a second primary melanoma.

However, the monitoring program is not the same for everyone.

Current European guidelines recommend adjusting the intensity of contact tracing according to the stage of the disease.

“"Everyone who has had melanoma should have this test done every 3 months."”

Instead of a single, uniform protocol, an individualized approach tailored to the patient and tumor characteristics is needed.

How to perform a self-examination of the skin?

It is important for a person to know their own skin.

At regular intervals:

face and scalp,

front and rear of the body,

arms and hands,

legs,

soles of the feet and spaces between the toes,

hard-to-see areas

It can be controlled.

A mirror or someone nearby can be used for assistance.

The Turkish Dermatology Association also particularly emphasizes self-examination of the skin in patient education for the early detection of new or changing lesions. (Turkish Dermatology Association)

Frequently Asked Questions

Can every mole be a melanoma? The vast majority of moles are benign. Furthermore, a significant portion of melanomas develop as new lesions on normal skin, not from pre-existing moles.

Does melanoma only come in black? No. Amelanotic melanomas can be pink, red, or skin-colored.

Will having a lesion removed spread melanoma? No. Proper removal and pathological examination of the suspected lesion are fundamental to diagnosis. (Turkish Dermatology Association)

Does dermoscopy definitively diagnose melanoma? It significantly enhances the diagnostic assessment; the definitive diagnosis is made by histopathology.

Is chemotherapy used in melanoma? In modern melanoma treatment, immunotherapy and targeted therapies have greatly reduced the role of conventional chemotherapy. (American Academy of Dermatology)

Can melanoma be completely cured if caught early? In early melanomas, surgical treatment alone may be sufficient, and the treatment success rate is high. (American Academy of Dermatology)

Is it possible to protect against melanoma? It is not possible to prevent all melanomas; however, avoiding excessive UV exposure and tanning beds reduces modifiable risks. Early detection also significantly affects the outcome of the disease.