Melanoma is one of the few cancers you can see before it does anything at all. Caught while it is still confined to the surface, it is cured by a simple excision in a clinic room; once it has grown deeper, the whole picture changes. The check takes five minutes and needs only a mirror and good light.
What you'll read
The five letters
| Letter | What to look for |
|---|---|
| A — Asymmetry | One half does not match the other |
| B — Border | Edges are ragged, blurred or notched |
| C — Colour | More than one shade: brown, black, red, white or blue |
| D — Diameter | Larger than about 6 mm, the width of a pencil eraser |
| E — Evolving | Changing in size, shape, colour, or starting to itch or bleed |
The letter that matters most is E. A mole you have had since childhood that has looked the same for twenty years is far less concerning than a new spot that has changed over three months — even a small, symmetrical one.
The ugly duckling sign
Most people's moles look like siblings — roughly the same colour and pattern. A melanoma often stands out as the one that does not belong to the family. If you scan your back in a mirror and one spot draws your eye every time, that is the one to have examined, whether or not it ticks the ABCDE boxes.
The places people forget
- The scalp — ask someone to part your hair, or use two mirrors
- The soles of the feet and between the toes, where melanoma is easy to mistake for a bruise
- Under fingernails and toenails: a new dark streak that widens deserves prompt attention
- Behind the ears, the back of the neck and the upper back
- The genital and perianal area, which is examined far too rarely
What happens at a skin check
A dermatologist examines the skin with a dermatoscope, a magnifier with polarised light that reveals patterns invisible to the naked eye. Suspicious lesions are photographed and mapped so they can be compared at the next visit. If a lesion needs removing it is excised entirely under local anaesthetic and sent for pathology — a shave or a partial sample is not appropriate when melanoma is suspected, because the depth of invasion determines everything that follows.
Who is at higher risk
- Fair skin that burns easily, red or blond hair, light eyes
- A history of blistering sunburn, especially in childhood
- Use of sunbeds at any point in life
- More than fifty moles, or several unusual-looking ones
- A close relative who had melanoma
- A weakened immune system, including after an organ transplant
Frequently asked questions
How quickly should a suspicious mole be seen?
Within a few weeks, not months. Melanoma thickness is measured in fractions of a millimetre and the prognosis changes sharply with depth, so a short delay is exactly the kind that matters.
Can melanoma appear where the sun never reaches?
Yes. Acral melanoma occurs on palms, soles and under nails, and mucosal melanoma in the mouth, nose or genital tract. These types are not related to sun exposure and are more common in people with darker skin, in whom melanoma is often diagnosed late for exactly that reason.
Is melanoma curable?
Thin, early melanoma is cured by excision in the large majority of cases. Even advanced melanoma has been transformed by immunotherapy and BRAF-targeted drugs over the last decade, with durable responses that were unimaginable before — but early removal remains far and away the best outcome.
Worried about a mole?
If a lesion has already been removed, send the pathology report. A melanoma specialist will confirm the depth, the stage and whether further surgery or systemic treatment is indicated.