Melanoma is a skin cancer that starts in melanocytes, the cells that make pigment. It usually appears as a new mole or a change in an existing one, and less often under a nail, on the sole of the foot, in the eye or on a mucous surface.
It is less common than other skin cancers but more likely to spread, which is why early removal matters so much. A thin melanoma removed early is often dealt with by surgery alone. A thicker or spread melanoma needs a team approach and a longer plan.
Symptoms
- A mole that changes in size, shape or colour over weeks or months
- A lesion that looks different from your other moles, sometimes called the ugly duckling sign
- Irregular border, several colours, or a width over about 6 mm
- A mole that itches, bleeds, crusts or becomes raised
- A dark streak under a nail that widens, or pigment spreading onto the nail fold
- A pink or red growing lump with no pigment, which is easy to overlook
- A new lump in the groin, armpit or neck near a previous melanoma
Causes and risk factors
Most melanomas are linked to ultraviolet damage from sunlight and sunbeds, particularly blistering sunburns in childhood and intense intermittent exposure. Fair skin that burns easily, red or blond hair, many moles, atypical moles, a previous melanoma and a close relative with melanoma all raise the risk. A weakened immune system does too. Some types, such as melanoma on the palms, soles and under nails, are not clearly related to sun and occur in all skin tones, where they are often diagnosed late.
How it is diagnosed
- Skin examination with dermoscopy: A dermatologist examines the lesion and the rest of your skin with a handheld magnifier that shows pigment patterns invisible to the naked eye.
- Excision biopsy: The whole suspicious lesion is removed with a narrow margin under local anaesthetic. Shaving or partial sampling is avoided where possible because thickness drives everything that follows.
- Pathology report: The key figures are the Breslow thickness in millimetres, ulceration and the margins. These set the stage and the next steps.
- Sentinel lymph node biopsy: Offered for melanomas above a certain thickness. The first draining node is found with a tracer and removed to check for microscopic spread.
- Imaging and gene testing: CT, PET-CT or MRI are used for thicker or spread disease. Tumour testing for BRAF and other mutations guides drug choice in advanced cases.
Treatment options
- Wide local excision: After the biopsy, a second operation removes a safety margin of normal skin, usually 1 to 2 cm depending on thickness. Often done under local anaesthetic, sometimes with a flap or graft.
- Sentinel node biopsy: Done at the same sitting as the wide excision. It is a staging test more than a treatment, and it decides whether further therapy is discussed.
- Adjuvant immunotherapy or targeted therapy: For higher stage disease after surgery, checkpoint inhibitors or BRAF and MEK inhibitors can lower the chance of return. Courses usually run for about a year.
- Treatment of advanced melanoma: Immunotherapy and targeted tablets are the mainstay. Radiotherapy and surgery are used for selected deposits, including in the brain.
- Follow-up skin checks: Regular full skin and node examinations for years, with photography or mole mapping if you have many atypical moles.
When it is urgent
A melanoma itself is rarely an emergency, but do not wait months with a changing mole: see a doctor locally within a couple of weeks. If you have known melanoma and develop seizures, severe new headache, weakness on one side, coughing blood, or if you are on immunotherapy and get severe diarrhoea, breathlessness or profound fatigue, go to your local emergency department or oncology unit the same day.
Travelling to Türkiye for treatment
Travel can make sense for a fast dermoscopy assessment and excision biopsy, for wide local excision with sentinel node biopsy as a planned operation, and for a second opinion on pathology slides and staging scans. Bring your slides or blocks and reports. Year-long drug courses and the regular skin checks that follow are better organised close to home, because side effects of immunotherapy need quick access to the team that prescribes it.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
How quickly does a suspicious mole need to be removed?
Within a few weeks is the usual aim. It is not a same-day emergency, but delay of many months can allow a thin melanoma to thicken, and thickness is what decides the outlook.
Will I need chemotherapy?
Classic chemotherapy is now rarely used. If drug treatment is needed it is usually immunotherapy or targeted tablets, and many people with thin melanomas need surgery only.
Can a melanoma be treated with laser or freezing?
No. Destroying the lesion without pathology loses the thickness measurement and risks leaving cancer behind. Suspicious pigmented lesions should be cut out and examined.
Does having many moles mean I will get melanoma?
It raises the risk but most moles never change. Learning your own skin, photographing it, and having periodic dermoscopy checks is the sensible response.