Melanoma: A Subtle Change on the Skin That Can Be Life-Changing

Summer means more time outdoors, holidays by the sea, swimming, and greater exposure to sunlight. However, this is also the time of year when it is especially important to pay closer attention to your skin. Intense ultraviolet radiation, repeated sunburn, and inadequate sun protection are significant risk factors for skin cancer, including melanoma.

At first, melanoma may look like an ordinary mole or a small, inconspicuous mark. Nevertheless, it is the most serious form of skin cancer because it can spread relatively quickly to the lymph nodes and other organs.

The good news is that when melanoma is detected early, it is often highly treatable. For this reason, it is essential to monitor changes in the skin and consult a dermatologist whenever something appears unusual or concerning.

Melanoma is a malignant tumour that develops from melanocytes, the cells responsible for producing melanin, the pigment that gives the skin its colour.

It most commonly develops on the skin, although in rare cases it can also arise in the eye or on mucous membranes. Contrary to a common misconception, melanoma does not always develop from an existing mole. Most melanomas appear as entirely new lesions on previously normal-looking skin.

This means that it is not enough to monitor only the moles you have had for many years. Any new spot, lump, or unusual skin lesion also deserves attention.

Why Is Melanoma So Dangerous?

Melanoma accounts for only a proportion of all skin cancers, but it is generally more aggressive than the more common basal cell and squamous cell carcinomas.

If it is not detected early, melanoma can grow into the deeper layers of the skin and spread to other parts of the body, including:

• the lymph nodes,
• the lungs,
• the liver,
• the bones,
• the brain.

One of the most important prognostic factors is known as Breslow thickness, which measures how deeply the tumour has grown into the skin. It is measured in millimetres during the histological examination of the removed tissue.

The deeper the melanoma grows, the greater the risk that it may spread. This is why it is sometimes said that, with melanoma, a single millimetre can make a significant difference.

Importantly, this does not refer to the diameter of the mole on the skin’s surface, but to the actual depth of the tumour.

Melanoma Does Not Have to Be Black

Melanoma is often imagined as a very dark or black mole. In reality, it can appear in many different colours.

It may be:

• brown,
• black,
• grey,
• bluish,
• red,
• pink,
• almost colourless.

Amelanotic melanoma contains very little pigment or none at all. It may therefore resemble a pink patch, a pimple, a small lump, or an area of irritation that does not heal.

These forms can be more difficult to recognise because they do not resemble a typical dark mole.

The Most Important Warning Sign Is Change

The ABCDE rule is commonly used when checking moles.

A – Asymmetry

One half of the mole looks different from the other.

B – Border

The edges may be blurred, jagged, uneven, notched, or irregular.

C – Colour

The mole contains several colours, or its colour gradually changes over time.

D – Diameter

Larger moles deserve particular attention. However, melanoma can also be smaller than 6 mm, so size alone is not enough to determine whether a lesion is suspicious.

E – Evolving

The mole changes over time. It may grow or change in shape, colour, surface texture, or border.

Evolution over time is one of the most important warning signs. A melanoma does not have to meet all the ABCDE criteria. Sometimes, the only suspicious feature is that the lesion changes over several weeks or months.

Other reasons to seek medical assessment include:

• bleeding,
• oozing,
• itching,
• pain,
• crusting without an obvious injury,
• hardening,
• rapid growth,
• a surface that does not heal.

These symptoms do not automatically mean melanoma, but they should not be ignored.

The “Ugly Duckling” Sign

A person’s moles often resemble one another in colour, shape, and size.

A mole may be suspicious if it looks noticeably different from the others. It may be darker, lighter, larger, more irregular, or simply appear unusual compared with the rest.

This principle is known as the “ugly duckling” sign.

When examining your skin at home, it is therefore important not only to assess individual moles, but also to compare them with one another.

Melanoma Can Develop in Areas That Receive Very Little Sunlight

Although UV radiation is an important risk factor, melanoma can also develop in areas that are normally covered.

It is important to check:

• the soles of the feet,
• the spaces between the toes,
• the palms of the hands,
• the skin beneath the nails,
• the scalp,
• the back,
• the buttocks,
• intimate areas.

Melanoma beneath a nail may appear as a new brown or black line that gradually becomes wider. Not every change in nail colour is dangerous, but newly developed or changing pigmentation should be assessed by a dermatologist.

The fact that a particular area is not tanned or is rarely exposed to sunlight does not mean that there is no risk.

Short but intense periods of sun exposure are particularly relevant to the development of melanoma. Typical examples include spending several hours sunbathing while on holiday, prolonged exposure by the sea, or suddenly exposing the skin to strong sunlight after months spent mostly indoors.

Repeated sunburn, especially during childhood and adolescence, is also highly significant.

However, this does not mean that everyday sun exposure is harmless. UV radiation damages the DNA of skin cells, and its effects accumulate throughout life.

The greatest risk therefore comes from a combination of:

• intense sun exposure,
• repeated sunburn,
• inadequate sun protection,
• long-term cumulative UV exposure.

The risk is higher among people who:

• have fair skin,
• have blonde or red hair,
• burn easily,
• have many moles,
• have atypical moles,
• have experienced repeated sunburn,
• have used sunbeds,
• have previously had melanoma or another type of skin cancer,
• have a family history of melanoma,
• have a weakened immune system.

However, melanoma can also develop in people with darker skin or in those without any known risk factors.

In people with darker skin tones, melanoma may be more likely to appear on the soles of the feet, the palms of the hands, or beneath the nails.

Melanoma Does Not Affect Only Older People

The incidence of melanoma generally increases with age, but the disease can also occur in young adults.

A new or changing mole should therefore never be dismissed simply because a person is young or otherwise feels healthy.

In its early stages, melanoma often causes no pain or general symptoms. A visible change in the skin may be the only warning sign.

Regular use of broad-spectrum sunscreen helps reduce UV-related skin damage and is an important part of melanoma prevention.

However, sunscreen alone is not enough.

For effective protection, it is recommended to:

• use broad-spectrum protection against both UVA and UVB radiation,
• choose SPF 30 or higher,
• apply a sufficient amount,
• reapply it regularly,
• reapply after swimming, sweating, or towel-drying,
• seek shade,
• wear suitable protective clothing and a hat,
• protect the eyes with sunglasses,
• avoid sunbeds.

Sunscreen should not be treated as permission to remain in direct sunlight indefinitely. The best protection comes from combining several preventive measures.

Sunbeds Are Not a Safe Alternative

A tan is not a sign of healthy skin. It is the skin’s response to damage caused by UV radiation.

Sunbeds can expose the skin to very intense UVA and UVB radiation and increase the risk of skin cancer. They are therefore not a safer way to tan.

Self-tanning cosmetic products that do not involve UV exposure do not cause melanoma. However, they usually provide little or no protection from the sun. Sunscreen is still necessary when using them.

Regular self-examination can help identify changes at an early stage.

It is best to check the skin systematically:

1. Examine your face, ears, and neck.
2. Check your chest, abdomen, and the front of your torso.
3. Examine your arms, underarms, palms, and the spaces between your fingers.
4. Use a mirror to check your back, buttocks, and the backs of your legs.
5. Do not forget the soles of your feet and the areas beneath your nails.
6. Examine your scalp.
7. Look for new lesions as well as changes in existing moles.

Photographs taken under similar conditions can help you monitor changes over time. However, they are not a substitute for a professional medical examination.

A partner or another person close to you can help check areas that are difficult to see, such as the back or scalp.

A dermatologist will first examine the skin and usually assess the suspicious lesion using a dermatoscope.

Dermoscopy provides a magnified view of structures that cannot be seen clearly with the naked eye. If the lesion appears suspicious, it is generally removed surgically and sent for histological examination.

Only microscopic examination of the tissue can reliably confirm or rule out melanoma.

When melanoma is diagnosed, specialists assess factors including:

• the depth of the tumour,
• the presence of ulceration,
• the surgical margins,
• other microscopic characteristics.

The next steps in treatment are then determined according to these findings.

Modern Treatments Have Significantly Improved the Prognosis

The main treatment for early-stage melanoma is surgical removal.

When the tumour is detected early and removed completely, the chances of long-term cure can be very high.

For more advanced or metastatic melanoma, treatment options have expanded considerably in recent years. These may include:

• immunotherapy,
• targeted therapy for selected genetic mutations,
• surgery,
• radiotherapy,
• other specialised treatment methods.

Modern therapies can help control the disease for a prolonged period in some patients. However, advanced melanoma remains a serious condition.

Early diagnosis therefore continues to offer the greatest advantage.

Arrange a professional skin examination if you notice:

• a new, unusual mole,
• a change in size, shape, or colour,
• irregular borders,
• a mole that looks different from the others,
• bleeding or oozing,
• repeated crusting,
• itching or pain,
• a new line beneath a nail,
• a pink or red lesion that does not heal,
• any change that causes concern.

There is no need to wait until a mole begins to hurt or grows significantly. Early melanoma is often completely symptom-free.

Two Minutes That Can Make a Significant Difference

Examine your skin regularly, look for new lesions, and pay attention to changes in existing moles.

Self-examination cannot prevent melanoma, but it can help identify a suspicious change while it is still small and highly treatable.

When in doubt, it is always safer to show the lesion to a dermatologist than to wait several months to see whether it continues to change.

Melanoma can look like an ordinary mole. It does not have to be black, large, or painful. It may develop as a completely new lesion and can also appear in areas that receive little or no sunlight.

The most important warning sign is change.

Protect your skin from intense UV radiation, avoid sunburn, and monitor the development of skin lesions. An early visit to a dermatologist can make a crucial difference.

Barcelona Medical Consulting can help you arrange a consultation with an experienced dermatologist in Barcelona, a dermoscopic examination of your moles, and, where necessary, further diagnosis and treatment.