What Does an Early Melanoma Look Like?

Melanoma does not always look dramatic or obviously dangerous. In fact, some of the melanomas detected at an early stage can be quite subtle.

One of the most useful things you can do is become familiar with your own skin. A spot that is new, changing or simply different from your other spots deserves attention.

The ABCDE signs of melanoma

The ABCDE guide is a useful way to assess a mole or pigmented spot:

A — Asymmetry

One half of the spot looks different from the other.

B — Border

The edges may be irregular, uneven, scalloped or poorly defined.

C — Colour

The lesion may contain several colours or different shades of brown, black, red, pink or other colours.

D — Diameter

Larger lesions can attract attention, but melanoma can also be smaller than 6 mm, particularly when it is growing.

E — Evolving

Perhaps most importantly, the spot is changing—whether in its size, shape, colour, elevation or other characteristics.

The “ugly duckling” principle

Another concept I find particularly useful is looking for the spot that simply doesn’t look like the others.

Most people develop a pattern to their moles. They may have many of them, but they often share similar colours, shapes and appearances.

A melanoma may break that pattern. It can be the one lesion that catches your attention because it looks different from everything around it. Cancer Council similarly recommends watching for spots that are new or different from your other spots.

Melanoma isn’t always a dark mole

This is an important point.

Although melanoma is commonly associated with a dark brown or black lesion, some melanomas can be pink, red or relatively lacking in pigment.

Nodular melanoma can look particularly different. It may present as a raised, firm and rapidly growing lump and can sometimes bleed or crust. For these lesions, the EFG rule can be useful:

E — Elevated

F — Firm

G — Growing

Can melanoma appear where the sun doesn’t shine?

Yes.

Although UV exposure is a major risk factor, melanoma can occur in places people may not routinely examine, including the soles of the feet, palms and underneath the nails. Melanoma can also occur in other less common locations.

This is why checking your skin means looking beyond just the face, arms and other obviously sun-exposed areas.

Can you diagnose melanoma just by looking at it?

No.

Appearance provides clues, but a suspicious lesion requires proper clinical assessment. Dermoscopy allows a doctor to examine structures within a lesion that cannot be adequately assessed with the naked eye.

For people with multiple moles or increased melanoma risk, total-body photography can also help identify changes over time. If melanoma is suspected, diagnosis ultimately requires removal or biopsy of the lesion and examination by a pathologist.

When should you get a mole checked?

Don’t wait for a mole to satisfy every ABCDE criterion.

If you notice a spot that is new, changing, growing, bleeding or simply looks different from your other spots, it is reasonable to have it assessed.

Early detection matters. Localised melanoma is primarily treated surgically, and outcomes are substantially better when melanoma is identified before it has spread.

The most important message is simple: know what is normal for your skin, and pay attention when something changes.

Dr Colin McTari

Skin Cancer & Dermatology