Melanoma
Melanoma
Also known as:Malignant melanoma; China Second Rare Disease Catalog item 48
Melanoma is a cancer of melanocytes that can arise in skin, nails, mucosa, or the eye; it is included in China's second rare disease catalog, although frequency varies greatly by country and ancestry.
Start Here
A quick guide to the next step: which department to start with, what to prepare, and what to ask.
Skin or nail lesions usually start with dermatology. Mucosal or eye lesions should be assessed by the relevant specialty, with biopsy or pathology arranged quickly.
Melanoma can begin in a changing mole, but also on the sole, palm, under a nail, in the mouth, nose, genital tract, anus, or eye. Suspicious lesions need prompt specialist assessment.
Early disease is treated mainly with complete surgery. Higher-risk or advanced disease may need immunotherapy, targeted therapy, radiation, clinical trials, and long-term follow-up.
Most cases are not inherited. Multiple relatives with melanoma, pancreatic cancer, or very young onset may justify counseling for CDKN2A and other predisposition genes.
Melanoma may be mistaken for an ordinary mole, nail fungus, bruise, callus, or mouth ulcer. Laser, freezing, or cosmetic mole removal before pathology can delay diagnosis.
This page helps patients and families organize care leads. It does not replace a clinician’s diagnosis or treatment plan. For testing, medication, referrals, emergency care, and support applications, follow qualified clinicians, medical institutions, support organizations, and official sources.
Diagnosis Path
Organized around the practical patient journey: identify clues, avoid common delays, then prepare for care.
When to Suspect It
- A mole or pigmented spot becomes asymmetric, irregular at the border, uneven in color, larger, or clearly evolving over weeks to months.
- One spot looks unlike your other moles, or begins bleeding, ulcerating, itching, hurting, or becoming raised.
- A dark streak under a nail, pigment spreading around the nail, or an unexplained pigmented mass in the mouth, nose, genital tract, anus, palm, or sole.
- Past melanoma or a family pattern of melanoma or pancreatic cancer.
Common Wrong Turns
- Using laser, freezing, caustic creams, or cosmetic removal before pathology is obtained.
- Treating a dark nail streak as fungus or trauma for a long time without dermoscopy or biopsy when indicated.
- Removing only the visible surface without reporting Breslow thickness, ulceration, margins, and staging information.
Departments to Start With
- Dermatology
- Surgical oncology or melanoma clinic
- Ophthalmology
- ENT, oral medicine, gynecology, or colorectal surgery based on lesion site
Before the Visit
- Photograph the lesion and record size, color, shape, and timing of change; avoid treating it yourself.
- Bring dermoscopy images, biopsy or excision pathology, immunohistochemistry, molecular testing, and imaging reports.
- List sunburn history, immunosuppression, family cancer history, and prior skin cancer.
- For nail, sole, or mucosal lesions, note trauma history, bleeding, pain, and rate of growth.
Tests to Ask About
- Dermoscopy and appropriate biopsy or excisional biopsy rather than destructive treatment.
- Breslow thickness, ulceration, margins, mitotic rate, and whether sentinel lymph node biopsy is needed.
- Lymph node evaluation, ultrasound, CT, PET-CT, or brain MRI when needed for staging.
- BRAF, NRAS, KIT, NTRK, and other molecular testing in advanced or high-risk disease.
Questions for the Doctor
- Is my melanoma in situ, early invasive, regional lymph node disease, or metastatic disease?
- Are the margins adequate, and do I need wider excision or sentinel lymph node biopsy?
- Do I need immunotherapy, targeted therapy, radiation, or adjuvant treatment?
- What should I self-check, and how often do I need skin, lymph node, and imaging follow-up?
Basic Information
Medical Notes
More complete medical explanations are kept here for discussion with clinicians.
Symptoms
Cutaneous melanoma often appears as a new pigmented lesion or a changing mole. ABCDE clues are asymmetry, irregular border, uneven color, increasing diameter, and evolution; the “ugly duckling” sign, where one mole looks different from the rest, is also useful.
People in Asian populations should pay close attention to soles, palms, nails, and mucosal sites. Nail melanoma may appear as a widening dark streak, nail distortion, bleeding, or pigment spreading beyond the nail fold. Mucosal melanoma may cause nosebleeds, oral pigment, anal bleeding, or genital lesions.
Diagnosis
Suspicious lesions should be preserved for pathology rather than destroyed with laser, freezing, or caustic treatment. Depending on site, the doctor may choose excisional biopsy or another appropriate biopsy. The pathology report should include Breslow thickness, ulceration, margins, mitotic features, and immunohistochemistry when needed.
Staging evaluates local tumor features, lymph nodes, and distant spread. Some thicker or high-risk lesions need sentinel lymph node biopsy. Advanced, recurrent, or high-risk disease often needs BRAF, NRAS, KIT, NTRK, or other testing to guide targeted therapy or trials.
Treatment
The foundation of early melanoma treatment is complete surgical excision with appropriate margins. Depending on thickness, ulceration, lymph nodes, and stage, wider excision, sentinel lymph node biopsy, adjuvant immunotherapy, or targeted therapy may be recommended.
Advanced melanoma care now often uses immune checkpoint inhibitors, BRAF/MEK targeted therapy, KIT-directed therapy for selected cases, local treatments, radiation, and clinical trials. Mucosal, acral, and ocular melanoma may follow different pathways and should be reviewed by experienced teams.
Long-term Care
Follow-up includes self-checks of skin and mucosa, lymph node awareness, clinician skin exams, and imaging or laboratory tests when indicated. Patients should report new or changing lesions and tell the oncology team about possible immunotherapy side effects such as diarrhea, rash, endocrine symptoms, cough, or abnormal liver tests.
Fertility and Family
Most melanoma is not clearly inherited. Multiple melanomas, melanoma plus pancreatic cancer in the family, very young onset, or multiple primary tumors may justify genetic counseling for CDKN2A and related genes. People of reproductive age should discuss fertility preservation and pregnancy timing before systemic treatment.
When to Seek Urgent Care
Seek urgent care for uncontrolled bleeding, severe infection or pain at a lesion, new neurologic symptoms, shortness of breath, severe headache, bone pain, or serious symptoms during immunotherapy such as severe diarrhea, jaundice, breathlessness, or confusion.
Prognosis
Earlier detection and complete excision improve outlook. Thickness, ulceration, lymph node status, metastasis, site, and molecular features shape recurrence risk and treatment options.