What does it look like?
The ABCDE's of Melanoma
Early detection is key when it comes to treating melanoma. The ABCDE rule is a simple and effective way to evaluate moles or spots on the skin that could be cancerous. Here’s what to look for:
- A – Asymmetry
One half of the mole or spot doesn’t match the other in shape or size.
- B – Border
The edges are irregular, ragged, notched, or blurred.
- C – Colour
The colour is uneven, with shades of brown, black, red, white, or even blue.
- D – Diameter
The spot is larger than 6 mm (about the size of a pencil eraser), although melanomas can sometimes be smaller.
- E – Evolving
The mole is changing in size, shape, colour, or elevation—or you notice new symptoms like bleeding, itching, or crusting.
If you notice any of these signs, it's important to have the spot evaluated by a healthcare provider or dermatologist as soon as possible. Early detection can save lives.
*A tip when trying to detect a Melanoma – one of these things is not like the others! Generally, a Melanoma will be very distinct from any other moles you may have. It may look, feel or change differently than your other moles. Those are signs it needs to be checked by your Dermatologist!
The "Ugly Duckling" Sign
Another important warning sign of melanoma is what's known as the “Ugly Duckling” sign. This approach is based on the idea that most normal moles on your body tend to look similar to each other—so when one stands out as different, it should raise concern.
An “ugly duckling” mole may be:
- Larger or smaller than surrounding moles
- A different colour—either much darker or lighter
- A different shape or texture
- The only mole in an area, with no others nearby for comparison
This method emphasizes the importance of not just looking for textbook signs of melanoma (like the ABCDEs), but also comparing moles to their neighbors. If one looks noticeably different—it may be an early sign of melanoma and should be examined by a healthcare professional.
Melanoma Statistics & Facts
It takes only one blistering sunburn to double a person’s chances of developing melanoma
Melanoma is one of the most common types of cancer for youth between the ages of 15-29
Life-time risk for melanoma is now
1 in 63 versus 1 in 1500 in the 1930s
In North America, one person dies from melanoma every hour
The leading cause of melanoma is overexposure to ultraviolet (UV) radiation from the sun or artificial sources (tanning beds, sunlamps)
Early exposure to tanning beds can increase a person’s chance of developing melanoma by up to 75%
Melanoma Staging Criteria
Once a biopsy confirms melanoma, a second surgery is usually needed to remove additional tissue around the area, ensuring the melanoma is fully excised with proper margins. Before this surgery, several important factors are considered. The pathologist will identify the type of melanoma and then determine its stage. This includes measuring the Breslow depth, which is how deep the melanoma extends from the skin surface to its deepest point, and Clark’s level, which describes how far the melanoma has penetrated into the skin layers. These measurements help provide important information about the outlook and guide the best treatment plan for you.
Types of melanoma
Superficial Spreading
This type of Melanoma appears in the upper layers of the skin and spreads outwards. It accounts for 70% of Melanomas diagnosed
Nodular
This type of Melanoma is more dangerous as it grows quickly and deeply into the skin. It typically appears on areas of the skin that have not been exposed to the sun and have a raised area that is usually very dark or sometimes red.
Lentigo Maligna
Acral Lentiginous
Acral Lentiginous
This type of Melanoma is directly caused by excessive sun exposure. Found commonly in order people, it generally appears as a large flat dark spot with areas of brown and black.
Acral Lentiginous
Acral Lentiginous
Acral Lentiginous
This Melanoma is most found in people with darker skin tones or Asian decent. They appear on the palms of hands, soles of feet or underneath fingernails or toenails.
The 5 Stages of Melanoma
Based on the thickness and other features of the tumour, stages provide information to help guide the treatment, prognosis, and recurrence risk, as well as if further tests need to be completed.
Stage 0: The tumour is limited to the upper layers of the skin and has not spread (Melanoma in-situ). Surgical excision is the only treatment required. Prognosis is excellent.
Stage 1: Considered to be an early Melanoma. Depending on severity (based on Breslow depth and Clark’s level), a Sentinel Lymph Node Biopsy may be indicated. Treatment also includes surgical re-excision, which can be done at the same time as the Sentinel Lymph Node Biopsy.
Stage 2: The Melanoma is more advanced and goes deeper into the skin. A sentinel lymph node biopsy is recommended. There is a moderate risk of recurrence or spread to another area of the body after surgical excision because of the tumour depth.
Stage 3: The Melanoma has spread to nearby lymph nodes. These will be removed during treatment.
Stage 4: This is the most advanced stage of Melanoma. The Melanoma has spread to another part of the body – usually the lungs, liver, brain or abdomen. This situation is uncommon.
Stages 3 & 4 require post-surgical management to prevent the recurrence or spread of the Melanoma. The following treatment options are available and may be combined:
Breslow Depth (Thickness)
Once the type of Melanoma is determined, it is then given a Breslow depth. This is the most important determining factor for the prognosis of a Melanoma. The deeper the Melanoma is found to be, the more likely it has spread to other areas and the higher likelihood it will recur even once removed.
Melanomas that are found to be >1mm thick do not tend to spread. Treatment for these Melanomas are surgical removal with a specific margin skin. No further treatment or testing is required.
If the Breslow index is <1mm, a Sentinel Lymph Node Biopsy is suggested to test to determine if the Melanoma has spread to nearby lymph nodes. The results of this test help determine the stage of Melanoma and what treatment is required. Some further tests that may be required are bloodwork, a CT scan or a PET scan.
Additional Factors That Influence Melanoma Prognosis
When it comes to understanding how serious a melanoma may be, doctors consider more than just the size or depth of the lesion. Several other factors help determine the likelihood of spread and the best course of treatment.
1. Ulceration
Ulceration means the outer layer of skin over the melanoma has broken down or eroded. This is considered a sign of a more aggressive cancer. Melanomas with ulceration are more likely to spread and are typically staged as more advanced compared to those without ulceration.
2. Mitotic Rate
Mitotic rate reflects how quickly the cancer cells are dividing. A higher rate means the cells are multiplying faster, which usually lead to larger tumors and greater risk of spreading (metastasizing). It's considered the second most important factor (after Breslow thickness) in predicting melanoma outcomes. In very think melanomas (less than 1mm thick), this number can significantly influence staging and treatment decisions.
3. Satellite Lesions
These are small clusters of melanoma cells found in the skin near the main tumor—specifically more than 0.05 mm but less than 2 cm away. Their presence is noted during staging and can indicate a more advanced disease.
4. In-Transit Metastases
Similar to satellite lesions, these are melanoma cells that have traveled through lymphatic vessels and settled more than 2 cm from the primary tumor but have not yet reached the nearby lymph nodes. Like satellites, in-transit metastases affect how the melanoma is staged and managed.
What is a Sentinel Lymph Node Biopsy?
A sentinel lymph node biopsy is a procedure used to find out if melanoma has started to spread beyond the skin. The sentinel lymph node is the first node that cancer cells are likely to reach as they travel through the lymphatic system.
Here’s how it works:
- A small amount of radioactive dye is injected near the melanoma site.
- The dye travels to the first draining lymph node—the "sentinel."
- That node is then surgically removed and tested for cancer cells.
What Do The Results Mean?
- Negative sentinel node: It’s very unlikely that the melanoma has spread elsewhere in the body.
- Positive sentinel node: All lymph nodes in that region may be removed for further evaluation. However, it’s important to note that a positive result doesn’t automatically mean the prognosis is worse—it’s primarily used to help guide diagnosis and treatment planning.
Treatment for Melanoma
Surgical Removal of Melanoma
Stage 0 to Stage 1 (low-risk)
When melanoma is detected early—limited to the upper layers of the skin with no signs of spreading—it is usually treated with surgical excision alone. This involves removing the melanoma along with a safety margin of surrounding healthy skin, typically 5 mm to 1 cm wide, depending on the tumor’s depth. The removed tissue is sent to a lab to confirm that all margins are clear of cancer cells, which means no further surgery is needed. In certain cases, particularly when the melanoma is in a cosmetically or functionally sensitive area like the face, a more precise technique called Slow Mohs Micrographic Surgery may be used. This approach removes the melanoma in stages while carefully examining each layer under a microscope. If the melanoma is thicker than 0.8 mm or has other high-risk features, a sentinel lymph node biopsy may also be recommended to check for early spread. Often, this biopsy can be performed during the same surgical procedure as the excision.
Stage 2 (intermediate high-risk melanomas)
Because stage 2 melanoma carries a higher risk of spreading to the lymph nodes, doctors often recommend a sentinel lymph node biopsy in addition to surgical excision. This helps determine whether the melanoma has begun to spread beyond the skin. If cancer cells are found in any of the lymph nodes, additional treatment may be advised after surgery to help lower the risk of the melanoma returning. These treatments may include options like radiation therapy or immunotherapy, depending on the individual case and overall health plan.
Treatment for Advanced Melanomas
Stage 3 and stage 4 (advanced melanomas)
Melanomas become more challenging to treat once they spread beyond the original tumor site to nearby lymph nodes or distant organs, but recent advances in immune-based therapies have brought new hope—especially for patients with stage 3 and stage 4 melanoma.
For those with stage 3 disease, adjuvant therapies are now available after surgical removal to help prevent or delay the cancer’s return and improve long-term survival rates.
Patients with stage 4 melanoma also have access to a growing number of effective treatment options following surgery. Even if one therapy isn’t successful, there are often others to try, many of which have shown strong success in shrinking tumors, slowing disease progression, and significantly extending life expectancy—sometimes by months or years, and in some cases, even offering the potential for a cure.
Immunotherapies: Immunotherapy has revolutionized the treatment of advanced melanoma by harnessing the power of the body’s own immune system to fight cancer. These therapies work by boosting the immune response, using synthetic versions of natural immune proteins to help the body recognize and attack melanoma cells more effectively. By enhancing the immune system's ability to target and destroy cancer, immunotherapies have led to significant progress in improving outcomes for patients with more advanced stages of the disease.
Chemotherapy: Chemotherapy is now used less frequently in the treatment of melanoma, thanks to the effectiveness of newer immunotherapies and targeted treatments. However, it may still be considered in cases where other therapies have not been successful. Chemotherapy works by circulating throughout the body to target and kill rapidly dividing cancer cells, helping to slow or stop tumor growth and prevent further spread.
Radiation: Radiation therapy is not commonly used as a primary treatment for melanoma but can be helpful in certain situations—particularly if the cancer has spread to the brain or other distant areas. In these cases, radiation may be used to shrink tumors, relieve pain, or reduce symptoms. It can also be used after surgery at the original melanoma site to help ensure any remaining cancer cells are destroyed, especially if there's a high risk of recurrence. Radiation works by using high-intensity X-ray beams to stop tumor cells from growing and multiplying. In cases where melanoma returns at the original site or nearby lymph nodes, radiation may help reduce or eliminate the tumor and lower the chance of further spread. It can also be used alongside other treatments to enhance their effectiveness when the disease has already spread.
Support for patients with melanoma
Melanoma Network of Canada
Melanoma Network of Canada
Melanoma Network of Canada
The Melanoma Network of Canada (MNC) provides support services, information, and programs for individuals whose lives have been changed by melanoma and skin cancer. MNC is the leading national voice for patients in Canada, advocating for drug therapies, for early detection and improved treatment access. They work diligently to prevent more Canadians from developing skin cancer through public awareness and sun safety.
Save Your Skin Foundation
Melanoma Network of Canada
Melanoma Network of Canada
The Save Your Skin Foundation is a national patient-led not-for-profit group dedicated to the fight against non-melanoma cancers, melanoma and ocular melanoma nationwide education, advocacy, and awareness initiatives. Save Your Skin Foundation is committed to playing an active role in reducing the incidence of skin cancer in Canada, and ensuring equal, timely, and affordable access to best care and compassionate support for all Canadians living with skin cancer, wherever they are in in their journey.