Melanoma is a type of skin cancer. It develops from cells in the skin called melanocytes. The cells start to grow and divide more quickly than usual. In melanoma, the melanocytes start to spread into the layers of skin. When they grow out of control, they usually look like a dark spot or unusual-looking mole on your skin.

Young person

It is important to know the symptoms of melanoma, so it can be found and treated as early as possible. Early-stage melanomas (called thin melanomas) are usually cured with surgery.

The skin

The skin does a lot of important things:  

  • It keeps everything inside the body
  • It protects your insides from infections and injury
  • It helps keep your body temperature normal
  • It lets you feel things by touch.

The skin has two layers:

  • Epidermis. This is the top (surface) layer of skin. It is tough and waterproof. Epidermis cells are constantly being rubbed off and replaced.
  • Dermis. Nerves, blood vessels, sweat glands and hair roots are in this layer.

Below the skin is a layer of fat.


Melanocytes are cells in the skin that make melanin. Melanin gives the skin its colour. It also protects skin from being harmed by the sun.  

When our skin comes into contact with sunlight, the melanocytes make more melanin. The extra melanin absorbs more ultraviolet (UV) rays. It also makes the skin darker, making it look suntanned. A suntan is a sign that the skin is trying to protect itself. 

People with naturally dark (brown or black) skin have the same number of melanocytes as people with white skin. But people with darker skin make more melanin. This means they have more natural protection from the sun’s UV rays. 

Moles are made from close groups of melanocytes. Most people with white skin have about 10 to 50 moles on their skin. Some people can have as many as 100, which can increase the risk of getting melanoma. 

Vitamin D  

It is important to be careful about how much sun you are exposed to. But you also need some sunlight to make enough vitamin D to keep your bones and teeth healthy.

It is usually easy for people who have never had melanoma to get enough sun exposure. In the UK, this means going outside regularly (without sunscreen) for 10 to 15 minutes around midday. The amount of sun exposure you need to build up enough vitamin D depends on your hair and skin type. Darker skin types need more sun exposure. But you should not stay out long enough to let your skin redden or burn.

If you have (or already had) melanoma, ask your skin specialist for advice on sun exposure and vitamin D.

Symptoms of melanoma

Melanoma can start with a change in a mole or freckle you already have. Or you might notice a new, strange-looking mole, or a dark area of skin that was not there before.  

It can be difficult to tell the difference between a melanoma and a normal mole. You can use the ABCDE checklist to help you: 

  • Asymmetry– Normal moles are usually evenly shaped all around. Melanomas usually have an irregular or uneven shape.  
  • Border– Normal moles usually have a smooth-looking edge. Melanomas usually have jagged edges.  
  • Colour– Normal moles are usually one shade of brown. Melanomas can have different shades of brown mixed with black, red, pink, white or even a blue tint.  
  • Diameter– Normal moles are not usually bigger than the blunt end of a pencil. This is about 6mm across from one side of the mole to the other. Melanomas often grow bigger than this.  
  • Evolving– Changes to a mole could be a sign of melanoma, so look for changes in size, shape or colour.  

See your doctor straight away if you have:  

  • any of the ABCDE signs  
  • any unusual marks on your skin that last more than a few weeks  
  • tingling or itching in a mole  
  • a crusting or bleeding mole  
  • something growing under a nail, or a new, dark-coloured stripe along part of the nail.  

If you are worried about a mole, make an appointment to see your GP straight away. Remember, melanoma can be cured when it is found early.  

Causes and risk factors of melanoma

Exposure to UV light 

One of the main risk factors for melanoma is giving your skin too much exposure to UV light (radiation). UV light mainly comes from the sun and sunbeds. Too much UV light damages our skin cells and can cause melanoma years later.

If you want to look tanned, it is safest to use fake-tan instead of sunbathing and using sunbeds.


The number of people diagnosed with melanoma in the UK is increasing. People are going abroad on sunny holidays more often. But you can also get too much sun in the UK when the weather is hot. So, you need to be careful in the UK, not just on holiday in hot countries. The risk from sunlight is higher for people with fair skin and pale or blue eyes.


Using sunbeds increases your risk of getting a melanoma. Your risk gets higher:

  • the more you use them
  • the younger you are when you start.

You also get UV light from nail dryers during a gel manicure. The risk of melanoma is low, but to be safe it is best to air-dry your nails. You can also use sunscreen on the backs of your hands 15 to 20 minutes before the manicure.  


If you get blistering from sunburn, especially as a child, it can increase your risk of getting melanoma later on. So, it is important to protect the skin from sunburn, especially for children.  

Having lots of moles or having strange-looking moles  

Your risk of getting melanoma is increased by having:  

  • lots of moles (over 100)
  • moles that are unusually big (over 5mm), with an irregular shape and colour.

This can run in families.

Having lots of moles does not mean you will get melanoma. But you should be careful about how much time you spend in the sun. It is also important to keep checking the moles. Your GP can send you to a skin clinic to learn how to do this properly.

Birth marks 

Most birth marks do not increase your risk of getting melanoma. But having a birth mark called a congenital naevus can cause a higher risk. This is particularly if the birth mark is larger than 20cm across (from one side to the other). People with a congenital naevus should have regular skin checks at a skin clinic. It is a good idea to keep checking smaller birth marks for any changes. But they do not usually need regular check-ups by a doctor or specialist nurse.   

Your skin type  

You are more at risk of melanoma if you have: 

  • fair skin 
  • freckles 
  • blue eyes 
  • fair or red hair 
  • a skin type that burns more easily. 

You will need to be careful about how much time you spend in the sun, to stop yourself getting sunburnt.  

If your skin is naturally darker (brown or black), your risk of melanoma is lower. This is because your skin is naturally more protected against it. But you can still get melanoma if you have darker skin. 

Having close relatives with melanoma  

Having one or more close relatives (parents, brothers, sisters or children) with melanoma increases your risk. The more relatives that have melanoma in the family (including aunts, uncles and grandparents), the higher the risk for you. This may be because you share the same skin type or your family members tend to have lots of moles. But occasionally, melanoma happens because there is a faulty gene in the family.  

If one of your relatives has had melanoma, protecting yourself against the sun is even more important.  

Reduced immunity  

People with a weakened immune system are at a higher risk of getting melanoma. Your immune system fights infection and diseases in your body. It can become weaker after an organ transplant or if you have HIV.  

If your risk of melanoma is higher because of your immune system, your GP can send you to a skin clinic. They will show you how to check your skin.  

If you are worried about melanoma

If you think you have some of the symptoms of melanoma, you should go to your GP straight away. It is always best to get symptoms checked and you are not wasting your GP’s time. They will be able to talk to you about your symptoms. If they think cancer could be causing them, they will find out with [tests] or send you to a specialist.

Having tests for melanoma

Visiting your GP  

If you are worried about a mole or any new marks on your skin, you should see your GP. They will examine the mole. If they think it might be a melanoma, they will send you to a specialist doctor at the hospital. You should see a specialist within 2 weeks.  

At the hospital

Your appointment will be at a skin clinic or a special clinic for diagnosing melanomas early (pigmented lesion clinic). You will see a skin specialist (dermatologist) or a plastic surgeon. They are both experienced in treating skin cancers. You might also see a specialist skin cancer nurse for more support.  

The specialist will examine your mole and ask how long you have had it and how it has changed. Your specialist will find out a lot just by looking at the mole and listening to what you say. They may look at your mole with a small instrument called a dermatoscope. This is not painful and gives a bigger, clearer picture of the mole.  

If there is any possibility it could be a melanoma, your specialist will advise you to have the mole removed. This is called an excision biopsy.  

Excision biopsy

First, the doctor injects a local anaesthetic around the mole. This makes the area go numb, so you won’t feel anything. Then they cut out the mole and a tiny amount of normal skin around it. They close the area up with stitches. The doctor will remove the stitches after a week or two. Or they might dissolve by themselves.  

After removing the mole, the doctors will examine it under a microscope to find out if it is a melanoma. This is called a biopsy.  

You will have to go back to the clinic a few weeks later to get the results. If it is a melanoma, you will usually need to have some more tests (see below) and then further surgery.  

When melanoma is treated early, it is usually cured. 

Further tests

Most melanomas do not spread. If it does, it usually goes to the closest lymph nodes.  

You may have a CT or MRI scan to check whether melanoma has spread to other parts of the body.  

Tests to check the lymph nodes

Lymph nodes help your body fight infection and disease. They are small and bean-shaped. There are groups of lymph nodes around the body. They are connected to each other by a network of tiny tubes that carry a fluid called lymph.  

Your specialist might suggest you have tests if:  

  • the lymph nodes nearest to the melanoma look or feel swollen  
  • you have had treatment and are at risk of the melanoma coming back.  

The doctor will explain which tests they think you should have.  

Fine needle aspiration (FNA)

The doctor gently puts a fine needle (attached to a syringe) into the lymph node and takes some fluid. The test can be a little uncomfortable, but it is over quickly.  

The fluid is then examined under a microscope to see whether there are any cancer cells. 

Ultrasound scan

An ultrasound scan uses sound-waves to build up a picture of the lymph nodes and the area around them.  

Sentinel lymph node biopsy (SLNB)

When lymph fluid drains from the area of the melanoma, the sentinel lymph node is the first lymph node it drains to. If an SLNB is right for you, you usually have it at the same time as having surgery to treat the melanoma.

  • Step 1: radioactive liquid is injected. To find the sentinel node, the doctor injects a tiny amount of harmless radioactive liquid near the area of the melanoma.  
  • Step 2: blue dye is injected. Next, they inject a blue dye. Any lymph nodes that show on an x-ray as blue (meaning radioactive) are the sentinel nodes. 
  • Step 3: the sentinel lymph nodes are removed. The surgeon removes the sentinel lymph nodes through a small cut in the skin. They send them to a lab to be checked for cancer cells. If there are no cancer cells in the sentinel node, the other lymph nodes are usually always okay.  

Having lymph node tests

If you need any of these tests, your specialist or skin nurse will tell you more about them. 

If the tests are positive, your specialist may suggest an operation to remove all the lymph nodes in that area. This is called a lymph node dissection. The specialist will explain the operation to you and discuss the benefits and disadvantages.  

Waiting for test results

Waiting for test results can be scary. Remember that you do not have to keep your worries to yourself. You could talk about how you feel and get support from family, friends or your specialist nurse and doctor.


Surgery for melanoma

Melanomas in young people are usually found early and cured. Surgery is the most common treatment for melanoma.

After removing the melanoma, the doctor will measure how thin or thick it is. This is called the Breslow thickness. Knowing this helps the team decide on the best treatment for you. Most melanomas are 1 millimetre or less deep.

You will usually need a second operation to take away some healthy skin and tissue around where the melanoma was. This is called a wide local excision. You will have this done to make sure no melanoma cells are left. Occasionally, enough tissue is removed during the excision biopsy, so you will not need another operation.

Surgery is usually the only treatment needed for melanoma. If there is risk of the melanoma coming back, your specialist will talk to you about having treatment as part of a clinical trial. This is to try to reduce the risk, and is called adjuvant treatment. But it is not standard treatment.

It is rare for melanoma in young people to spread to other parts of the body. If it has spread, other treatments may be used to slow down and control it.

Wide local excision

You have this operation under a general anaesthetic as an outpatient. You usually go home later the same day.

The surgeon takes some normal-looking skin from around and underneath the melanoma. This is to make sure there are no melanoma cells left. The amount of skin the surgeon removes depends on how deep the melanoma is (the Breslow thickness).

The wound can usually be stitched together. It will look red and sore at first, but this will slowly get better. Your skin nurse will tell you how to take care of it. After 5 to 14 days, your stitches will be removed. You will have a scar, but usually it is small and becomes less noticeable with time.

If you have had a wide or deep area of skin removed, you might need a skin graft.

Skin graft

If it’s needed, you have a skin graft operation at the same time as the wide local excision. First, the surgeon takes a layer of skin from a part of your body without the melanoma (called the donor site). Then they use this skin to cover the area where they removed the melanoma (called the grafted area).

You have a dressing covering the grafted area until it heals. At first, the area will look red and swollen. But eventually, it will heal and the redness will fade. You will also have a dressing covering the donor site, to protect it from getting infected.

After a skin graft, you can usually go home the same day, or you might need a short stay in hospital. It depends on where the graft is and how big it is. You will need to get lots of rest, for the first couple of weeks, to let the graft heal properly. You may need to take some time off.

Your doctor or skin nurse will tell you more about what to expect.

Operation to remove the lymph nodes

You have this operation under a general anaesthetic. You usually need to stay in hospital for a few days. It is sometimes called a lymph node dissection.

The operation will depend on the group of lymph nodes that are removed. Your specialist or skin nurse will talk to you about this.

After the operation, you are at a higher risk of getting swelling called lymphoedema. For example, you could get lymphoedema:

  • in the arm, if the lymph nodes in your armpit were removed
  • in the leg, if the lymph nodes in your groin were removed.

There are things you can do to reduce the risk of lymphoedema. Your nurse will talk to you about this.

Adjuvant treatment for melanoma

Treatment after surgery to try to reduce the risk of a cancer coming back is called adjuvant treatment. The risk of a melanoma coming back depends on:  

  • how thick it is (Breslow thickness)  
  • whether tests show it has spread to the lymph nodes.  

Adjuvant treatment for melanoma is often given in a cancer research trial. This means doctors are still testing the treatment. So we do not yet know how well it works at helping people with melanoma live longer.  

Your cancer specialist will talk to you about any trials happening at the moment and what may be suitable for you. They will give you all the information you need. You can talk to them and your family before you decide what to do.  

Usually drugs called targeted therapies are given as adjuvant treatment for melanoma. Targeted therapies (sometimes called biological therapies) interfere with the way cancer cells grow and divide. There are different types. Your cancer doctor or specialist nurse can tell you which drug may be used.  

Treatment if the melanoma spreads

It is rare for melanoma in young people to spread to other parts of the body. But if it does, you may be given these treatments to slow down and control it:  

  • Immunotherapy uses drugs that boost your immune system to attack cancer cells. 
  • Targeted therapies are drugs that interfere with the way cancer cells communicate with each other. This can affect the way they grow and divide.  
  • Chemotherapy uses anti-cancer drugs to destroy cancer cells.  

Other treatments

Other treatments can help control symptoms, such as pain. The doctor or nurse will explain them to you.  

After treatment for melanoma


After treatment finishes, you will come back to the clinic to see your specialist. How often you see them and how long you do this for depends on the melanoma you had. It is important to go to these appointments. It can help to make a note of them in your phone or diary.

At the clinic, your nurse or doctor will show you how to check your skin and what to look out for. Use the ABCDE checklist so you notice any mole changes early. 

Always get in touch with them straight away if you are worried about anything. 

Sun safety

When you have your follow-up appointments, your nurse or doctor will also give you advice about sun protection. 

After you’ve had a melanoma, you are more at risk of getting another one. Protecting yourself from the sun helps reduce this risk, so this is really important for you. 

Following these tips will help: 

  • Avoid going out in strong sunlight between 11am and 3pm during the summer in the UK or hot countries abroad.
  • Protect yourself whenever you go out in the sun. Use high-factor sunscreen of at least SPF 30. Put it on often (using the directions on the bottle), and especially after swimming.
  • Cover up when you are in the sun. Wear long sleeves, a wide-brimmed hat, and trousers or a long skirt or sarong.
  • Wearing sunscreen does not mean you can stay out in the sun for longer. The best protection is to cover up and stay out of strong sunlight.
  • Never let your skin burn.
  • Avoid using sunbeds. If you want to look tanned, use fake tan.

It is important to take care in the sun, but you do need some sunlight to make vitamin D. This helps keep your bones and teeth healthy. If you don’t have much sun exposure, your vitamin D levels can get very low. When you are diagnosed with melanoma, you will have a blood test to check your vitamin D level. If your vitamin D level is low, your specialist will talk to you about the best way to increase it. They may suggest you take vitamin D supplements. 

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Based on content originally produced by Macmillan Cancer Support.