Skin cancer is one of the most common forms of cancer in the United Kingdom, yet it is also one of the most treatable when caught in the initial stages. Your skin is your body’s largest organ, acting as a protective barrier against the environment. However, this exposure makes it vulnerable to damage from ultraviolet (UV) radiation.
Noticing a new mole or a change in an existing one can be a source of significant anxiety. It is completely normal to feel worried about finding an abnormality on your skin. However, understanding what to look for empowers you to take control of your health.
According to Cancer Research UK, there are around 16,700 new melanoma skin cancer cases in the UK every year. This statistic highlights why vigilance is essential. By familiarising yourself with the early warning signs, you can prioritise your well-being and seek professional advice when it matters most.
In this article, we explain exactly how to recognise the early signs of melanoma, perform self-examinations, and understand when to see a GP.
What is melanoma?
Melanoma is a type of skin cancer that develops from melanocytes. These are the cells responsible for producing melanin, the pigment that gives your skin its colour.
While melanoma is less common than non-melanoma skin cancers (such as basal cell carcinoma), it is generally considered more dangerous because it is more likely to spread (metastasise) to other parts of the body if not treated early.
Most melanomas are caused by exposure to UV light from the sun or sunbeds. However, there are other factors at play, including genetics and skin type. It is crucial to realise that melanoma can appear anywhere on the body, not just on areas frequently exposed to the sun.
Common types of melanoma
Understanding the different presentations of the disease can help in early detection. The NHS outlines several types:
- Superficial spreading melanoma: The most common type in the UK. It tends to grow outwards on the surface of the skin before growing downwards.
- Nodular melanoma: A faster-developing type that grows downwards into the deeper layers of skin quite quickly. It often appears as a raised lump.
- Lentigo maligna melanoma: Usually affects older people and develops in areas of skin that have been damaged by the sun over many years, such as the face.
- Acral lentiginous melanoma: A rare type that appears on the palms of the hands, soles of the feet, or under the nails. It is not linked to sun exposure.
Recognising the signs: The ABCDE checklist
Dermatologists and health organisations, including the British Association of Dermatologists, recommend using the ABCDE rule to evaluate moles. This simple checklist helps you distinguish between a normal mole and a potential melanoma.
If you notice any of the following features, you should book an appointment with your GP immediately.
A for Asymmetry
Normal, benign moles are usually symmetrical. If you were to draw a line through the middle of a normal mole, the two halves would match.
Melanoma signs:
- The two halves of the mole differ in shape.
- One side looks significantly larger or distorted compared to the other.
B for Border
Benign moles typically have a smooth, defined edge. They look like a clear spot on the skin.
Melanoma signs:
- The edges are blurred, ragged, or notched.
- The border is irregular, making it difficult to define where the mole ends and the normal skin begins.
C for Colour
Most harmless moles are a single shade of brown. Homogeneity is a good sign.
Melanoma signs:
- The mole contains multiple colours or uneven shades.
- You may see different shades of black, brown, and tan.
- In some cases, areas of white, grey, red, pink, or even blue may be visible.
D for Diameter
While melanomas can be tiny, they are often larger than benign moles.
Melanoma signs:
- The spot is wider than 6mm (about the size of a pencil eraser).
- However, do not ignore smaller abnormalities if they exhibit other ABCDE traits, as early-stage melanomas can be small.
E for Evolving
This is arguably the most critical factor. Benign moles generally stay the same over time.
Melanoma signs:
- The mole changes in size, shape, or colour.
- The texture changes, becoming raised or hard.
- New symptoms develop, such as itching, bleeding, or crusting.
The ‘Ugly Duckling’ sign
Another helpful method for identification is the “Ugly Duckling” sign. Most of your moles will look similar to one another—they are your “family” of moles.
A potential melanoma often stands out like an ugly duckling. It looks different from your other moles. If you have one lesion that is darker, larger, or just “looks wrong” compared to the rest, it warrants a check-up.
How to perform a skin self-examination
Macmillan Cancer Support advises getting to know your skin well. Checking your skin once a month can help you spot changes early. Here is a step-by-step guide to performing a thorough self-exam.
- Get the lighting right: Use a bright room and a full-length mirror. Have a hand-held mirror ready for hard-to-see areas.
- Face and head: Examine your face, nose, lips, and ears. Use the hand mirror to check your scalp, parting your hair as you go.
- Hands and arms: Check your palms, the backs of your hands, and between your fingers. Look at your fingernails. Move up your forearms and elbows to your underarms.
- Torso: Stand in front of the full-length mirror. Check your neck, chest, and torso. Women should check underneath the breasts.
- Back: With your back to the full-length mirror, use the hand mirror to inspect your neck, shoulders, and upper and lower back.
- Lower body: Inspect your buttocks and the backs of your legs. Sit down to check your feet, including the soles and between the toes.
Comparison: Normal Mole vs. Potential Melanoma
The table below outlines the key differences to help you identify potential warning signs quickly.
| Feature | Normal Mole (Benign) | Potential Melanoma (Malignant) |
|---|---|---|
| Symmetry | Symmetrical halves match. | Asymmetrical; halves do not match. |
| Edges | Smooth, even, and defined. | Blurred, rough, or ragged borders. |
| Colouration | Single, uniform shade of brown. | Mix of colours (brown, black, red, white). |
| Size | Usually smaller than 6mm. | Often larger than 6mm (though can be smaller). |
| Evolution | Remains consistent over years. | Changes in size, shape, or texture quickly. |
| Sensation | Painless and non-itchy. | Can be itchy, tender, or painful. |
| Surface | Smooth skin texture. | May bleed, ooze, or become crusty. |
Risk factors you should know
Anyone can develop melanoma, but certain factors increase your risk. According to the British Skin Foundation, having a pale skin type that burns easily is a significant risk factor.
Key risk factors include:
- Ultraviolet (UV) exposure: Frequent sunburns, especially during childhood, or use of sunbeds.
- Mole count: Having more than 50 moles on your body.
- Family history: A close relative who has had melanoma.
- Previous history: Having had skin cancer before.
- Immune suppression: Taking medicines that lower your immune system.
If you fall into a high-risk category, you might want to discuss a surveillance plan with your GP.
Frequently Asked Questions
Does a melanoma always bleed?
No, not always. While bleeding, oozing, or crusting can be signs of advanced melanoma, early-stage melanomas often do not bleed. Look primarily for changes in shape, colour, and size. If a mole bleeds spontaneously without injury, see a doctor.
Can melanoma appear on skin that never sees the sun?
Yes. While UV exposure is a primary cause, melanoma can develop in areas like the soles of the feet, palms of the hands, genitals, or inside the mouth. This is why a full-body check is vital, regardless of your tanning habits.
Is an itchy mole a bad sign?
Moles can itch for various reasons, such as dry skin or irritation from clothing. However, persistent itching in a specific mole can be a sign of cellular changes. If the itch does not go away or is accompanied by visual changes, get it checked.
What happens if my GP suspects melanoma?
If your GP is concerned, they will refer you to a specialist dermatologist, usually under the “two-week wait” system in the UK. The specialist may use a dermatoscope to examine the lesion and may recommend a biopsy to confirm the diagnosis.
The Bottom Line
Recognising the early warning signs of melanoma is a vital skill that can save your life. While the thought of cancer is frightening, remember that melanoma is highly treatable when detected early.
Make a habit of checking your skin monthly using the ABCDE rule. Look out for asymmetry, irregular borders, multiple colours, large diameters, and any evolution in appearance. If you notice a “ugly duckling” on your skin or have a gut feeling that a mole isn’t right, do not hesitate.
Contact your GP immediately for an assessment. It is always better to be cautious and get the all-clear than to ignore a potential symptom. Your proactive approach to skin health is your best defence.
