Skin conditions6 min readUpdated
Early Signs of Melanoma: The ABCDEs and When to Get a Mole Checked
The early signs of melanoma: the ABCDE rule, the ugly duckling sign, melanomas that break the rules (nodular, amelanotic, acral, nail), who is at risk, how to check your skin and what happens at a skin check.
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Early signs of melanoma include a mole or spot that is asymmetrical, has an irregular border, has several colors, is larger than about 6 mm, or is changing (the ABCDEs), or one that looks different from your other moles (the ugly duckling sign). Some melanomas are raised and fast-growing, pink or red, or appear on the palms, soles or under a nail. Any new, changing, itching or bleeding spot should be checked; found early, melanoma has a 5-year survival rate above 99%.
- ABCDE: asymmetry, border, color, diameter over about 6 mm, evolving.
- A changing spot is the most important warning sign.
- The ugly duckling sign: a spot that looks different from your other moles.
- Nodular, amelanotic, acral and nail melanomas may not follow the ABCDEs.
- Check your skin monthly, including palms, soles, nails and scalp.
- Found before it spreads, melanoma has a 5-year survival rate above 99%.
On this page 10 sections
Melanoma is the most serious common skin cancer, but it is also one of the most curable when it is caught early. When melanoma is found before it spreads, more than 99% of people are alive five years later. The single most useful habit is knowing your own skin, so you notice a new spot or a mole that changes, and getting it checked quickly.
This guide shows the early signs of melanoma, including the ABCDE rule, the “ugly duckling” sign and the melanomas that do not follow the rules, how to check your skin at home, and what happens at a skin check.
The ABCDEs of melanoma
Dermatologists use five warning signs to help spot melanoma. One sign is enough to get a spot checked.
- A: AsymmetryOne half of the spot does not match the other.
- B: BorderThe edge is irregular, scalloped, notched or blurred.
- C: ColorSeveral shades of tan, brown or black, or patches of red, white or blue.
- D: DiameterUsually larger than 6 mm (about a pencil eraser), although melanomas can be smaller when found.
- E: EvolvingAny change in size, shape, color or height, or a new symptom such as itching, crusting or bleeding.
“Evolving” is the most important sign. A spot that is changing deserves a check even if it looks fine on every other count.
Normal mole or warning sign?
Usually harmless
A typical mole
- ShapeRound or oval, even on both sides
- EdgeSmooth and clear
- ColorOne even shade of brown or tan
- Over timeStays the same for years
Get it checked
Possible melanoma
- ShapeLopsided or uneven
- EdgeRagged, notched or blurred
- ColorSeveral colors, or very dark
- Over timeNew, growing, changing, itching or bleeding
The “ugly duckling” sign
Most of your moles tend to look alike. A spot that looks different from the rest, whether larger, smaller, darker, lighter or a different shape, stands out like an ugly duckling and should be checked, even if it does not fit the ABCDEs. A single dark spot with no other moles around it counts too.
Melanomas that break the rules
| Type | What to look for |
|---|---|
| Nodular melanoma | A firm, raised bump that grows over weeks; may be dark, pink or red. Think EFG: elevated, firm and growing |
| Amelanotic melanoma | Little or no pigment: pink, red, skin-colored or clear, easily mistaken for a pimple or scar |
| Acral melanoma | On the palms, soles of the feet or under a nail; the most common melanoma in people with darker skin |
| Nail melanoma | A new or widening brown or black streak in a nail, especially if it spreads onto the skin around the nail |
| Lentigo maligna | A slowly growing, flat, uneven brown patch on sun-damaged skin of the face, often in older adults |
These types are why dermatologists treat the ABCDEs as a guide, not a test. Any spot that is new, changing or does not heal needs a look.
Book a skin check soon if you notice a new mole after age 30, a mole that is changing, a spot that itches, bleeds or crusts, a sore that does not heal within a few weeks, a dark streak in a nail, or a spot that looks different from all your others. Most will be harmless, but early checks are what make melanoma so treatable.
Who is at higher risk?
- Fair skin that burns easily, red or blond hair, light eyes or freckles
- Many moles (more than 50), or large or unusual moles
- A personal or family history of melanoma
- Blistering sunburns, especially in childhood, or use of tanning beds
- Lots of sun exposure over time, which is common in Southern California
- A weakened immune system
Melanoma affects all skin tones. Lifetime risk is about 1 in 33 for White Americans and lower for Hispanic and Black Americans, but in darker skin it is more often found late, partly because it tends to appear in places people do not check, such as the soles, palms and nails.
How to check your skin at home
- Pick a day each month and check in good light, with a full-length mirror and a hand mirror.
- Look everywhere: face, ears, neck, chest, belly, arms, the backs of your hands, palms and fingernails.
- Check the hidden places: soles, between the toes, toenails, backs of the legs, buttocks and genital area.
- Use the hand mirror for your back, scalp (part your hair or ask for help) and the back of your neck.
- Take photos of moles you are watching, with a ruler beside them, so you can compare next month.
What happens at a skin check
A full-body skin exam takes about 20 to 30 minutes. Your provider looks at your skin from scalp to soles, often with a dermatoscope (a lighted magnifier), and notes any spots to watch. If a spot looks suspicious, a quick skin biopsy under local numbing removes some or all of it for a lab to examine; results usually take 7 to 10 days. If it is melanoma, treatment depends on how deep it is, usually starting with surgery to remove it with a margin of normal skin, and we guide you through the next steps and referrals.
Prevention
- Use broad-spectrum SPF 30+ sunscreen every day and reapply outdoors; see our guides to summer skincare and sunscreen ingredients.
- Seek shade between 10 a.m. and 2 p.m. and wear a hat, sunglasses and UPF clothing.
- Never use tanning beds.
- Check your skin monthly and see a provider yearly if you are at higher risk.
Skin checks in Carlsbad
Our dermatology team offers full-body skin cancer screenings, mole checks and biopsies at our South Carlsbad studio. Medical dermatology visits are $150 – $375. See our skin cancer screening and melanoma diagnosis pages, read about the types of skin cancer, or book a skin check on El Camino Real.
Frequently asked questions
What are the early signs of melanoma?
A new or changing mole, or one that is asymmetrical, has an irregular border, several colors or is larger than about 6 mm. A spot that looks different from your other moles, itches, bleeds or does not heal also needs a check.
What does early melanoma look like?
Often a flat or slightly raised, uneven brown or black spot with irregular edges, but some are pink, red or skin-colored, and some are raised bumps that grow quickly.
Can melanoma be cured if caught early?
Yes. When it is found before it spreads, the 5-year survival rate is more than 99%, usually with surgery alone.
Where does melanoma usually appear?
Anywhere, often on the back in men and the legs in women, but also on the palms, soles, under nails and on the scalp.
How often should I check my skin?
Once a month at home, and once a year with a professional if you have risk factors such as many moles, fair skin or a family history.
Does melanoma itch?
It can. Itching, crusting or bleeding in a mole is a reason to have it checked.
Sources
Insiyah Darugar
Insiyah Darugar, MSN, FNP is the founder and CEO of Glow Theory Aesthetic & Dermatology Studio in Carlsbad. She brings more than 15 years of hands-on experience in dermatology and aesthetics and completed the Dermatology Nurse Practitioner Fellowship at Lahey Hospital & Medical Center, a…
