Malignant melanoma

How is malignant melanoma diagnosed and treated?

Moles are common and an adult will have around 30 moles on average. While most of these moles will be harmless and not caused by skin cancer, in certain cases a new mole or skin lesion may appear, or an existing mole may change in character over time.

Skin cancer facts and risks

Skin cancer is now the most common cancer in the UK, and the incidence of malignant melanoma is doubling every 10 years. Malignant melanoma is now one of the most common cancers in young adults (aged 15-34) in the UK and claims more than 2000 lives a year. Certain men or women are more at risk of skin cancer, including those with fair or red hair, those with an increased number of freckles on their arms before the age of 20 and those who have had a previous non-melanoma type of skin cancer. However, 80% of all skin cancers are caused by overexposure to the sun and/or sunbeds.

Am I at increased risk of melanoma skin cancer?

We now know that there are a number of factors that increase the risk of melanoma skin cancer as follows:
  • Sex (increased risk in men)
  • Number of severe sunburns from age 2-18 (more sunburns, higher risk)
  • Age (older men and women at increased risk)
  • Hair colour at age 15 (lighter and red hair colour at increased risk)
  • Density of freckles on arms before age 20 (increased density, increased risk)
  • Number or raised moles on both arms (higher number, increased risk)
  • A previous diagnosis of non-melanoma skin cancer

Reasons to consider mole removal

If a mole has changed recently, or it has suspicious features, then your GP will arrange referral to a plastic surgeon or dermatologist who has a special interest in skin cancer. This service is available in the NHS, although waiting times to be seen in a clinic can be many weeks, or privately if you have medical insurance or want to pay for treatment. Mole removal is advised if you have noticed a mole that:
  • Has increased in size
  • Has changed in colour
  • Is greater than 7mm in size
  • Has an irregular shape
  • Has an irregular colour
  • Is inflamed or oozing
Although the majority of moles that present with these clinical signs will not be cancerous, a small proportion will contain malignant cells and may require further treatment following initial mole removal. Black or dark brown moles may be a sign of melanoma, the most dangerous form of skin cancer that can result in patient mortality. If you have noticed any of the above features, you should consider seeking medical advice to decide whether your mole should be removed or not.

Are there different types of malignant melanoma?

There are several different types of malignant melanoma as follows:

Superficial spreading melanoma:

The most common type or melanoma that presents in middle age. In the early stages, the melanoma spreads outwards rather than downwards into the skin and does not spread to other parts of the body until downward spread occurs.

Nodular melanoma:

Usually presents as a dark brown or black nodule on the skin and grows downwards at an early stage. It is often found on the back or chest.

Lentigo maligna melanoma:

This tumour usually arises on the face of older people who have had extensive sun exposure, and often arises in an enlarging area of pigmented skin.

Acral lentiginous melanoma:

This is a rare type of melanoma and often present on the soles of the feet, under toenails or the hands. It is more common in dark skinned people.

Amelanotic melanoma:

This is a rare type of melanoma that does not contain melanin (pigment), and as a result it can be mistaken for other skin lesions. It can present as a pink or red skin lesion, perhaps with a small amount of pigment at the edge of the lesion.

What does Malignant Melanoma stage mean?

There are several ways to categorise how advanced a melanoma is at diagnosis. The stage of a malignant melanoma is based on how deeply it has grown into the skin, and whether it has spread to other parts of the body. Staging can help to choose the most appropriate treatment for a patient with melanoma, and it can help estimate the likely prognosis. One way is to use the TNM system, which stages malignant melanomas according to Tumour size downwards in the skin (T), the number of lymph Nodes affected by tumour spread (N) and whether the tumour has Metastasised (spread) to other parts of the body (M). The Breslow thickness describes how far the malignant melanoma has grown down into the skin in millimeters. The Clark scale categorises malignant melanomas into one of five stages, depending on which layers of skin are breached by the melanoma. Based on the above classification, malignant melanomas can be grouped into 4 stages. Patients with Stage 1 and Stage 2 melanoma are usually treated by surgery and possible lymph node biopsy. Patients with Stage 3 melanoma are usually treated by surgery to remove the melanoma and lymph nodes, followed by possible chemotherapy, radiotherapy or biological therapy. Patients with Stage 4 melanoma, where the melanoma has spread to other parts of the body, may require a combination of different treatment. In general, patients with Stage 1 or Stage 2 melanoma have a better prognosis than patients with Stage 3 or Stage 4 disease.

How is malignant melanoma diagnosed?

Despite the majority of moles and skin lesions being healthy and normal, there are a small number that undergo change into melanoma, the most dangerous form of skin cancer that can result in patient mortality. Examination to look for early changes in a mole or other skin lesion as early as possible can therefore potentially save lives, by detecting melanoma at an earlier stage when treatment is likely to be more successful. Malignant melanoma diagnosis should be performed by a specialist nurse or doctor with expertise in recognising the early features of skin cancer. Changes that they will look for include a mole that has increased in size, changed in colour, is >7mm in size, has an irregular shape or colour or is inflamed or oozing. The skin cancer specialist may also use a state-of-the-art technique called dermoscopy, which looks into the upper layers of the skin to help detect skin cancers, including malignant melanoma at an early stage. Some clinics will also take high quality digital images and dermoscopic images so that they can be uploaded online and sent by telemedicine to consultant skin cancer specialist for expert opinion and advice on further management. If you are worried that you might have a mole or other skin lesion that could be a melanoma, one option is to book an appointment where your mole or skin lesion can be thoroughly examined by a specialist skin cancer nurse and images can be taken for telemedicine reporting by consultant skin cancer specialists. You can then be advised whether you require mole removal or not.

What happens if my skin lesion is a suspected malignant melanoma?

If a suspicious mole or skin lesion is identified on examination, then further treatment will be required. If your skin lesion is suspicious of melanoma, it would normally be completely removed for pathological assessment. Please click here for more information on mole removal or treatment (link to mole removal page).

When will I get my results following assessment for malignant melanoma?

If no signs of malignant melanoma are identified on examination, then you will be reassured immediately by the specialist skin nurse or doctor. If any digital or dermoscopic images are taken or a biopsy is performed, then results would normally be available with 5 working days.

Frequently asked questions

SkinCheck by SkinHealth UK

Do you have any concerns that a mole or skin lesion is new or has changed? SkinCheck is now available to provide a detailed skin assessment and a complete skin examination to give you peace of mind.

What is SkinCheck?

SkinCheck is a mole screening and skin cancer screening service provided by SkinHealth UK. At SkinHealth UK we only work with highly experienced skin cancer nurses, many of whom still work in NHS skin cancer clinics. Our nurses operate from a network of clinics/hospitals in England & Scotland, so we can book you in to a clinic close to your home or work address. SkinCheck may also be available at an in- company clinic for certain corporate clients. See our clinics page for more information about clinic locations (link to clinics page).

Why chose SkinCheck?

Your mole screening and complete skin examination will examine all your moles, including your back and soles of the feet, and any suspicious skin lesions will be analysed using state of the art technology (dermoscopy) by consultant skin cancer consultants. You will also learn your personal risk of melanoma, the most dangerous type of skin cancer, and what changes to look for in the future.

What does SkinCheck cost?

SkinCheck mole and skin cancer screening costs £175. Please see our pricing page for further information.

What does SkinCheck include?

Your consultation fee with SkinHealth UK will cover an online risk questionnaire based on skin type and lifestyle, and this will be followed by a 25-minute consultation with a specialist nurse comprising:
  • A review of your skin cancer risk assessment
  • Complete skin examination including dermoscopy
  • Education in what skin changes to look for, and how to protect your skin
  • Mole by mole results letter with relevant images

When do I get my SkinCheck results?

If no suspicious skin lesions are identified on examination, you will be reassured by our specialist skin cancer nurse and a results letter will be emailed to you within 48 hours. If any digital or dermoscopic images are taken for telemedicine reporting, then our consultant skin cancer specialist will produce a report within 3-5 working days. The report will include mole by mole images and results, with advice about whether further investigation or treatment is required.

If I have images taken, what might the report say?

If you have digital or dermoscopic images taken during your SkinCheck appointment, then there are three possible outcomes as follows: 1. No suspicious features – you will be reassured that no further treatment is required. 2. No suspicious features – surgery would only be required for cosmetic or functional reasons (bleeding of weeping). 3. Suspicious features – further investigations and probable biopsy required.

Where would I have further treatment if required?

If your SkinCheck assessment identifies any suspicious features, you will require further investigation or treatment. SkinHealth UK can arrange for you to be seen by privately one of our specialist skin cancer consultants in our network or if you would like to be referred to the NHS, out detailed results letter can be taken to you GP who can then refer you to a local skin cancer clinic. Please click here for more information on mole removal or treatment

If you are concerned that you have Skin Cancer, you should speak to a medical professional as soon as possible.

With SkinHealth UK, you can book an appointment with a specialist nurse at a clinic near you, and have your results within 5 days of your appointment.

To book your appointment, call us on 0800 876 6662 or request a call