Melanoma

Also called Skin cancer, Malignant melanoma

The most dangerous skin cancer, and one of the most curable when caught early. Look at the whole skin, including the parts that never see sun.

What it is

Around 17,500 people are diagnosed with melanoma in the UK each year, and rates have risen sharply over decades.

Caught at stage 1, almost everybody survives five years. Caught at stage 4, survival falls dramatically. Few cancers have such a steep gradient, and few are so visible from the outside.

Most melanomas are related to UV exposure, particularly episodes of sunburn and sunbed use. But some occur in places that never see sunlight: soles of feet, palms, under nails, and on mucous membranes.

Those acral melanomas are proportionally commoner in people with darker skin and are diagnosed later, partly because both patients and clinicians are looking in the wrong places. That is a real and correctable inequality.

Signs you might notice

Use ABCDE. Asymmetry. Border that is irregular. Colour that varies. Diameter over 6mm. Evolving, meaning changing.

Any mole that changes in size, shape or colour.

A new mole in an adult, particularly after 40.

Itching, bleeding or crusting of a mole.

A dark streak under a nail that was not there before.

A new or changing mark on the sole, palm, or in the mouth.

How it can affect day-to-day life

The commonest reason for delay is not noticing. Moles on the back are the classic example, and people living alone are diagnosed later for exactly that reason.

Sunbed use in the UK is legal over 18 and it substantially raises melanoma risk, especially with use before 35.

For people with a learning disability or who need help with personal care, whoever provides that care is very often the only person who sees the whole skin. That makes skin checks part of the job rather than an extra.

Supporting someone well

Look at the whole skin. If you support somebody with washing or dressing, that includes the back, soles, between toes, and nails.

Photograph anything uncertain with a ruler or coin for scale, and re-check in four weeks.

Get any changing mole seen promptly, and ask about the two-week wait pathway.

Protect skin: shade, clothing, high-factor sunscreen, and no sunbeds ever.

Do not assume darker skin means no risk. Check the acral sites specifically.

Report a new dark streak under a nail rather than assuming it is a bruise.

Where to get help

See a GP for any changing mole and ask about urgent dermatology referral.

Melanoma Focus run a helpline on 0808 801 0777.

Photographs of the lesion help enormously at the appointment.