Melanoma Evaluation and Treatment Guidance in Danville, CA
Melanoma: Checking It and Treating It, in Danville, CA
Melanoma is a potentially serious skin cancer that begins in melanocytes, the cells that make skin pigment. It is often highly treatable when found early, but it can spread to lymph nodes and other organs if it grows deeper. A new, changing or unusual-looking spot should be examined promptly. Diagnosis is made with a skin biopsy, and treatment depends on the pathology and stage, most early melanomas are treated surgically, while higher-risk or advanced disease may require coordinated specialty care.
Melanoma is a skin cancer that starts in the cells that make the colour in your skin. Found early, it is usually very treatable. If it grows deeper it can spread, to the lymph glands and to other organs, and that is what makes it serious. Any spot that is new, changing or simply looks odd should be examined soon. The diagnosis is made by taking a small sample of skin and testing it. What happens next depends on what that test shows: most early melanomas are dealt with by surgery, while deeper or more advanced ones need a team of specialists.
Melanoma: the essentials
The short version
A cancer of melanocytes, the pigment-producing cells of the skin.
A cancer that starts in the cells which make the colour in your skin.
Thin, localized melanoma is often highly treatable; deeper or spread melanoma requires more complex care.
A thin melanoma that has stayed put is usually very treatable. A deeper one, or one that has spread, needs far more complicated care.
Dermatologic examination followed by biopsy of a suspicious lesion.
A skin doctor examines it, then takes a small sample of anything suspicious.
Surgical excision with a margin of normal-appearing skin based on the pathology and melanoma stage.
Cutting it out, together with a margin of normal looking skin. How wide that margin is depends on the test results.
Selected melanomas may require sentinel lymph-node biopsy, imaging, medical oncology, surgical oncology or other specialty care.
Some melanomas need a lymph gland checking, scans, or care from a cancer specialist or a specialist surgeon.
A new or changing spot; ABCDE features; an “ugly duckling” that looks different from other moles; itching, bleeding or a non-healing lesion.
A new spot, or one that is changing. A spot that looks different from all your others. Anything that itches, bleeds, or will not heal.
What does melanoma look like?
What does melanoma look like?
Melanoma can look many different ways. The most useful warning is change: a new spot, a mole that evolves, or a lesion that looks different from the rest deserves attention even if it is small.
It can look like all sorts of things. The most useful warning sign is change: a spot that is new, a mole that is altering, or one that looks unlike the rest of yours. That is worth attention even when it is small.
- A, Asymmetry: one half does not match the other.
- B, Border: edges may be irregular, scalloped or poorly defined.
- C, Color: more than one color or an uneven distribution of pigment can be concerning.
- D, Diameter: many melanomas are larger than 6 mm when found, but melanoma can be smaller.
- E, Evolving: change in size, shape, color, symptoms or surface is important.
- Melanoma can be pink, red or skin-colored and can occur on palms, soles or under nails, including in darker skin tones.
- Uneven shape: one half does not match the other.
- Ragged edge: the border may be uneven, scalloped, or hard to make out.
- More than one colour, or colour that is patchy rather than even.
- Size: many melanomas are bigger than about a quarter of an inch when they are found, but they can be smaller.
- Changing: in size, shape, colour, surface, or how it feels. This is the most important one.
- Melanoma can be pink, red or skin coloured, and it can appear on your palms, the soles of your feet, or under a nail. That is true for every skin colour.
Who is at higher risk for melanoma?
Who is at higher risk?
Anyone can develop melanoma, but risk rises with ultraviolet exposure, a personal or family history of melanoma, many or atypical moles, immune suppression and certain inherited factors. Skin color does not eliminate risk.
Anyone can get melanoma. The risk is higher with more sun, if you or your family have had one before, if you have a lot of moles or unusual looking ones, if your immune system is suppressed, and with certain inherited genes. Having darker skin does not remove the risk.
- Indoor tanning and intense ultraviolet exposure increase risk.
- A history of blistering sunburns, especially earlier in life, is relevant.
- People with many moles or atypical moles may need a personalized surveillance plan.
- A first-degree relative or personal history of melanoma increases risk.
- Immunosuppression and some inherited cancer syndromes can increase risk.
- Sunbeds, and intense sun, raise the risk.
- Sunburns bad enough to blister, especially when you were young, matter.
- If you have many moles, or unusual looking ones, you may need a personal plan for keeping an eye on them.
- A parent, brother, sister or child who has had melanoma, or having had one yourself, raises your risk.
- A suppressed immune system, and some inherited cancer conditions, raise it too.
Educational ABCDE guide for melanoma warning signs
A teaching guide to the warning signs in a mole.
Diagram showing melanoma evaluation, biopsy, pathology and treatment planning
A diagram showing how melanoma is assessed: examining it, taking a sample, testing it, and planning treatment.
How is melanoma diagnosed?
How is it diagnosed?
A dermatologist examines the lesion and, when melanoma is suspected, performs a biopsy so a pathologist can determine whether cancer is present and measure features that guide treatment. A photograph alone cannot confirm or rule out melanoma.
A skin doctor examines the spot, and if melanoma is possible, removes a sample. A specialist then looks at that tissue under a microscope, decides whether it is cancer, and measures the things that decide the treatment. A photograph on its own can neither confirm nor rule out melanoma.
| Skin examination | The lesion and surrounding skin are examined; dermoscopy may be used | Helps identify which spots need biopsy |
|---|---|---|
| Biopsy | Part or all of the suspicious lesion is removed using the method best suited to its size and location | Provides the tissue diagnosis |
| Pathology report | A pathologist evaluates melanoma type, thickness and other features | Guides excision margins, staging and whether additional tests are considered |
| Further staging when indicated | Selected patients may need sentinel lymph-node biopsy and/or imaging | Checks whether higher-risk melanoma has spread |
Examining your skin The spot and the skin around it are looked at, often with a magnifier. That decides which spots need a sample taken.
Taking a sample Part or all of the spot is removed, by whichever method suits its size and place. That gives us the answer.
The laboratory report A specialist works out the type of melanoma, how thick it is, and other features. That decides how much skin needs removing, and whether more tests are needed.
Checking further, if needed Some people need a lymph gland tested, or scans, to see whether a higher-risk melanoma has spread.
How is melanoma treated?
How is it treated?
Treatment is based on stage. For melanoma confined to the skin, surgery to remove the melanoma with an appropriate margin is the foundation of treatment. More advanced disease may require lymph-node procedures, immunotherapy, targeted therapy, radiation or other oncology-directed care.
It depends how far it has got. If the melanoma is still only in the skin, surgery to remove it with a margin around it is the foundation of treatment. If it has gone further, it may need lymph gland surgery, medicines that train the immune system to attack it, medicines aimed at particular faults in the cancer, radiotherapy, or other care led by a cancer specialist.
| Melanoma in situ / early localized melanoma | Wide local excision | The final margin is chosen from pathology and guideline-based factors |
|---|---|---|
| Selected higher-risk localized melanoma | Excision plus consideration of sentinel lymph-node biopsy | Not every patient needs a sentinel-node procedure |
| Melanoma involving lymph nodes or high recurrence risk | Surgery and/or systemic therapy coordinated with melanoma specialists | Modern immunotherapy and targeted therapy may be considered according to stage and tumor features |
| Metastatic melanoma | Medical oncology-led systemic therapy; surgery/radiation may have selected roles | Requires individualized multidisciplinary care |
Very early melanoma, still in the top layer Cut out with a margin of normal skin. How wide that margin is comes from the laboratory report and national guidelines.
Early melanoma with higher risk features Cut out, and a lymph gland may be tested as well. Not everyone needs that.
Melanoma in the lymph glands, or at high risk of returning Surgery and medicines, arranged with melanoma specialists. Modern immune treatments and targeted medicines may be options depending on the details.
Melanoma that has spread Led by a cancer specialist, using medicines that treat the whole body. Surgery and radiotherapy may have a part to play. Care is planned by a team, around the individual.
Is Mohs surgery used for melanoma?
Is Mohs surgery used for melanoma?
Not routinely for every melanoma. Standard wide local excision remains the usual treatment for most localized cutaneous melanomas. Mohs or staged excision may be considered for selected melanoma in situ or anatomically sensitive cases by specialists with appropriate melanoma pathology methods.
Not usually. For most melanomas that are still in the skin, the standard treatment is cutting it out with a margin. Mohs, or a staged removal, may be considered for certain very early melanomas, or in places where sparing skin matters a great deal, by specialists using the right laboratory methods for melanoma.
- Do not choose the procedure before the biopsy and pathology are known.
- The dermatologist may refer to a Mohs surgeon, surgical oncologist or melanoma center when the case requires expertise beyond routine office excision.
- Do not settle on a procedure before the sample has been taken and tested.
- Your skin doctor may refer you to a Mohs surgeon, a cancer surgeon or a melanoma centre when the case needs more than an ordinary office operation.
Diagram showing early melanoma surgery and referral pathways for higher-risk melanoma
A diagram showing surgery for early melanoma, and where higher-risk cases get referred.
Illustration, not clinical photography. Medically verified examples of melanoma. It is a general illustration for orientation only. Do not use it to judge a mark on your own skin, anything new, changing or not healing should be looked at in person.
This is a drawing, not a photo of a real melanoma. It is a general illustration to give you an idea, nothing more. Do not use it to judge a mark on your own skin. Anything new, changing, or not healing needs looking at in person.
How can I lower my melanoma risk and find it earlier?
How do I lower my risk, and catch it earlier?
You cannot remove all risk, but consistent ultraviolet protection and regular skin awareness can reduce preventable exposure and improve the chance of noticing melanoma early.
You cannot remove the risk entirely. But protecting yourself from the sun cuts the exposure you can control, and knowing your own skin makes it far more likely you notice a melanoma early.
- Avoid indoor tanning.
- Use shade, sun-protective clothing and broad-spectrum SPF 30+ sunscreen together.
- Check your skin regularly, including scalp, palms, soles and nails, at the interval recommended for your risk.
- Seek evaluation promptly for a spot that is new, changing, bleeding, painful or simply looks unlike your other spots.
- Never use a sunbed.
- Use shade, covering clothing and a broad spectrum SPF 30 or higher sunscreen together, not one instead of the others.
- Check your own skin regularly, including your scalp, palms, soles and nails, as often as is right for your risk.
- Get seen promptly for any spot that is new, changing, bleeding, painful, or simply unlike your others.
What can I expect after a melanoma diagnosis?
What happens after a melanoma diagnosis?
The outlook varies mainly with melanoma stage and tumor biology. Early melanoma is often treated successfully with surgery alone, while deeper or spread melanoma needs closer surveillance and may require additional treatment. A prior melanoma also increases the importance of lifelong skin follow-up.
How things go depends mostly on how far the melanoma had got, and on the kind it is. Early melanoma is often dealt with by surgery alone. A deeper one, or one that has spread, needs closer watching and may need more treatment. Having had one melanoma also makes lifelong skin checks important.
- Keep copies of the pathology report and treatment records.
- Follow the skin-exam schedule recommended for your melanoma stage and personal risk.
- Ask which symptoms or lymph-node changes should trigger earlier review.
- If oncology treatment is needed, care should be coordinated with clinicians experienced in melanoma.
- Keep your own copies of the laboratory report and your treatment records.
- Stick to the check up schedule recommended for your stage and your risk.
- Ask which symptoms, or which changes in your lymph glands, should bring you back sooner.
- If you need cancer treatment, it should be arranged with clinicians who deal with melanoma regularly.
Questions patients ask
Can melanoma be smaller than 6 mm?
Can a melanoma be small?
Yes. Diameter is only one part of the ABCDE guide. Small melanomas occur, so evolution and an unusual appearance matter.
Yes. Size is only one of the warning signs. Small melanomas happen, which is why change, and looking different from your other spots, matter more.
Can people with dark skin develop melanoma?
Can people with dark skin get melanoma?
Yes. Melanoma occurs in every skin tone and may develop on less sun-exposed sites such as palms, soles or beneath nails.
Yes. It happens in every skin colour, and it often turns up in places that get little sun, such as the palms, the soles, or under a nail.
Does every suspicious mole need to be removed?
Does every odd looking mole have to come off?
No. A dermatologist decides which lesions need biopsy based on examination, dermoscopy, history and change over time.
No. A skin doctor decides which ones need a sample taken, based on examining them, on a magnified look, on your history, and on whether they have changed.
If my biopsy shows melanoma, is more surgery always needed?
If the sample shows melanoma, do I need more surgery?
Usually a definitive excision is recommended after the diagnostic biopsy to remove any remaining melanoma and an appropriate margin of surrounding skin. The exact plan depends on the pathology.
Usually yes. After the sample confirms it, a second, wider removal is normally recommended, to take away anything left behind plus a margin of skin around it. Exactly how much depends on the laboratory report.
Does every melanoma require chemotherapy?
Does melanoma always mean chemotherapy?
No. Many early melanomas are treated with surgery alone. Advanced or higher-risk melanoma may require systemic treatments such as immunotherapy or targeted therapy selected by oncology specialists.
No. Many early melanomas are treated with surgery and nothing else. More advanced or higher-risk melanoma may need medicines that work through the whole body, chosen by cancer specialists.
How often should I have skin checks after melanoma?
How often will I be checked afterwards?
There is no single schedule for everyone. Follow-up depends on stage, personal risk, prior melanomas and specialist recommendations.
There is no single schedule. It depends on the stage, your own risk, whether you have had melanoma before, and what your specialists advise.
If this is a medical emergency, call 911. For an urgent skin problem during office hours, call the practice on (925) 820-3376 rather than using a form, messages are not monitored continuously.
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
