Keep Melanoma Away®

Who is at risk

• Fair skin that burns easily, light eyes, red or blond hair, and freckling.
• Sunburns — especially blistering burns in childhood. Intermittent intense exposure matters more than steady low-level sun.
• Tanning beds. Use before age 35 raises melanoma risk substantially. There is no safe tanning bed.
• Many moles (more than about 50), or atypical/dysplastic moles.
• Family history — a first-degree relative with melanoma roughly doubles risk; some families carry CDKN2A mutations.
• Personal history of melanoma or other skin cancer, and any cause of a suppressed immune system.
• Darker skin does not mean immunity. Melanoma is rarer but is more often found late, and more often on palms, soles and under nails.

Finding it early

There is no blood test and no scan. The tool is your eyes, and a dermatologist's.

Use ABCDE when you look: Asymmetry — one half unlike the other. Border — ragged or blurred. Color — more than one shade, or very dark. Diameter — bigger than a pencil eraser (though melanomas can be smaller). Evolving — changing in any way. Evolving is the most important letter.

The ugly duckling sign is just as useful: most of your moles look like siblings. The one that looks like it belongs to a different family deserves attention.

Check your own skin monthly, including scalp, between toes, soles and under nails. Ask someone to check your back. The USPSTF concludes there is not enough evidence to recommend routine whole-body screening for everyone at average risk — but people with many moles, atypical moles, a family history or a previous melanoma should be under regular dermatologist surveillance.

A changing spot needs looking at now, not at your next physical. Melanoma caught thin is usually cured by removing it.

How it’s diagnosed

Diagnosis requires a biopsy that removes the whole lesion where possible — an excisional biopsy — because the single most important measurement is how deep it goes, and a shave that cuts across the base can make depth impossible to judge.

The pathology report gives you Breslow thickness in millimetres, whether the surface is ulcerated, and the mitotic rate. Those numbers drive everything that follows.

For melanomas beyond a certain thickness, a sentinel lymph node biopsy is offered at the time of wider surgery: dye and a tracer identify the first node the area drains to, and that node is sampled. It is a staging test, not a treatment.

Molecular testing (BRAF in particular) is done when melanoma is advanced, because a BRAF mutation opens up targeted drugs.

Staging explained simply

Melanoma staging is unusual: depth matters more than width. A 2 cm flat freckle-like melanoma in situ is stage 0; a 3 mm dot that has grown 2 mm downward is not.

Grading and biology

Melanoma does not use the usual 1–3 grade. The features that act like grade are Breslow thickness, ulceration and mitotic rate — how deep, whether the surface has broken down, and how fast cells are dividing.

Subtype matters too: superficial spreading is the most common; nodular grows downward fastest and is often thicker at diagnosis; lentigo maligna arises on chronically sun-damaged skin; acral lentiginous occurs on palms, soles and nail beds and affects all skin tones.

BRAF status is the key molecular finding — roughly half of melanomas carry it, and it unlocks targeted therapy.

How it’s treated

Surgery is the primary treatment and usually the cure. The melanoma is excised with a margin of normal skin sized to its thickness. For most early melanomas, that is the whole treatment.

Immunotherapy has transformed advanced melanoma. Checkpoint inhibitors help the immune system recognize melanoma cells, and a meaningful proportion of people with stage IV disease now achieve durable, long-lasting control — an outcome that barely existed fifteen years ago. It is also used after surgery in stage III and higher-risk stage II.

Targeted therapy is for BRAF-mutant melanoma and often works quickly.

Radiation has a supporting role: after surgery when the risk of local return is high, for lentigo maligna on the face when surgery would be disfiguring or is not possible, and — importantly — for melanoma that has spread to the brain or bone, where stereotactic radiosurgery controls individual deposits precisely. Melanoma was long considered radiation-resistant; modern high-dose-per-fraction techniques changed that.

Where CureRays fits: we are the radiation specialists. For most early melanoma, the honest answer is that surgery is what you need and we are not the main event.

What the guidelines say

In broad strokes: excise with a margin matched to thickness; offer sentinel node biopsy once depth crosses a threshold; consider adjuvant immunotherapy for node-positive and higher-risk stage II; treat advanced disease with immunotherapy, or targeted therapy if BRAF-mutant; and use radiation selectively for local control and for brain or bone metastases.

Your team will follow national guidelines such as those from the National Comprehensive Cancer Network (NCCN). The description above is a plain-language overview of the general approach, not the guideline itself — your own plan may reasonably differ. NCCN publishes free NCCN Guidelines for Patients®.

Outcomes and odds of cure

Source: NCI SEER Cancer Stat Facts: Melanoma of the Skin, SEER 21 (excluding IL), 2015–2021.

These are population statistics from the National Cancer Institute's SEER program. They describe large groups of people, not any one person, and they lag current treatment by several years — people treated today often do better. They cannot predict what will happen to you.

Two trends worth knowing. New melanoma diagnoses have been rising about 1.2% a year, while deaths have been falling about 2.8% a year (SEER, through 2023) — we are finding more of it, and treating advanced disease far better than we used to. The distant-stage figure of 34.6% would have been in single digits before modern immunotherapy.

Side effects and how we watch for them

Surgery leaves a scar proportional to the margin taken; sentinel node biopsy can cause fluid collection and, less often, lasting swelling of the limb.

Immunotherapy side effects are different in kind from chemotherapy. Because the drug releases a brake on the immune system, that system can attack normal organs — skin, bowel, thyroid, liver, lungs, and occasionally pituitary or pancreas. Most are manageable when caught early, and some are permanent (thyroid replacement, for example). New diarrhea, a rash, breathlessness or profound fatigue on immunotherapy should be reported the day it starts, not at the next appointment.

Radiation effects depend entirely on the site treated.

How it is assessed: graded on a standard scale at each visit, with blood tests including thyroid and liver function monitored on a set schedule during immunotherapy.

Follow-up, remission and survivorship

Remission means no detectable melanoma. Surveillance continues because a second primary melanoma is genuinely common — having had one is itself a risk factor for another.

Follow-up is mostly skin and lymph node examination on a schedule set by your stage, typically every 3–6 months for the first few years, then annually, often for life. Imaging is added for higher stages.

Survivorship means lifelong sun protection, monthly self-examination, and knowing your own skin well enough to notice a new stranger. Ask about genetic counselling if melanoma runs in your family.

Questions people actually ask

Informational only, not medical advice — confirm with your care team.

Go deeper on melanoma

Read the full plain-language guide, or ask our team where radiation fits in your plan.

Full melanoma guide