David T. Harvey, MD Mohs Surgeon & Cosmetic Dermatologist

Malignant Melanoma is known as one of the most aggressive types of skin malignancy. Melanoma accounts for less than 5% of skin cancer cases but causes a large majority of skin cancer deaths. In fact, it is estimated that about 9,480 people will die of melanoma in 2013. The American Cancer Society estimates that about 76,690 new malignant melanoma cases will be diagnosed in the United States during 2013. From 1970 to 2009, the incidence of malignant melanoma increased by 800 percent among young women and 400 percent among young men. Malignant melanoma is more than 10 times more common in whites than in African Americans. It is slightly more common in males than in females. The lifetime risk of getting melanoma is about 2% (1 in 50) for whites, 0.1% (1 in 1,000) for blacks, and 0.5% (1 in 200) for Hispanics. The risk for each person can be affected by a number of different factors, which are described below.


Ultraviolet (UV) light exposure

Ultraviolet (UV) radiation is thought to be a major risk factor for most melanomas. Sunlight is the main source of UV radiation, which can damage the genes in your skin cells. Tanning lamps and booths are also sources of UV radiation. People with excessive exposure to light from these sources are at greater risk for skin cancer, including melanoma. Statistically, 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation. The amount of UV exposure depends on the intensity of the radiation, length of time the skin was exposed, and whether the skin was protected with clothing and sunscreen. The nature of the UV exposure may play a role in melanoma development. Many studies have linked the development of melanoma in the trunk, legs, and arms to frequent sunburns (especially in childhood). The fact that these areas are not constantly exposed to UV light may also be important. Some experts think that melanomas in these areas are different from those on the face and neck, where the sun exposure is more constant. And different from either of these are melanomas that develop on the palms, soles, nails or internal surfaces such as the mouth and vagina, where there has been little or no sun exposure.

Moles (Multiple or Atypical)

A nevus (the medical name for a mole) is a benign (non-cancerous) melanocytic tumor. Moles are not usually present at birth but begin to appear in children and teenagers. Most moles will never cause any problems, but a person who has many moles is more likely to develop melanoma. A dysplastic nevus, or atypical mole, is a type of mole that particularly increases a person’s risk of melanoma. Dysplastic nevi (nevi is the plural of nevus) often look a little like normal moles but also look a little like melanoma. They can appear in areas that are exposed to the sun as well as those areas that are usually covered, such as the buttocks and scalp. They are often larger than other moles.

Learn the “ABCDE” Rule

Melanoma lesions can be identified by the “ABCDE” rule. In essence this refers to skin lesions which are Asymmetric, have Border irregularity, develop a multitude of skin Colors, have a Diameter greater than 6mm, or are Evolving or changing. The earliest sign of a melanoma is itching. Moles or freckles which bleed, are tender or grow rapidly should also be evaluated by a dermatologist.

  • A = Asymmetry of a mole
  • B = Border irregularity of a mole
  • C = Multiple Colors to a mole
  • D = Diameter greater than 6mm (Pencil Eraser)
  • E = Evolving Mole (Enlarging, Itching, Bleeding)

Melanoma Patients Information Page – an excellent source for the latest treatments available for melanoma patients and a list of support groups. https://melanoma.org/.


The treatment of malignant melanoma is surgical removal of the lesion with an appropriate margin of normal skin. In some instances, lymph node removal, radiation treatment or chemotherapy are utilized but these treatments are usually reserved for aggressive melanoma lesions which may have spread internally. Melanoma spread can also be detected by techniques such as PET Scans or lymph node scintigraphy which can identify the sentinel lymph node. Follow up total body skin examinations should be performed every 3 to 6 months. Ocular exams such as the Optomap test should also be performed.