Melanoma Check & Diagnosis

What Is Melanoma?

Melanoma is a cancer of the melanocytes — the pigment cells that give skin its colour. It is the most dangerous of the common skin cancers because it can metastasise early: a melanoma just a few millimetres thick can already have spread microscopic cells to lymph nodes and internal organs. It can appear anywhere on the body, including areas that never see the sun — the soles of the feet, under nails, and, in men, on the back; in women it often occurs on the legs.

At the same time, melanoma found before it invades deeply is almost always curable with a minor procedure. That is the whole point of melanoma screening: find it thin, treat it early, and the statistics change dramatically in your favour.

The ABCDE Rule of Melanoma

When you check your own skin, use the ABCDE rule as a guide for what deserves a doctor's attention:

• A — Asymmetry: one half of the spot does not match the other half
• B — Border: edges are irregular, ragged, blurred or notched
• C — Colour: uneven colour — shades of brown, black, red, white or blue within the same lesion
• D — Diameter: larger than about 6 mm (the size of a pencil eraser), though smaller melanomas exist
• E — Evolving: the spot is changing in size, shape, colour or sensation — itching, bleeding or crusting

Also watch for the "ugly duckling" sign — a mole that simply looks different from all your other moles. Any mole that stands out from the crowd deserves a professional mole check, even if it looks small.

What Happens at a Melanoma Check?

A full-body melanoma check at our melanoma clinic is a systematic head-to-toe examination of your skin, including areas you cannot easily see yourself — the scalp, back, buttocks, between the toes and the soles of the feet. The examining doctor uses a dermatoscope (a magnifying device with polarised light) to look below the skin surface, where early melanoma reveals structures invisible to the naked eye. This combination of a full body skin check and dermoscopy is far more accurate than a quick look or a phone photo.

If you have many moles, atypical moles, a family history of melanoma or a previous melanoma, mole mapping adds a further layer of safety: whole-body photography creates a baseline record of your moles, and suspicious lesions are photographed individually and compared at every future visit. Change over time is one of the strongest warning signs of melanoma, and mapping is the most reliable way to detect it.

How Melanoma Is Diagnosed

No melanoma diagnosis can be made from appearance alone — a lesion suspected of being melanoma is removed (or sampled) and sent to a pathologist. This is called a biopsy, and it is usually a quick procedure under local anaesthetic. Excisional biopsy — removing the entire lesion with a small margin — is preferred whenever possible, because it lets the pathologist measure the tumour fully.

The most important measurement in the pathology report is the Breslow thickness — how deep the melanoma has grown into the skin, measured in millimetres. Breslow thickness is the single strongest predictor of melanoma behaviour and directly guides melanoma treatment: a 0.5 mm melanoma and a 3 mm melanoma require very different plans. Other reported features include ulceration, mitotic rate and whether the margins are clear.

Melanoma Treatment Options

• Wide local excision — after the diagnosis is confirmed, the biopsy scar and surrounding skin are re-excised with a margin determined by the Breslow thickness, to remove any remaining melanoma cells. This is the core melanoma treatment for early-stage disease
• Sentinel lymph node discussion — for thicker melanomas, your doctor will discuss whether a sentinel lymph node biopsy is appropriate, to check whether the melanoma has spread to the nearest lymph node basin
• Margin-controlled excision — staged surgical techniques with microscope verification of edges are used where complete, confirmed removal matters most. See staged margin-controlled surgery
• Regular skin surveillance — after treatment, scheduled full-body skin checks (often every 3–6 months initially) plus self-examination become part of long-term care

Melanomas that have spread beyond the skin are treated by melanoma treatment units in the hospital system, using immunotherapy and targeted drug therapy. Your melanoma doctor will coordinate any referral promptly if the pathology shows higher-risk disease.

When to Book a Melanoma Check

• Any mole or spot showing ABCDE changes, or an "ugly duckling" that stands out from your other moles
• A new spot that appears after age 30, or any spot that bleeds, itches or will not heal
• Every 12 months as a baseline for most adults — more often if you have fair skin, many moles, a family history of melanoma or a previous skin cancer
• Before starting immunosuppressive medication, and regularly if you use it

You do not need to be worried about one particular spot to book. A routine skin cancer check is a sensible habit in Australia — the same way dental checks and eye tests are. Early melanoma is found on routine checks far more often than by chance.

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