Skin Cancer · Burien & Bellevue, WA
Melanoma
The most dangerous skin cancer — responsible for the majority of skin cancer deaths. Detected early, melanoma is nearly always curable. Regular skin exams and prompt evaluation of changing moles are essential.
Schedule an AppointmentWhat Is Melanoma?
Melanoma is a malignant cancer that originates in melanocytes — the pigment-producing cells found primarily in the skin but also in the eyes and mucous membranes. Although it accounts for only about 1% of skin cancer diagnoses, melanoma causes the overwhelming majority of skin cancer deaths — more than 8,000 per year in the United States.
What makes melanoma so dangerous is its capacity to metastasize — to spread through the lymphatic system and bloodstream to distant organs including the liver, lungs, brain, and bones. The thickness of the primary tumor at the time of diagnosis is the single most important prognostic factor, which is why early detection through regular skin exams is so critical.
The ABCDE Warning Signs
The ABCDE criteria were developed to help both patients and clinicians identify suspicious pigmented lesions. Evaluate your moles and spots for the following:
A — Asymmetry
Draw an imaginary line through the center of the spot. In a normal mole, both halves will match. In melanoma, one half often looks different from the other in shape, color, or elevation.
B — Border
Benign moles have smooth, clearly defined borders. Melanoma borders are often irregular, jagged, notched, or poorly defined — the color may seem to bleed into the surrounding skin.
C — Color
A normal mole is typically a single shade of brown. Melanoma often contains multiple colors — different shades of brown and black, and sometimes areas of red, white, or blue-black.
D — Diameter
Most melanomas are larger than 6 mm (about the diameter of a pencil eraser) when first diagnosed, though some may be smaller. Any new or enlarging spot should be evaluated regardless of size.
E — Evolving
Any mole or skin lesion that is changing in size, shape, or color, or that develops new symptoms such as itching, bleeding, or crusting, deserves prompt evaluation.
Types of Melanoma
Superficial Spreading Melanoma
The most common type, accounting for about 70% of melanomas. It grows outward across the skin surface before growing downward into deeper layers, giving a window of opportunity for early detection. It typically appears as a flat or slightly raised discolored patch with irregular borders and variable color.
Nodular Melanoma
The second most common and most aggressive type. It grows vertically (downward) from the start, often appearing as a rapidly growing dark bump or dome-shaped lesion. It may be amelanotic (lacking pigment), making it easy to mistake for a benign lesion such as a blood blister or basal cell carcinoma.
Lentigo Maligna Melanoma
Develops within a lentigo maligna — a precursor lesion that arises on heavily sun-damaged skin, usually on the face in older adults. It has often been present for years before the invasive melanoma component develops. It tends to grow slowly and is often large at the time of diagnosis.
Acral Lentiginous Melanoma
Appears on the palms, soles, and under fingernails or toenails. It is the most common subtype in people with darker skin tones. Because it occurs in areas not routinely checked, it is often diagnosed at a more advanced stage.
Risk Factors
- UV exposure from sun and artificial tanning devices
- History of blistering sunburns, especially in childhood or adolescence
- Use of tanning beds — increases melanoma risk by ~75% when started before age 35
- Fair skin, freckling, light eyes, and red or blonde hair
- Personal or family history of melanoma
- Large number of moles or atypical (dysplastic) moles
- Weakened immune system
- Certain genetic mutations (CDKN2A, CDK4) associated with familial melanoma
Staging and Survival Rates
Melanoma staging is based primarily on tumor thickness, ulceration, mitotic rate, lymph node involvement, and distant metastasis:
| Stage | Description | 5-Year Survival |
|---|---|---|
| Stage I | Thin melanoma (<2 mm), localized, no ulceration | ~98% |
| Stage II | Thicker melanoma, localized, may be ulcerated | 65–93% |
| Stage III | Spread to regional lymph nodes or satellite lesions | 40–78% |
| Stage IV | Distant metastasis to organs | 15–30% |
Treatment of Melanoma
Surgical Excision with Wide Margins
The primary treatment for all stages of melanoma is surgical excision. The required margin of normal tissue removed around the tumor is determined by tumor thickness: 0.5–1 cm for in situ melanoma, 1 cm for tumors ≤1 mm thick, and 2 cm for tumors >2 mm thick. The wound is closed primarily or with a flap or graft as needed.
Sentinel Lymph Node Biopsy
Recommended for melanomas ≥0.8 mm thick (T1b and above) to assess regional lymph node involvement. A radiotracer or dye is injected near the tumor to identify the sentinel node, which is then surgically removed and analyzed by a pathologist.
Immunotherapy
Checkpoint inhibitors — particularly anti-PD-1 agents (pembrolizumab, nivolumab) and CTLA-4 inhibitors (ipilimumab) — have revolutionized the treatment of advanced melanoma, achieving durable long-term remissions in a meaningful proportion of patients with stage III–IV disease.
Targeted Therapy
Approximately 50% of melanomas carry a BRAF V600E mutation. These tumors can be treated with combination BRAF/MEK inhibitor regimens (e.g., dabrafenib plus trametinib), which produce rapid, dramatic tumor responses, particularly useful in high-burden or rapidly progressing disease.
Schedule a Mole Check
If you have a changing mole, a new dark spot, or a family history of melanoma, don't wait. Our dermatologists provide full-body mole mapping and biopsy at both our Burien and Bellevue offices.
Schedule an AppointmentABCDE Quick Guide
- A — Asymmetry: one half unlike the other
- B — Border: irregular, ragged, or blurred edges
- C — Color: multiple shades within one spot
- D — Diameter: larger than 6 mm (pencil eraser)
- E — Evolving: any change in size, shape, or color
Frequently Asked Questions
What is the ABCDE rule and how do I use it?
The ABCDE rule is a simple self-examination guide. A = Asymmetry (one half differs from the other). B = Border (irregular, ragged, or blurred edges). C = Color (multiple shades of brown, black, red, white, or blue). D = Diameter (larger than 6 mm, about the size of a pencil eraser). E = Evolving (any change in size, shape, color, or new symptoms like bleeding or itching). If you notice any of these features in a mole or skin spot, schedule a dermatology evaluation promptly.
How is melanoma diagnosed?
Melanoma is diagnosed by skin biopsy — the suspicious lesion is removed (or a sample is taken) and examined under a microscope by a dermatopathologist. The biopsy also provides critical information about tumor thickness (Breslow depth) and other features that determine staging and treatment. If melanoma is confirmed, additional workup such as imaging or a sentinel lymph node biopsy may be recommended.
What is a sentinel lymph node biopsy and do I need one?
A sentinel lymph node biopsy (SLNB) is a surgical procedure that identifies and removes the first lymph node(s) that drain the area of the melanoma. It is used for staging melanomas that are at least 0.8 mm thick (T1b and above). If the sentinel node is free of cancer, the remaining regional nodes almost certainly are as well. If cancer is found, it helps guide additional treatment decisions.
What are the survival rates for melanoma by stage?
Survival rates vary dramatically by stage. Stage I melanoma (thin, localized) carries a five-year survival rate of approximately 98%. Stage II (thicker but still localized) ranges from 65–93% depending on depth. Stage III (spread to regional lymph nodes) ranges from 40–78%. Stage IV (distant metastasis) has a five-year survival rate of approximately 15–30%, though modern immunotherapy and targeted therapy have dramatically improved outcomes compared to just a decade ago.
Can tanning beds cause melanoma?
Yes. Tanning beds emit UV radiation at intensities that can be 10–15 times higher than midday sun. Using a tanning bed before age 35 increases melanoma risk by approximately 75%. The International Agency for Research on Cancer classifies tanning beds as Group 1 carcinogens — the same category as tobacco and asbestos.
What is the treatment for advanced melanoma?
Advanced melanoma (stage III–IV) is treated with a combination of surgery, immunotherapy, and targeted therapy. Checkpoint inhibitors such as pembrolizumab and nivolumab, along with combination regimens like ipilimumab plus nivolumab, have transformed outcomes for metastatic melanoma. For tumors with BRAF V600 mutations, targeted therapy with BRAF/MEK inhibitors is highly effective. These treatments are coordinated with oncology specialists.
A Changing Mole Deserves Prompt Attention
Stage I melanoma is nearly always curable. Stage IV is not. The difference is often a matter of months. Schedule your full-body skin exam at our Burien or Bellevue office today.