Melanoma

On light skin, melanoma mainly develops on areas that are regularly exposed to sunlight – such as your arms, legs, back, chest or head. It typically looks like an irregularly shaped mole or birthmark. It is usually dark reddish-brown or black in color, and the color is patchy. The color, size and shape can change over time.

On dark skin, melanoma more commonly develops on parts of the body like the soles of your feet, between your toes, under your nails or on the palms of your hands. It may also grow on the eyes, mouth or genitals. Melanoma sometimes looks like a darker spot on dark skin too, but it can be colorless, pink or red instead. When it appears under the nails, it might be mistaken for nail fungus or blood, or look like a dark stripe. But these stripes or patches are often harmless skin changes that people with dark skin commonly have under their nails, on their hands, feet, lips, tongue or inside of their mouth.

Aside from these changes in the skin, melanoma doesn't cause any symptoms at first. People often don’t notice it, or think it's something harmless. Symptoms such as pain or bleeding generally only occur when the melanoma starts growing into the surrounding tissue or spreading to other parts of the body. So melanoma may already have reached an advanced stage by the time it is detected. Melanoma sometimes develops inside an older mole or birthmark, but it is very often an entirely new skin growth.

There are a number of factors that can increase your likelihood of developing melanoma. These include exposure to sunlight, your skin type, your genes and your age.

Around the world, more and more people are being diagnosed with melanoma skin cancer. In Germany, about 26 out of 100,000 women and 29 out of 100,000 men developed melanomas in 2018. Altogether, nearly 23,000 people were diagnosed with melanoma in 2018.

There are different types of melanoma, and each progresses in a different way. Some only grow on the surface of the skin for quite a long time and can be removed in a simple procedure. Others grow into deeper layers of skin and surrounding tissue after a shorter amount of time. Those types are more likely to spread through the bloodstream or lymphatic system and then form metastatic (secondary) tumors in other parts of the body. If left untreated, they can be fatal within a few months.

In Germany, more than half of all melanomas are detected at an early stage. Most people with this kind of skin cancer survive it. About 11 out of 100 men and 6 out of 100 women die of melanoma within ten years of it being diagnosed.

Doctors can often tell whether an irregular-looking spot or blemish on the skin could be cancer just by looking at it. They can take a closer look at it using a dermatoscope. This instrument is like a strong magnifying glass with a light on it.

People sometimes wrongly assume that you can’t get skin cancer if you have darker skin. It is also harder to see melanoma on dark skin, and it often affects different places than it would on light skin. Because of this, the cancer may go undetected for a longer time. So it's even more important to look out for changes in dark skin too.

If the doctor thinks that someone has melanoma, it is usually removed completely – including some of the skin around the abnormal area. The removed tissue is then examined under a microscope to find out whether it really is melanoma or something else.

If it is thought that the melanoma may have reached a more advanced stage and already spread, other examinations are carried out. For instance, nearby lymph nodes are removed and checked for cancer cells, or they are examined using ultrasound. Other imaging techniques might be used too, such as computed tomography (CT scan) or magnetic resonance imaging (MRI scan). Further laboratory tests may be needed as well.

Skin cancer screening is meant for people who don't have any symptoms. In Germany, statutory health insurers pay for skin cancer screening every two years in people aged 35 and over. The idea is to detect skin cancer as soon as possible – ideally before it grows deeper into the tissue or spreads to other parts of the body (metastasis). That increases the chances of being able to provide better treatment and reach a full recovery.

In skin cancer screening, the doctor closely inspects all of your skin, from head to toe. For the examination to be thorough, they should also look at skin folds and mucous membranes.

Doctors who mainly examine people with lighter skin sometimes find it more difficult to recognize skin cancer on dark skin. This is because the cancer might look different and develop on other parts of the body in people with darker skin.

Aside from skin cancer screening, it's also important to look out for changes in your skin yourself and have a doctor examine any unusual areas.

There is no surefire way to prevent melanoma skin cancer. It is generally sensible to avoid overexposure to ultraviolet (UV) light. This mainly means not spending too much time in the sun without protection and not using tanning beds.

After melanoma is diagnosed, the first step is usually to try to remove it surgically. In advanced melanoma, the tumor has already grown into deeper layers of skin, or metastatic tumors have developed elsewhere in the body.

If surgical removal is no longer possible or not effective enough at that stage, other treatments such as radiation or medication might be used. Different medications can be used for different types and stages of melanoma.

You can find information about using tanning beds on the website of the German Federal Office for Radiation Protection (Bundesamt für Strahlenschutz, or BfS).

When people are ill or need medical advice, they usually go to see their family doctor first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.