At a glance

  • On light-colored skin, melanoma usually looks like an irregularly shaped dark spot.
  • On dark skin, it often looks like a darker spot too, but it may also be colorless, pink or red.
  • Melanoma is often detected in time, but it can be fatal if left untreated.
  • In Germany, statutory health insurers cover the costs of skin cancer screening every two years in people aged 35 and over.
  • If doctors think you might have melanoma or if you're diagnosed with melanoma, the affected tissue is surgically removed.


Photo of an older woman and doctor checking for unusual areas of skin

We all have moles, birthmarks or other small lumps and bumps that are a different color to the rest of our skin. This is perfectly normal and usually nothing to worry about. It is only rarely skin cancer.

Skin cancer comes in different forms. The main types are melanoma, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Basal cell cancer and squamous cell cancer are collectively known as non-melanoma skin cancer. On light-colored skin, melanoma often looks like a dark mole or birthmark.

Melanoma is usually removed surgically. If it's already at a more advanced stage, other treatments may be needed – such as medication or radiation.


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.

Illustration: Melanoma skin cancer on the knee (light skin)
Illustration: Melanoma skin cancer on the neck (light skin)
Illustration: Melanoma skin cancer on the chest (light skin)
Illustration: Melanoma skin cancer on the shoulder (light skin)
Illustration: Melanoma skin cancer on the cheek (light skin)
Illustration: Melanoma skin cancer under the foot (dark skin)
Illustration: Melanoma skin cancer on the finger (dark skin)

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.

Learn more

Detecting melanoma

Causes and risk factors

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 (CT scan) or (MRI scan). Further laboratory tests may be needed as well.


Skin cancer is meant for people who don't have any symptoms. In Germany, statutory health insurers pay for skin cancer 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 , 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 , 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.

Further information

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.

Agbai ON, Buster K, Sanchez M et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol 2014; 70(4): 748-762.

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Deutsche Krebsgesellschaft (DKG), Deutsche Krebshilfe (DKH). S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Melanoms. AWMF-Registernr.: 032-024OL. 2020.

Bradford PT. Skin cancer in skin of color. Dermatol Nurs 2009; 21(4): 170-177, 206; quiz 178.

Bundesamt für Strahlenschutz (BfS). Optical radiation: Legal regulations for sunbeds (in Germany). 2022.

Dadzie OE, Petit A, Alexis AF. Ethnic Dermatology: Principles and Practice. Hoboken: Wiley-Blackwell; 2013.

Dellavalle R. Skin cancer, moles, and actinic keratosis. In: Williams H, Bigby M, Herxheimer A et al (Ed). Edvidence-based dermatology. London: BMJ Books; 2014. P. 223-319.

Deutsche Krebsgesellschaft (DKG), Deutsche Krebshilfe (DKH), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Aktinische Keratose und Plattenepithelkarzinom der Haut (S3-Leitlinie). AWMF-Registernr: 032-022OL. 2020.

Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55(5): 741-760; quiz 761-744.

Jackson BA. Nonmelanoma skin cancer in persons of color. Semin Cutan Med Surg 2009; 28(2): 93-95.

National Institute for Health and Clinical Excellence (NICE). Melanoma: assessment and management (NICE Guidelines; No. 14). 2015.

Rivers JK. Is there more than one road to melanoma? Lancet 2004; 363(9410): 728-730.

Robert Koch-Institut (RKI), Gesellschaft der epidemiologischen Krebsregister in Deutschland (GEKID). Krebs in Deutschland für 2017/2018. 2021.

Walter FM, Birt L, Cavers D et al. 'This isn't what mine looked like': a qualitative study of symptom appraisal and help seeking in people recently diagnosed with melanoma. BMJ Open 2014; 4(7): e005566.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on February 21, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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