By Dr. Renata Prado

Board-certified dermatologist & fellowship-trained Mohs surgeon

 

Every day, as a dermatologist who specializes in skin cancer, I educate my patients on the signs of the deadliest skin cancer–melanoma. Dermatologists and our patients learn to memorize the ABCDE signs of melanoma:

Asymmetry

Border irregularity

Color variations

Diameter over ¼ inch (6 mm)

Evolution or change.

As dermatologists, we look at brown spots carefully. We monitor all moles. However, a rare subset of melanomas may not look like the funny irregular brown bump we see in brochures. Sometimes, melanoma does not look like a melanoma. It is an amelanotic melanoma.

As a board-certified dermatologist who specializes in the diagnosis and treatment of skin cancer, my goal is early diagnosis and early cure. Thus, I share with you the most common questions I hear about amelanotic melanoma.

Can melanomas not be brown?

Yes, some melanomas present with no brown pigment. They are often pink or skin color so are called amelanotic melanoma.

Even though amelanotic melanomas are not common (they account for approximately 1–8% of all melanomas), they need our attention. Amelanotic melanoma can resemble other skin cancers like basal cell or squamous cell carcinoma, or worse, maybe mistaken for benign moles, scars, or cysts. For this reason, their diagnosis may be delayed.

How can I recognize an amelanotic melanoma?

The diagnosis of an amelanotic melanoma may be challenging even for highly trained dermatologists. However, while these melanomas lack pigment, they often have other melanoma warning signs such as asymmetry or an irregular border. More importantly, they often present with the “E” in the ABCDEs – evolution or change. For this reason, new or changing lesions should be evaluated by your dermatologist. It is also important for you to monitor your skin monthly to notice any new spots which appear or change.

Another strategy that goes beyond the ABCDEs is the Ugly Duckling concept. Generally, moles on one individual tend to resemble each other. A mole that looks significantly different than others on the body should be evaluated.

Can melanoma appear on my nails?

Yes. Melanoma can form as a dark streak under the nail. Any dark streak on the nail needs to be evaluated by your dermatologist.

Can melanoma appear on sites I cannot see?

Again, yes. Melanoma can appear anywhere on your skin, including your scalp (even if you have thick hair), behind your ears, genitals, and on the bottom of your feet. Dermatologists perform a head to toe exam to evaluate your entire skin and look for skin cancers even in areas where you cannot see yourself. Another unusual but important type of melanoma is ocular melanoma, which is often diagnosed by your ophthalmologist.

When should I see a dermatologist?

If you have any new, growing, non-healing, bleeding or scabbing lesion, you should have it checked as soon as possible. It is important to have your skin check annually by your trusted dermatology provider. That includes a head to toe exam. For patients with a personal or family history of skin cancer, more frequent checks may be recommended.

Dr. Renata Prado is a board-certified Colorado Springs dermatologist. She is fellowship-trained in Mohs Micrographic Surgery and specializes in skin cancer surgery. Dr. Prado is part of Vanguard’s Colorado Springs dermatology practice in Briargate and Broadmoor.

Vanguard Skin Specialists began as a Colorado Springs dermatology practice and now has an additional office in Canon City, Pueblo, and Woodland Park. Vanguard specializes in the diagnosis and treatment of skin cancer, and also offers general dermatology, plastic surgery, and aesthetic medicine.