Every May, I think about the patients who came to me too late.
Not because they didn’t care about their health — most of them cared deeply. They came too late because no one had ever taught them what to look for. Because a mole that had been there for years felt familiar, not dangerous. Because they were busy, or nervous, or convinced that skin cancer was something that happened to other people.
Melanoma Awareness Month exists to change that. And as a dermatologist, it is one of the most important conversations I have all year.
Over 100,000 Americans will be diagnosed with melanoma this year. It is the fifth most common cancer in the United States, and it is the deadliest form of skin cancer — responsible for the overwhelming majority of skin cancer deaths despite representing only a fraction of skin cancer diagnoses.
Here is what makes melanoma uniquely dangerous: it moves fast, and it spreads. When caught early — Stage I or II, confined to the skin — the five-year survival rate is above 98%. When it reaches the lymph nodes, that number drops significantly. When it spreads to distant organs, survival drops further still.
The difference between a curable melanoma and a fatal one is almost entirely a matter of when it is found. Early detection saves lives. That is not marketing — it is oncology.
Most people know the word melanoma. Far fewer people could identify one.
Melanoma begins in melanocytes — the pigment-producing cells in your skin. It most commonly appears as a new or changing spot, but it does not always look the way people expect. It is not always dark brown or black. It is not always large. It does not always appear in sun-exposed areas.
Dermatologists use the ABCDE criteria as a teaching tool. Memorize it:
A — Asymmetry. One half of the mole does not match the other. If you drew a line through the center of a normal mole, both sides would look roughly the same. Melanoma does not follow that rule.
B — Border. The edges are irregular, ragged, notched, or blurred. A mole with crisp, clean, well-defined edges is far less concerning than one whose borders fade into the surrounding skin.
C — Color. Multiple shades within a single lesion — brown, black, tan, red, white, or blue — are a warning sign. Normal moles are one consistent color throughout.
D — Diameter. Anything larger than 6 millimeters — roughly the size of a pencil eraser — deserves attention. Note, however, that melanomas can and do present smaller than this.
E — Evolving. This may be the most important criterion. Any spot that is changing — in size, shape, color, elevation, or symptom (itching, bleeding, crusting) — warrants evaluation. Change is the red flag.
A mole that simply looks different from all the others on your body — that stands out as the odd one in your personal pattern — deserves a closer look regardless of whether it technically meets ABCDE criteria.
I want to address the lesions that get found late because patients — and sometimes even other clinicians — don’t think to look there.
Subungual melanoma occurs under fingernails and toenails and is frequently mistaken for a fungal infection or a bruise. If you have a dark streak running lengthwise under a nail — especially if it is widening, irregular, or the skin around the nail is discolored — please have a dermatologist evaluate it. Bob Marley died of subungual melanoma at 36. This type disproportionately affects people with darker skin tones.
Acral lentiginous melanoma appears on the palms, soles, and skin around the nails. It is the most common subtype in people with darker Fitzpatrick skin types, and it is diagnosed later because these areas are examined less frequently.
Mucosal melanoma occurs on mucous membranes — inside the mouth, nose, throat, and genitals. It is rare but aggressive, and it is often found at advanced stages because of its location.
Ocular melanoma develops in the eye — most commonly in the uveal tract — and can occur without any change in skin pigmentation. Annual comprehensive eye exams include evaluation of the choroid and iris for this reason.
The stereotype of melanoma as a “fair-skinned person’s disease” has real public health consequences. Yes, people with lighter skin, light eyes, red or blonde hair, and a tendency to burn are at significantly elevated risk. But melanoma does not skip anyone.
People with darker skin develop melanoma at lower rates, but when they do, it is diagnosed at later stages and carries a worse prognosis — partly due to reduced screening, partly due to subtypes like acral lentiginous melanoma, and partly due to the pervasive myth that darker skin is immune. It is not.
Additional risk factors every patient should know:
I will be direct about this: there is no safe level of tanning bed use.
Indoor UV devices deliver UVA radiation at concentrations that can exceed natural sunlight by 10 to 15 times. The “base tan” theory — that a tan provides protection — is biologically false. A tan is a sign of DNA damage. It is your skin’s emergency response, not evidence of health.
In 30 states and the District of Columbia, minors are now prohibited from using tanning beds. Several countries have banned them entirely. The science is unambiguous.
Sunscreen is effective. It reduces UV-induced DNA damage, lowers the risk of squamous cell carcinoma meaningfully, and has been shown in randomized controlled trials to reduce melanoma risk. It is not optional.
But sunscreen is not a force field. Here is what every patient should understand:
SPF 30 blocks approximately 97% of UVB rays. SPF 50 blocks about 98%. The difference between SPF 30 and SPF 100 is far smaller than marketing suggests. What matters more is whether you are applying enough and reapplying consistently.
Most people apply a fraction of the amount needed. The tested amount for SPF ratings is 2 mg/cm². In practice, most people apply 20–50% of that. Apply more than you think you need.
Broad-spectrum matters. SPF only measures UVB protection. Always choose a broad-spectrum sunscreen that also protects against UVA.
Reapplication every two hours is not optional during active sun exposure. Sunscreen degrades — sweating and swimming accelerate that degradation regardless of the “water-resistant” label.
Sunscreen is step one, not the whole strategy. Protective clothing, UPF-rated fabrics, wide-brimmed hats, UV-protective sunglasses, and seeking shade between 10 AM and 4 PM are all meaningful behaviors that sunscreen cannot replace.
My recommendation: annually for everyone, and every six months if you have a personal or family history of melanoma, more than 50 moles, a history of atypical moles, or significant cumulative sun exposure.
A full-body skin examination by a board-certified dermatologist takes about 15 minutes and covers areas you cannot adequately examine yourself — the scalp, behind the ears, between the toes, the back, and the perianal region. These are the locations where melanoma is most likely to be found late.
Do not wait for a spot to change to the point where you are certain something is wrong. The moment you notice something and think “I should probably have that looked at” — that is the right moment to call.
If you see any of the following, call the same week:
Skin cancer screening has historically been designed around, studied in, and marketed to patients with lighter skin tones. The imagery in awareness campaigns, the examples used in medical education, the locations where free skin checks are offered — all of this has contributed to a system where patients with darker skin are less likely to be screened, less likely to be diagnosed early, and more likely to die from melanoma when they do develop it.
If you are a person of color reading this: you are not immune to melanoma. Your risk is different, not absent. The types of melanoma most common in your population occur in areas that require deliberate examination. You deserve the same access to early detection that saves lives across all skin tones.
If you are a clinician reading this: I encourage you to examine your own patient population and ask whether you are equally aggressive about screening recommendations across all Fitzpatrick types.
Melanoma is largely survivable when it is caught early. Early detection depends entirely on education, access, and the willingness to act on uncertainty before it becomes certainty.
This month, do three things:
Melanoma Awareness Month is not about fear. It is about giving people the knowledge they need to act before the window closes.
About the Author
Dr. Sophia Reid is a board-certified dermatologist and obesity medicine specialist practicing in New Jersey. She specializes in medical and cosmetic dermatology, with a particular interest in skin cancer prevention, metabolic dermatology, and evidence-based aesthetic medicine.
This blog post is intended for general informational and educational purposes only. It does not constitute medical advice and is not a substitute for a consultation with a qualified dermatologist or physician.
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