They’re not necessarily what you might think

When it comes to Melanoma, if you’re like most people, you’re probably thinking rather ugly brown spot that follows the ABCD rules. And when you look, they’re mostly pretty obvious.

Except that’s where you’d be wrong.

Certainly, we’ve see many melanomas that conform to what we ‘expect’. However there are five other types, four of which that don’t even come close to ‘normal’. Just as an aside, ‘normal’ when it comes to medicine, is often a bit of a myth. So today, we thought we’d take a look at the different types of melanoma.

Before we begin, yes some grow slower than others, BUT ALL CAN BE EXCEPTIONALLY DANGEROUS AND LETHAL, if not diagnosed and treated in a timely manner.

Superficial spreading melanoma

These types of melanoma we ‘know’. It’s the ugly duckling brown-ish spot that has Asymmetrical pigmentation, irregular Borders, varies in Colour across its surface and tends to be bigger (larger in Diameter) than your other spots/freckles/moles. It tends to be more common in younger patients and has a tendency to occur on the trunk (torso) of people who likely have other moles (naevus).

These melanomas have a STRONG correlation with intermittent sun exposure.

6 other types of melanoma

Nodular melanoma

Whilst rarer (only seen in 10-15% of cases) than the superficial spreading melanoma, nodular melanomas fall into the category of different types of melanoma. Deaths from nodular melanoma are disproportionately higher than other forms of melanoma (and they tend to be found/diagnosed later too).

Part of the reason is that nodular melanoma doesn’t match the ABCDs of ‘typical’ skin cancer. They’re more EFG – Elevated, Firm and Growing. They’re often brown/black, but can also appear pink, red or the colour of your general skin tone. Hence they can be confused with squamous cell carcinomas or angiomas – particularly if viewed with the naked eye. See why a proper skin cancer check is important.

They’re generally found on older patients and tend to be found on where the skin is likely to get the most sun damage, such as the head, neck and shoulders. The number of moles and freckles you have on your skin tend not to predict your risk of getting a nodular melanoma.

These melanomas have a STRONG correlation with areas of sun damaged skin.

Lentigo maligna melanoma

Lentigo maligna melanoma has a tendency to skew towards affecting more women than men[1] and represents about 10-15% of all melanomas. They’re often found on the face, head and neck where the skin has often been exposed to the sun the most.

These different types of melanoma can be slower growing – taking months or years before it becomes invasive. However they tend to lengthen asymmetrically over time.

Essentially lentigo maligna melanoma are seen as a cumulative ultra-violet injury. They’re more likely to occur if you’ve an increased number of nevi (moles), fair skin, a history of severe sunburn or spent years working outside.

Desmoplastic melanoma

These rare cancers typically appear on the head, face, neck, ears, nose and lips. And men are twice as likely to be diagnosed than women[2].

One of the greatest issues with these different types of melanoma is that it is usually similar to skin tone in colour, firm and might even look like a scar in its appearance. Hence it requires pathology testing in order to diagnose correctly.

Once a diagnosis is made, desmoplastic melanoma have a tendency to recur in the same/similar place as previously. And whilst they’re not likely to spread into lymp nodes, they can spread (metastasise) systemically throughout the body. So follow up is vital.

Acral lentiginous melanoma

Often found on the soles of the feet, palms of the hands and under the nails. This is considered one of the more aggressive types of melanoma[3], although not as aggressive as nodular melanoma. These cancers can look a bit patchy and can often be confused with a bruise or a stain or sometimes, even a plantar wart (verruca) or tinea infection.

More commonly found in patients of Asian or African heritage.

Subungal melanoma (nail melanoma)

A variant of acral lentiginous melanoma (above), these types of melanoma usually presents as a dark stripe under the nail plate – usually the thumb or big toe, but can be any finger/toe.

It is often confused with the kind of injury that might be sustained from catching your finger/toe in a car door or dropping something onto them (or even an infection) and hence that can lead to a delay in getting a proper diagnosis. And that in turn often leads to a lower five-year survival rate.

It often starts as a stripe/band up the nail which then over time;

  • Widens at the base of the nail
  • Experiences pigmentation change
  • Can cause the nail plate to crack, thin or change shape (distort)
  • Can ulcerate, bleed or form a nodule

Especially, if you suspect you have this type of melanoma, please, get it checked as soon as possible.

Spitzoid melanoma

These are related to the benign Spitz naevus (mole) that looks like a pink spot with a well defined border – often seen in children.

However the melanoma version is can be round or asymmetrical, regular or irregular and pink to variegated in colour – generally found on the head or extremities of those older than 10 years of age. They can appear as a new lesion or within an existing Spitz naevus (mole) – hence you need to be aware of any changes in your moles as you get older.

Got a spot or a mole that sounds like something above or you’re concerned about a spot or been sunburned at some point in your life and haven’t had your skin checked by a skin cancer Dr yet (or for a while)? You can call us on 9999 0336 (Northern Beaches clinic) or 9223 1608 (Sydney City clinic) or you can pop your details in the form below and we’ll get back to you shortly with our next available appointment.

Northern Beaches

Building Q1, Level 2, Suite 9, 4 Daydream St, Warriewood

Appointment availability:
 Monday – Friday
Appointment times: 8.30am-5.00pm
Phone: 02 9999 0336
Fax: 02 9999 0337

Sydney City

L16, 109 Pitt St, Sydney

Appointment availability: Mondays & Thursday Only
Appointment times: 8.30 am - 5:30 pm
Phone: 02 9223 1608