What should you know about black melanoma?

Black melanoma usually refers to a melanoma containing dark pigment, not a separate medical type defined by colour alone. Melanoma can look black, brown, tan, pink, red or nearly colourless. A clinician cannot confirm melanoma from colour or a photograph; diagnosis generally requires examination and testing of sampled tissue.

Melanin can give a melanoma a very dark or uneven appearance. Features that raise concern include a new mark, change in an existing mole, asymmetry, an irregular edge, several colours, growth, bleeding or persistent irritation. These signs are reasons for assessment, but they do not establish the diagnosis. Melanoma also presents without dark pigment, so colour should never be the only screening clue.

If tissue testing confirms melanoma, the report describes features that help the specialist plan care. Depending on those findings and the clinical examination, further assessment may be offered to determine whether melanoma cells have moved beyond the original site.

Arrange a skin examination rather than trying to scrape, bleach or burn the area. Note when you first saw it and what has changed. A clear photograph with a familiar object for scale can help document change, although it cannot replace an examination. Tell the clinician about previous skin cancers, significant sun exposure and melanoma in close relatives.

When melanoma is suspected, the clinician may remove the entire visible lesion with a margin of skin for diagnosis. Confirmed disease is commonly managed with further surgery around the site. Lymph-node assessment, scans or medicines such as immunotherapy depend on the pathology and whether there is evidence of spread.

Book a prompt dermatology appointment for a new or changing dark lesion, a mole that looks unlike your others, or a spot that repeatedly bleeds, crusts, itches or fails to heal. Seek urgent care for heavy bleeding that does not stop with firm pressure or for severe symptoms such as new weakness, confusion, a seizure or a sudden intense headache. Those symptoms require urgent assessment regardless of their cause.

Ask whether the whole lesion should be removed for testing, where the sample will be taken and when to expect the pathology discussion. If melanoma is confirmed, ask what the report says about depth and margins, whether lymph-node assessment is relevant, which treatment is recommended and how the rest of your skin and lymph nodes will be monitored afterward.