Melanoma is a serious form of skin cancer that begins in the melanocytes, the cells that produce the pigment melanin. Catching melanoma early is crucial, as stage 1 melanoma is highly treatable if detected promptly. Knowing what to look for can help you identify potential signs of early stage melanoma on your skin.
What are the stages of melanoma?
Melanoma is categorized into different stages based on how far the cancer has spread:
- Stage 0 – The melanoma is only present in the top layer of skin (epidermis). This stage is also called melanoma in situ.
- Stage 1 – The melanoma is up to 2 mm thick and may be ulcerated. It is localized to the primary site and has not spread to lymph nodes or other organs.
- Stage 2 – The melanoma is between 1-4 mm thick. It has not yet spread to lymph nodes or other organs.
- Stage 3 – The melanoma has spread to nearby lymph nodes. The tumors can be of any thickness and may also have ulceration.
- Stage 4 – The melanoma has spread beyond the original skin site and nearby lymph nodes to other organs such as the lung, liver, brain, bone, or gastrointestinal tract.
What does stage 1 melanoma look like on the skin?
In stage 1 melanoma, the cancer is still localized to the top layer of skin and measures no more than 2 mm thick. Some key signs to look for include:
- Asymmetrical mole – Melanoma moles often lack symmetry and have irregular shapes compared to benign moles.
- Borders – The borders or edges may appear ragged, notched, or blurred.
- Color – There may be a variety of colors in the mole including black, brown, red, white, blue, and even pink.
- Diameter – Melanoma moles are often larger than 6 mm in size.
- Evolving – The mole may change in size, shape, color, or start to itch or bleed.
Here are some examples of how melanoma can appear on the skin during stage 1:
| Sign | Image |
|---|---|
| Asymmetrical shape |  |
| Irregular borders |  |
| Varied colors |  |
| Diameter over 6 mm |  |
| Oozing or bleeding |  |
These photos demonstrate how melanoma can present itself in many ways during early stage 1. Pay attention for any new or changing moles on your skin that have these traits. It is important to show your dermatologist any suspicious moles for evaluation.
Where does stage 1 melanoma occur?
Stage 1 melanoma can develop anywhere on the skin, but the most common locations include:
- Legs (especially lower legs for women)
- Back (for men)
- Face and neck
- Arms
- Shoulders and chest
- Hands and feet (palmar and plantar skin)
- Fingers and toes
- Nail beds
- Head and scalp
Melanoma often occurs in areas that receive more sun exposure. However, it can develop anywhere on the body. Be diligent about examining all areas of skin, not just sun-exposed places. Use a hand-held mirror to check your back and have a partner help look at areas that are harder to see.
Are stage 1 melanomas always dark in color?
While melanoma is often thought of as a black or brown mole, during stage 1 it can present with a wide variety of colors. Only about 30% of melanomas are black in color. Other colors melanoma can appear in stage 1 include:
- Pink – Red or pink hues are possible.
- Blue – Blue-black is a common melanoma color.
- White – White, light gray, orhypopigmented lesions occur.
- Light brown/tan – Early melanoma can mimic a tan mole.
- Dark brown – Dark brown is more common than black.
- Purple – Unusual vascular patterns can appear.
- Red – Reddish lesions are possible.
The most important warning sign is any new or changing mole on your skin. Be aware that melanoma is not always a classic black color, especially in early stage 1. Pay attention to all mole changes, regardless of color.
Can stage 1 melanoma be flat?
Yes, in stage 1 melanoma can present as a flat, slowly growing lesion rather than an elevated bump. Features to look for in a flat melanoma include:
- It may start as a freckle that slowly enlarges and darkens
- The edges can appear faded and blurry
- It can have a variety of colors mixed in
- It may develop an oozing or crusty surface
Flat, slow-growing melanomas are the most common type found during screening skin exams. Being aware that stage 1 melanoma is not always a raised bump is important for early detection.
What does melanoma look like under the nails?
Melanoma under and around the fingernails and toenails can have some distinctive appearances in stage 1, including:
- Brown or black streaks in the nails – Linear pigmentation emerging from the nail folds or matrix can signal subungual melanoma.
- Dark spots on the nail plate – Pigmentation forming a dark band or spot under or on the nail.
- Nail lifting – The nail plate can detach from the nail bed and lift up.
- Grooves or ridges – Visible grooves running vertically down an affected nail.
- Bleeding of the cuticles – The skin around the nail may bleed and not heal.
It is important to monitor all nails for any new abnormal-looking lines, growths, color changes, or bleeding to catch melanoma under the nails in stage 1.
Can stage 1 melanoma be mistaken for other skin conditions?
Yes, sometimes in stage 1 melanoma can be mistaken for other benign skin lesions. Some conditions it may be confused with include:
- Moles – Most moles are harmless, but any mole that changes warrants an evaluation by a dermatologist.
- Seborrheic keratosis – Wart-like harmless growths that can resemble melanoma.
- Melanocytic nevus – Non-cancerous moles.
- Blood blister – Subungual hematomas under nails can appear similar to subungual melanoma.
- Warts – Unusual wart-like or keratotic growths should be checked.
- Lentigo – Dark freckles or sunspots known as lentigines.
When in doubt, it’s always best to get any suspicious or changing skin lesions evaluated professionally. Experienced dermatologists can identify melanoma in stage 1 versus benign growths through exams and biopsies when needed.
Are enlarged lymph nodes associated with stage 1?
Enlarged or palpable lymph nodes in the region around a suspicious mole can indicate later-stage melanoma that has spread. However, in true stage 1 melanoma, the cancer is still only located in the outermost layer of skin and has not yet spread to lymph nodes internally.
Some key points about lymph nodes in stage 1 melanoma:
- Lymph nodes will not be enlarged or swollen in the area.
- Lymph node involvement indicates at least stage 3 melanoma.
- Normal sized regional lymph nodes help confirm stage 1 classification.
- No special imaging tests are needed to evaluate lymph nodes in stage 1.
Checking for lymph node enlargement is an important part of clinical detection and staging of melanoma. A lack of swollen nodes in the region of a suspicious skin lesion can help confirm early stage 1 classification.
How fast does stage 1 melanoma grow and spread?
The typical growth rate and spread risk for stage 1 melanoma includes:
- Growth rate averages 0.5 mm per month, but can vary.
- Tumor thickness ranges from 1-2 mm.
- 5-year survival rate is over 97% with proper treatment.
- Average Breslow thickness is under 0.8 mm.
- Low but real risk of spread to lymph nodes and beyond if not treated.
Catching melanoma at stage 1 means the cancer has not yet penetrated beyond the top layer of the skin. However, without treatment it can progress and spread quickly to advanced stages in just months. Early recognition and treatment are vital.
| Stage 1 Melanoma Statistic | Range |
|---|---|
| Growth rate in mm/month | 0.3 – 0.7 mm/month |
| Average tumor thickness | Under 2 mm thick |
| 5-year survival rate | 97-100% |
| Average Breslow depth | Under 0.8 mm |
Being aware of the relatively fast growth potential allows patients and doctors to act quickly to treat stage 1 lesions before extensive spread can occur.
What are the treatment options for stage 1 melanoma?
Treatment for stage 1 melanoma focuses on completely removing the tumor and any nearby abnormal cells to prevent recurrence. Standard treatments include:
- Excisional surgery – Wide local excision to remove the melanoma with some surrounding healthy tissue.
- Mohs surgery – Precise layer-by-layer removal and microscopic examination to minimize skin removal.
- Lymph node biopsy – May be done to confirm no spread to nearby lymph nodes.
- Immunotherapy medicines – May be used after surgery to prevent recurrence.
- Radiation therapy – Sometimes used post-surgery for high risk tumors.
- Clinical trials – Experimental therapies may be options.
The primary treatment is surgical removal.Immunotherapy and radiation may be considered after surgery for higher risk situations. Clinical trials are also an option if available.
What is the recurrence risk for stage 1 melanoma?
When detected and treated early in stage 1, the recurrence risk is relatively low. But patients still require monitoring and follow-up to watch for potential recurrence or new primary melanomas over time.
- Recurrence risk ranges from 3-8% after standard treatment.
- Higher risk in tumors > 0.75 mm thick or with ulceration.
- Most recurrences happen within 2-3 years.
- Lifelong annual skin checks are recommended.
- Higher lifelong melanoma risk than general population.
Patients treated for stage 1 melanoma need ongoing dermatology monitoring and surveillance to watch for recurrence, new primaries, or spread. But the overall prognosis is excellent with early diagnosis and treatment.
Conclusion
Identifying potential melanoma in the earliest stage 1 offers the best prognosis. Look for new or changing moles that feature asymmetry, irregular borders, varied colors, larger size, elevation, and bleeding or crusting. Stage 1 lesions can vary widely in appearance. Be aware melanoma can develop anywhere on the body, not just sun-exposed sites. Check the entire skin surface, nails, and scalp. Learn what is normal for your skin and discuss any changing lesions with your dermatologist promptly. With early detection and treatment of stage 1 melanoma, survival rates are over 97%.
