Common types of melanoma

Understanding melanoma terminology

Melanoma can have very different appearances. This page brings together the eight existing topics in this section and explains what each name describes. The entries are not all separate subtypes, nor are they equally common.

Superficial spreading, nodular, lentigo maligna melanoma and acral lentiginous melanoma are traditional clinical and histological categories. “Nail melanoma” identifies a location, “amelanotic” describes little or no pigmentation, and “desmoplastic” identifies a particular histological variant. “Metastatic” means the disease has spread from its original site.

These categories can overlap: a nodular melanoma can be amelanotic, and different subtypes can become metastatic. The type alone does not determine stage, prognosis or treatment. Appearance can raise suspicion, but diagnosis requires specialist assessment and examination of tissue.

Superficial spreading melanoma

This is the most frequent form in many fair-skinned populations. It tends initially to spread sideways within the epidermis but can become invasive. It may appear as a changing patch with asymmetry, irregular edges or several colours, arising within a mole or on previously normal skin.

“Superficial spreading” describes a growth pattern; it does not automatically mean low risk or disease still confined to the epidermis. The pathology report establishes invasion and depth. Read more about superficial spreading melanoma.

Nodular melanoma

Nodular melanoma tends to grow into deeper skin early and may enlarge rapidly. It often appears as a raised lesion or nodule, which may be dark or pink with little pigment. A relatively regular shape or uniform colour does not exclude it.

Alongside the ABCDE rule, attention to an elevated, firm and growing lesion—the EFG criteria—can help identify concerning changes. These are not a diagnostic test but a reason to seek prompt assessment. Read more about nodular melanoma.

Lentigo maligna and lentigo maligna melanoma

This form is seen particularly on chronically sun-damaged skin, often on the face and neck of older people. It can appear as an irregular patch that changes slowly over time.

Lentigo maligna is melanoma in situ confined to the epidermis; lentigo maligna melanoma has invaded the dermis. It is therefore not simply a benign sun spot. Slow growth is not a reason to postpone assessment. Read more about lentigo maligna melanoma.

Acral lentiginous melanoma

This affects acral sites, especially the palms and soles, and may involve the nail unit. It can appear as a changing pigmented patch, although its appearance varies.

It can affect people of any skin colour. It represents a larger proportion of melanomas in dark-skinned populations, which does not mean melanoma overall is more common in those populations. Its relationship with UV exposure differs from that of forms typically found on sun-exposed skin. Read more about acral lentiginous melanoma.

Nail melanoma

This term means melanoma of the nail unit. It may present as a longitudinal pigmented band that changes or widens, pigmentation around the nail, or a lesion disrupting the nail plate. Presentations with little pigment also occur.

Not every dark band is melanoma: bruising and benign pigmentation are possible. However, a persistent change, particularly affecting one nail, warrants assessment. Remembering an injury does not by itself exclude other causes. Read more about nail melanoma.

Amelanotic melanoma

Amelanotic melanoma has little or no recognisable pigment and may look pink, red or similar to the surrounding skin. “Amelanotic” describes this feature and can apply to different subtypes.

The absence of dark colour may lead to confusion with inflammatory lesions or other skin tumours. A new growth that enlarges, changes or bleeds needs assessment even if it does not resemble a mole. Skin observation should therefore include more than brown or black marks. Read more about amelanotic melanoma.

Desmoplastic melanoma

This is a rare variant, often associated with chronically sun-damaged skin, particularly on the head and neck. It may present as a firm, poorly pigmented area resembling a scar.

Its name refers to microscopic tissue features that include a fibrous component. The external appearance can be nonspecific, and diagnosis requires adequate histological examination. A scar-like lesion that appears without explanation or changes deserves attention. Read more about desmoplastic melanoma.

Metastatic melanoma: spread of disease

“Metastatic” is not an eighth primary subtype identifiable from the lesion’s appearance. It means melanoma cells have reached sites beyond their origin. This can refer to regional involvement, such as certain lymph nodes, or distant spread. These situations require precise staging.

Distant metastases define stage IV, while regional involvement may fall within stage III. Skin colour or lesion shape cannot establish this distinction. Investigations and treatment depend on disease extent and characteristics and are discussed with the specialist team. Read more about metastatic melanoma.

From type to diagnosis and stage

Clinical examination and dermoscopy help identify a suspicious lesion. Diagnostic confirmation relies on tissue sampling and histological examination. A photograph, a type name or resemblance to a description cannot provide reliable self-diagnosis.

In invasive melanoma, Breslow thickness measures tumour depth in millimetres. Ulceration, lymph node involvement and distant spread contribute to staging. Type and stage therefore answer different questions: type describes disease characteristics, while stage describes its extent.

Prognosis and treatment cannot be inferred from subtype alone. If you have a pathology report, ask for an explanation of the diagnosis, thickness, ulceration, margins and any further investigations needed. Our diagnosis guide brings together information about this pathway.

When to seek assessment

Report a new mark or one unlike the others, a changing mole, a growing nodule or a persistent bleeding lesion. The ABCDE rule is helpful but does not cover every presentation: some melanomas are small, pale or relatively symmetrical.

Skin self-examination should include the soles, spaces between toes, nails and areas that are difficult to see. Do not wait for every described sign to appear or try to assign a subtype yourself. The useful next step is assessment, explaining when the change began and how it has evolved.