Types of Melanoma: Subtypes and What They Mean for Treatment
Written by North Editorial Staff | Clinically reviewed by Laura Morrissey, RN, BSN | Last reviewed: March 2026
Key Takeaways
There are four main types of melanoma: superficial spreading, nodular, lentigo maligna, and acral lentiginous melanoma: each with distinct appearance, location, and growth pattern.
Superficial spreading melanoma is the most common, accounting for about 70% of all cases.
Nodular melanoma is the most aggressive common subtype, growing quickly in a vertical direction with a higher risk of ulceration and late diagnosis.
Acral lentiginous melanoma occurs on the palms, soles, and under the nails; it is more common in people with darker skin tones and is not primarily driven by UV exposure.
Rare subtypes, including amelanotic melanoma, desmoplastic melanoma, and mucosal melanoma: are frequently missed because they don’t look like typical melanoma.
While most melanomas are treated primarily based on stage rather than subtype, location and tumor biology can influence specific treatment choices.
What Are the Main Types of Melanoma?
There are four main types of melanoma: superficial spreading (most common, ~70%), nodular (15–30%, most aggressive common form), lentigo maligna (slow-growing, typically on chronically sun-damaged skin in older adults), and acral lentiginous (palms, soles, under nails; more common in darker skin tones). Each subtype has a distinct appearance, growth pattern, and location, though all are treated primarily based on stage.
Superficial Spreading Melanoma
Superficial spreading melanoma is by far the most common subtype, accounting for approximately 70% of all melanoma diagnoses. It can occur anywhere on the body but is most frequently found on the trunk (back and chest) in men and the legs in women.
As its name suggests, this subtype grows outward (radially) across the surface of the skin before it begins to grow downward (vertically) into deeper tissue. This horizontal growth phase can last months to years, which is part of why superficial spreading melanoma is often caught at an earlier, more treatable stage than nodular melanoma.
What it looks like: A flat or slightly raised lesion with an irregular, notched, or scalloped border. The defining feature is color variation, shades of tan, brown, black, pink, red, and sometimes white or gray can appear within the same lesion. White or lighter areas within the spot often represent regression, where the immune system has partially attacked the tumor. The classic ABCDE criteria (Asymmetry, Border, Color, Diameter, Evolving) were largely developed with superficial spreading melanoma in mind.
This is the subtype most people picture when they think of melanoma, and it is the one most reliably caught with standard skin self-exam and routine dermatology appointments.
Nodular Melanoma
Nodular melanoma accounts for approximately 15–30% of all melanomas and is the most aggressive of the common subtypes. Unlike superficial spreading melanoma, nodular melanoma skips the radial growth phase entirely, it grows vertically (downward into the skin) from the start, which means it can reach a dangerous Breslow thickness quickly.
Nodular melanoma most often appears on the trunk, head, or neck, and it affects men more often than women. It can develop in previously normal skin rather than from an existing mole.
What it looks like: A raised, dome-shaped, firm nodule, typically dark brown or black, though it can be red, pink, or skin-colored (amelanotic nodular melanoma). It may bleed or ulcerate. Because it lacks the irregular borders and color variation typically associated with melanoma, it is easy to mistake for a benign cyst, blood blister, or hemangioma. The “EFG” mnemonic was developed specifically for nodular melanoma: Elevated, Firm, Growing.
Because of its rapid vertical growth, nodular melanoma is diagnosed at a greater Breslow thickness on average than other subtypes, which contributes to its higher mortality. Any firm, raised, growing lesion, especially one that bleeds easily, should be evaluated promptly.
Lentigo Maligna Melanoma
Lentigo maligna (the in-situ precursor) and lentigo maligna melanoma (the invasive form) typically develop in older adults on chronically sun-damaged skin, most often on the face, neck, or ears, but also on the forearms and hands. This subtype is strongly associated with years of cumulative sun exposure and is most common in adults over 60.
Lentigo maligna grows very slowly in its in-situ phase, sometimes remaining on the surface of the skin for a decade or more before becoming invasive. This slow growth makes it one of the more treatable melanomas when caught early, but its large size and location on the face can make complete surgical excision challenging.
What it looks like: A flat, irregularly shaped patch that is tan, brown, or dark brown, often with variation in color across the lesion. It tends to be larger than other melanoma subtypes by the time it is noticed, sometimes several centimeters across. The borders are irregular and may be difficult to define precisely, which complicates surgical planning.
Because of its location on the face and the need for precise margin control, Mohs micrographic surgery is often preferred for lentigo maligna melanoma when feasible. Staged excision with careful margin evaluation is another option at specialized centers.
Acral Lentiginous Melanoma
Acral lentiginous melanoma is a distinct subtype that arises on acral (extremity) surfaces: the palms of the hands, the soles of the feet, and the nail apparatus (subungual melanoma). It is the least common of the four main subtypes in the overall population, but it is disproportionately common in people with darker skin tones, including Black, Asian, and Hispanic individuals, and represents the most common form of melanoma in these populations.
Crucially, acral lentiginous melanoma is not primarily driven by UV radiation. Its occurrence on palms and soles, areas with minimal UV exposure, reflects a different biological pathway from other melanoma subtypes. This distinction has treatment and genetic testing implications.
What it looks like: On the palms and soles, acral lentiginous melanoma typically presents as an irregularly shaped dark brown or black patch or streak that may be flat initially and grow over time. Subungual melanoma, under the nail, appears as a longitudinal dark streak (melanonychia) running the length of the nail. It is easily mistaken for a bruise or fungal discoloration. Features that distinguish subungual melanoma from benign nail changes include: the streak does not grow out with the nail over time, it is widening, it extends onto the skin of the nail fold (Hutchinson’s sign), or it is accompanied by nail distortion.
Because acral sites are not routinely examined during skin self-checks or even some clinical skin exams, acral lentiginous melanoma is frequently diagnosed at a more advanced stage, contributing to worse outcomes in populations where it is most common. Including the palms, soles, and nails in every skin exam is essential.
Rare Subtypes
Beyond the four main types, several less common melanoma subtypes are important to know about:
Amelanotic melanoma is a subtype characterized by little or no pigment, it appears pink, red, or skin-colored rather than brown or black. It can occur as any of the main subtypes (superficial spreading, nodular, acral) but without the visual cue of dark coloration. Because it doesn’t look like “typical” melanoma, amelanotic melanoma is frequently misdiagnosed as a sore, pimple, pyogenic granuloma, or eczema. Any pink or red lesion that is growing, irregular, or persistent deserves evaluation.
Desmoplastic melanoma is a rare subtype most often found on the head and neck, frequently in areas of chronically sun-damaged skin in older adults. It has an unusually high rate of local recurrence after surgery because the tumor cells infiltrate along nerve pathways (perineural invasion) and can extend well beyond the visible borders of the lesion. Desmoplastic melanoma has greater sensitivity to radiation than typical melanoma, and postoperative radiation is often recommended. BRAF mutations are less common in this subtype.
Mucosal melanoma arises in the mucous membranes, the mouth, nasal passages, sinuses, throat, vagina, vulva, anus, and urethra. It is rare and not related to UV exposure. Because these locations are not easily visible, mucosal melanoma is typically diagnosed at a more advanced stage. It tends to carry a less favorable prognosis than cutaneous melanoma. Molecularly, mucosal melanoma more often carries C-KIT mutations than BRAF mutations, which has treatment implications, C-KIT inhibitors (such as imatinib) may be relevant.
How Melanoma Type Affects Treatment
The fundamental principle in melanoma treatment is that stage drives the treatment plan far more than subtype. Whether you have superficial spreading melanoma or nodular melanoma, if both are Stage I, the treatment approach is broadly the same: wide local excision with appropriate margins and sentinel lymph node biopsy for eligible tumors. Adjuvant immunotherapy for high-risk early stages, and systemic immunotherapy or targeted therapy for advanced disease, applies across subtypes.
That said, subtype and tumor location do influence specific decisions:
Lentigo maligna melanoma on the face often calls for Mohs surgery or staged excision rather than standard wide excision to preserve function and appearance while ensuring clear margins.
Desmoplastic melanoma warrants consideration of postoperative radiation given its high local recurrence rate.
Mucosal melanoma may benefit from C-KIT inhibitor testing when BRAF is wild-type, and surgery is often more complex given anatomical location.
Acral lentiginous melanoma under the nail may require partial or complete nail removal as part of excision.
BRAF mutation testing is still recommended for all advanced melanomas regardless of subtype, though BRAF mutations are less common in acral lentiginous and mucosal subtypes.
For more on treatment options across all subtypes, see our articles on melanoma treatment and melanoma stages. If you’ve been diagnosed and are exploring your options, melanoma symptoms and what does melanoma look like may also be helpful reference points.
If you’ve been diagnosed with any type of melanoma and want to explore clinical trials, North’s trial finder can help you find current options.
Frequently Asked Questions
What is the most common type of melanoma?
Superficial spreading melanoma is the most common type, accounting for approximately 70% of all melanoma diagnoses. It is characterized by a flat or slightly raised lesion with an irregular border and multiple colors, most often found on the trunk or legs. It grows horizontally across the skin surface before penetrating deeper, which typically allows more time for early detection.
What is amelanotic melanoma?
Amelanotic melanoma is a type of melanoma that produces little or no melanin pigment, so it appears pink, red, or skin-colored rather than brown or black. It can occur as a variant of any melanoma subtype. Because it lacks the dark coloration typically associated with melanoma, it is frequently misdiagnosed or overlooked. Any persistent pink or red spot that is growing, has irregular borders, or does not heal should be evaluated by a dermatologist.
What is acral lentiginous melanoma?
Acral lentiginous melanoma is a subtype of melanoma that arises on the palms, soles, and under the nails. It is not primarily associated with UV radiation exposure. While it is the least common subtype in the overall population, it is the most common form of melanoma in people with darker skin tones, including Black, Asian, and Hispanic individuals. Subungual acral lentiginous melanoma, under a fingernail or toenail, appears as a dark streak that may widen over time and does not grow out with the nail.
Which type of melanoma is most aggressive?
Nodular melanoma is considered the most aggressive of the common subtypes. It skips the radial (horizontal) growth phase and immediately begins growing vertically into the deeper layers of the skin, allowing it to reach a dangerous Breslow thickness rapidly. It is often elevated, firm, and actively growing, and because it can be dark or skin-colored, it may not be immediately recognized as melanoma. Nodular melanoma accounts for a disproportionate share of melanoma deaths relative to its incidence.
Does melanoma type affect survival?
Subtype influences prognosis primarily through its effect on how early the melanoma tends to be detected. Superficial spreading melanoma, with its prolonged horizontal growth phase, is typically caught at a thinner depth than nodular melanoma, which directly improves outcomes. Mucosal and acral lentiginous melanomas are often diagnosed at a later stage due to their less visible locations, which is associated with worse outcomes. At the same stage and Breslow depth, however, treatment is broadly similar across subtypes and outcomes are more comparable.
References
National Cancer Institute. Melanoma Treatment (PDQ), Patient Version. https://cancer.gov/types/skin/patient/melanoma-treatment-pdq
American Academy of Dermatology Association. Melanoma: Types of Melanoma. https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/overview
American Cancer Society. What Is Melanoma Skin Cancer? https://www.cancer.org/cancer/types/melanoma-skin-cancer/about/what-is-melanoma.html
Bastian BC. The molecular pathology of melanoma: an integrated taxonomy of melanocytic neoplasia. Annu Rev Pathol. 2014;9:239-271. https://pubmed.ncbi.nlm.nih.gov/24460190.
Bradford PT, Goldstein AM, McMaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005. Arch Dermatol. 2009;145(4):427-434. https://pubmed.ncbi.nlm.nih.gov/19380664.
Chen LL, Jaimes N, Barker CA, Busam KJ, Marghoob AA. Desmoplastic melanoma: a review. J Am Acad Dermatol. 2013;68(5):825-833. https://pubmed.ncbi.nlm.nih.gov/23267722