What Does Melanoma Look Like? A Visual Guide

Key Takeaways

• Melanoma does not always look like a dark, irregular mole. Some forms are pink, red, or skin-colored; some are raised bumps; some are streaks under a nail.

• The ABCDE rule: Asymmetry, Border, Color, Diameter, Evolving, is the most reliable guide for assessing whether a spot warrants evaluation.

• Appearance varies significantly by melanoma subtype: superficial spreading, nodular melanoma, lentigo maligna, acral lentiginous melanoma, and amelanotic melanoma each have distinct visual features.

• On darker skin, look specifically at the palms, soles, and under the nails, sites where melanoma is more common in people of color and where it is most frequently missed.

• Dermoscopy: a magnification tool used by dermatologists, reveals structures invisible to the naked eye and significantly improves diagnostic accuracy.

• Common look-alikes include seborrheic keratosis, blue nevi, dermatofibromas, and solar lentigines, but don’t attempt to self-diagnose. Get any uncertain spot checked.

• Melanoma hidden in unusual places, the scalp, between the toes, inside the eye, on the genitals, is regularly missed. Full-body awareness matters.

What Does Melanoma Look Like?

Melanoma most often appears as an irregularly shaped spot on the skin with multiple colors, an uneven or notched border, and a tendency to change over time. The ABCDE rule: Asymmetry, Border, Color, Diameter, Evolving, captures the key visual features to assess. Appearance varies significantly by subtype and location: some melanomas are dark brown and flat; others are pink, dome-shaped, or hidden under a nail. Any spot that looks different from your others, or that is changing, deserves professional evaluation.

Early Melanoma: What to Watch For

Early melanoma often appears unremarkable at first glance, which is precisely what makes it dangerous. The features that distinguish it from a benign mole are frequently subtle, and the most telling sign is often change over time rather than any single dramatic feature.

Shape: Early melanoma is typically flat or only very slightly raised, not a bump, not obviously elevated. It may look like a stain on the skin. As it grows, some areas may become raised while others remain flat, creating an irregular surface topography.

Border: Where a benign mole has a smooth, clean, well-defined edge, an early melanoma border is irregular, notched, scalloped, or with a jagged perimeter. Some areas of the edge may appear to fade or blur into the surrounding skin. The border may look as if the spot is spreading in some directions but not others.

Color: This is one of the most reliable visual clues. A benign mole is typically a single, uniform shade of tan or brown. An early melanoma contains two or more distinct colors within a single lesion, combinations of tan, brown, dark brown, black, pink, red, gray, or white can appear simultaneously. The presence of white or light areas within a previously darker spot can indicate regression, a zone where the immune system has attacked the tumor and destroyed some pigmented cells, leaving pale patches. A mix of colors within one spot is a strong prompt to seek evaluation.

Size: Melanoma lesions are often larger than 6 mm in diameter, roughly the width of a pencil eraser, when first noticed, though this is a guideline, not a rule. Smaller melanomas exist and can be just as dangerous if they have other concerning features. Do not wait for a spot to cross a size threshold before seeking evaluation.

The “ugly duckling” sign: Stand back and look at all the moles on a given body area. A benign mole population tends to have a family resemblance, they look similar to each other. A melanoma often looks distinctly different from all the others: it may be darker, larger, more irregular, or simply different in character. This is the ugly duckling sign, and it is a useful heuristic even when individual ABCDE criteria are subtle.

Early vs. benign mole side by side: A benign mole is round or oval, one shade of uniform brown, with a smooth well-defined edge, stays the same month after month. An early melanoma is asymmetrical, multi-toned (brown and black with areas of pink or white), has a notched or scalloped border, and may have grown or changed in the past few months.

Melanoma by Type: How Each Subtype Looks

Superficial Spreading Melanoma

Superficial spreading melanoma, accounting for approximately 70% of all cases, is the subtype most people picture when they think of melanoma. It is flat or only very slightly raised and spreads horizontally across the skin surface before growing downward.

Visual description: A flat-to-barely-raised lesion, typically oval or irregularly shaped, ranging from one to several centimeters when diagnosed. The defining characteristic is color variation within a single spot: shades of tan, brown, dark brown, and black are common, often with areas of pink, red, or white within the same lesion. The white or light areas represent regression, immune-mediated clearing of pigmented cells, and are a particularly specific feature. The border is irregular, notched, or scalloped rather than smooth and round. On the back, it can be easy to confuse early lesions with an irregular pigmented spot until the color variation and border irregularity become apparent.

Most commonly found on the back and shoulders in men, and the legs and back in women.

Nodular Melanoma

Nodular melanoma accounts for 15–30% of melanomas and grows vertically (downward) from the start, making it the most aggressive common subtype. It looks very different from superficial spreading melanoma.

Visual description: A raised, dome-shaped or nodular lesion, clearly elevated above the surrounding skin surface. It is firm to the touch, not soft like a cyst. The color is most often uniformly dark brown to black, without the color variation typical of superficial spreading melanoma. However, it can also appear red, dark red, pink, or even skin-colored (amelanotic nodular form), these less-pigmented variants are particularly likely to be misidentified as a benign cyst, blood blister (hematoma), or vascular lesion (hemangioma). The lesion may bleed with minor trauma, ulcerate, or develop a crust over the surface. It grows noticeably over weeks to months. The “EFG” mnemonic, Elevated, Firm, Growing, was developed specifically for nodular melanoma to alert clinicians to the unusual features that distinguish it from the ABCDE presentation.

Most commonly on the trunk, head, and neck.

Lentigo Maligna

Lentigo maligna is the in-situ form; lentigo maligna melanoma is the invasive form. Both are most common on the chronically sun-damaged skin of older adults.

Visual description: A flat, irregularly shaped, macular (non-raised) lesion on the face, neck, ears, or forearms. The color is typically tan, light brown, and brown, more uniformly light in early stages, developing darker areas as it evolves. Unlike the dramatic multi-color variation of superficial spreading melanoma, lentigo maligna tends toward more muted tan-brown tones. However, within that range, color variation and uneven distribution are present. The size is a notable feature, lentigo maligna is often large (several centimeters) by the time it is noticed, because it grows very slowly. The borders are irregular and can be difficult to define precisely, which is one reason surgical planning is complex for this subtype. Early lesions are particularly easy to dismiss as a liver spot or age spot.

Most commonly on the face, particularly the cheek, nose bridge, and temple.

Acral Lentiginous Melanoma

Acral lentiginous melanoma arises on the palms, soles, and under or around the nails (subungual melanoma). It is the most common melanoma subtype in people with darker skin tones and is not driven by UV radiation.

Visual description on palms and soles: A dark brown or black irregular patch or flat lesion, typically with irregular borders and some color variation. On the sole of the foot, it may initially look like a bruise or a darkened callus. Over time, it enlarges and the color variation and border irregularity become more pronounced. It may develop satellite lesions, small dark spots near the main lesion, as it advances.

Visual description under the nail (subungual): This presentation is particularly easy to miss. Subungual acral lentiginous melanoma most often presents as a longitudinal melanonychia, a dark brown or black streak running the length of the nail from the cuticle toward the tip. Key distinguishing features from a benign nail streak: the streak does not grow out with the nail over time; it is widening (becoming broader at the cuticle end); it is dark brown to black rather than gray; the pigmentation extends onto the skin of the nail fold (called Hutchinson’s sign, a specific and important finding); or the nail plate is distorted or destroyed. A dark streak under the thumb or big toe, the most common sites, that does not behave like a bruise (resolving over 2–3 months as the nail grows) should be evaluated.

Amelanotic Melanoma

Amelanotic melanoma is any melanoma subtype that produces little or no melanin pigment. The result is a lesion that looks nothing like the classic dark-brown melanoma most people imagine.

Visual description: A pink, red, or skin-colored lesion, sometimes slightly shiny, sometimes matte. It may look like a pimple that won’t heal, a small scar, a pink irritated patch, or a pyogenic granuloma (a benign vascular bump that bleeds easily). In its nodular form, it is often a raised, firm, pink-red dome. It may have a faint tan or darker rim at the edge but no significant brown or black pigmentation. The lack of melanin pigment means it is frequently dismissed by patients and providers alike as something innocuous, which is why amelanotic melanoma is associated with a higher rate of delayed diagnosis.

Any pink, red, or skin-colored lesion that is new, growing, has irregular borders, does not heal, or bleeds easily should be evaluated by a dermatologist, even if it looks nothing like melanoma.

Melanoma on Different Skin Tones

Lighter skin tones. The classic ABCDE presentation, dark brown or black lesion with irregular borders and color variation, is most visually prominent on light-colored skin, where the contrast is highest. People with fair skin are more likely to develop melanoma on sun-exposed areas (back, shoulders, legs), and the visual contrast makes irregular pigmented lesions relatively easier to see.

Medium skin tones. Melanoma can appear darker or may show more subtle color variation in people with medium or olive skin tones. The brown-on-brown contrast requires careful examination. Dermoscopy is particularly valuable for distinguishing melanoma from benign pigmented lesions in this group.

Darker skin tones. For people with dark skin, melanoma most often occurs on acral sites, the palms, soles, and under the nails, where the skin is lighter and the color contrast is more pronounced. However, melanoma can occur anywhere on the body. Any new or changing dark spot, irregularity, or unusual patch anywhere, not just acral sites, warrants attention. The key principle remains the same regardless of skin tone: look for change, irregularity, and anything that looks different from your other skin markings.

Where to Look: Melanoma in Hidden Places

Melanoma can occur anywhere on the body, including sites that are rarely examined, which is why melanoma is frequently caught late in these areas.

Scalp. Melanoma on the scalp often remains hidden under hair for months or years before being noticed. To examine the scalp, use a comb or hair dryer on a low setting to part the hair in sections, and use a hand mirror to see the scalp. Pay attention to the hairline, the crown, and the nape of the neck. You can also ask a hairdresser to report any unusual spots.

Between the toes. The web spaces between the toes are a site for acral lentiginous melanoma that is almost never examined. Spread your toes and inspect each web space at your monthly self-exam.

Soles of the feet. Sit down and use a hand mirror or a mirror on the floor to examine the full sole of each foot. Dark patches, irregular spots, or any changing lesion on the sole should be evaluated.

Under the fingernails and toenails. Look for longitudinal dark streaks. Any dark streak under a nail, especially one that is widening, extends onto the surrounding skin, or is not growing out, deserves prompt evaluation.

Behind the ears and the outer ear canal. These chronically sun-exposed areas are easy to overlook. Use a hand mirror to examine behind each ear at every self-exam.

Genitals. Melanoma can develop on the skin of the genitals and the surrounding areas. This site is rarely included in skin self-exam guidance but should be checked.

Eyes. Ocular melanoma develops inside the eye and is typically invisible from the outside. It may cause no symptoms until advanced, or may produce floaters, blurred vision, or a visible iris change. Routine dilated eye exams are the primary way it is detected.

Melanoma vs. Benign Spots: Common Look-Alikes

Many common benign skin lesions can resemble melanoma, particularly to the untrained eye. The following are the most frequent look-alikes, but this list is not a guide to self-diagnosis. If you are uncertain about a spot, the only correct action is to have a dermatologist evaluate it.

Seborrheic keratosis. This is one of the most common benign skin growths, particularly in older adults. It appears as a raised, rough, “stuck-on” or “waxy” lesion that may be tan, brown, or very dark brown to near-black. Seborrheic keratosis can be alarming in appearance, but its surface texture, waxy, crumbly, and clearly superficial, is distinctive. Dermoscopy typically reveals characteristic patterns (milia-like cysts, comedo-like openings) that distinguish it from melanoma.

Blue nevus. A uniformly blue-gray pigmented papule, often small (2–6 mm), with smooth borders and a stable history. The uniform blue-gray color and regular borders are reassuring features, but unusual blue-gray lesions should be evaluated.

Dermatofibroma. A firm, slightly raised, brown or reddish-brown lesion, usually on the legs. It typically has a characteristic “dimple sign”, pushing on the lesion from the sides causes it to dimple inward. It is benign but can occasionally resemble a pigmented lesion.

Solar lentigines (age spots/liver spots). Flat, uniformly pigmented brown macules on chronically sun-exposed skin, particularly the face, forearms, and hands. They are uniform in color and have reasonably well-defined borders. Unlike lentigo maligna, they remain stable and uniform. Dermoscopy shows a characteristic finger-like pigment pattern distinct from melanoma.

Pyogenic granuloma. A bright red, raised, friable lesion that bleeds easily and grows rapidly. It can resemble an amelanotic nodular melanoma. Any rapidly growing vascular lesion should be biopsied.

When to See a Doctor Immediately

See a dermatologist promptly if any spot:

• Bleeds without injury or trauma

• Grows rapidly over days to weeks

• Has changed noticeably in color, size, or shape over the past few months

• Itches persistently or causes ongoing discomfort or burning

• Is new, raised, and firm, especially if flesh-colored or pink

• Is a dark streak under a nail that is widening or does not grow out

• Simply looks distinctly different from all your other spots

You do not need certainty that something is wrong before making an appointment. Dermatologists evaluate suspicious spots every day, and most turn out to be benign. Getting checked, and being told the spot is fine, is always the right call. The lesions that cause the most harm are the ones that are watched and waited on too long.

For more on recognizing specific warning signs, see melanoma symptoms. For information about what happens when you see a doctor, see melanoma diagnosis. For more on specific subtypes, see types of melanoma. For guidance on routine monitoring, see melanoma screening.

If you’ve noticed a spot you’re concerned about and have been diagnosed with melanoma, North’s trial finder can help you explore current treatment options.

Frequently Asked Questions

What does early melanoma look like?

Early melanoma most often appears as a flat or very slightly raised spot with an irregular, notched, or scalloped border and two or more colors within the same lesion, shades of brown, black, tan, pink, or white. It may look like a mole that has become irregular on one side, or a new spot that is noticeably different from your other moles. The single most important feature is change: any spot that is evolving in size, shape, color, or sensation over weeks to months. Early melanoma often does not look dramatically different from a normal mole at first glance, which is why the ABCDE rule and the ugly duckling sign are important tools.

What does melanoma look like on dark skin?

On darker skin tones, melanoma most commonly occurs as acral lentiginous melanoma: a dark brown or black irregular patch on the palm, sole, or a dark streak under a nail. Subungual melanoma (under the nail) appears as a longitudinal dark streak that widens over time and does not grow out. On the body surface, any new or changing irregular spot, regardless of color contrast, warrants attention. The ABCDE criteria apply to all skin tones, though the visual contrast may be less pronounced on darker skin, making dermoscopy particularly valuable.

Can melanoma be skin-colored?

Yes. Amelanotic melanoma is a subtype that produces little or no pigment, making it appear pink, red, or skin-colored. It can look like a pimple, a sore that won’t heal, a pyogenic granuloma (red bleeding bump), or a flat pink irritated patch. Because it lacks the dark coloration associated with typical melanoma, it is frequently overlooked by patients and sometimes by clinicians. Any growing, non-healing, firm, or irregularly bordered pink or red lesion should be evaluated, especially if it bleeds easily.

What does melanoma under a nail look like?

Subungual melanoma (melanoma under a nail) typically appears as a longitudinal dark stripe, brown or black, running from the base of the nail to the tip. Unlike a bruise under the nail (which grows out with the nail over 2–3 months), a melanoma streak does not resolve over time and may widen. Hutchinson’s sign, pigmentation that extends from the nail onto the surrounding skin of the nail fold, is a specific feature that distinguishes subungual melanoma from benign nail pigmentation. The nail plate may eventually become distorted or destroyed. Any new dark streak under a nail, particularly in the thumb or big toe, that does not behave like a resolving bruise should be evaluated promptly.

How do I tell the difference between a mole and melanoma?

A benign mole is typically round or oval, uniformly one shade of tan or brown, with smooth well-defined borders, stable in appearance over years, and smaller than 6 mm. Melanoma has one or more of the ABCDE features: Asymmetry (unequal halves), Border irregularity (notched, scalloped, or blurred edge), Color variation (multiple shades within one lesion), Diameter over 6 mm, or Evolving (changing in any way). The ugly duckling sign, a spot that looks distinctly different from all your others, is also a useful prompt. When in doubt, don’t try to decide, make an appointment with a dermatologist. A dermoscopy examination can resolve uncertainty far more reliably than visual inspection alone.

References

1. American Academy of Dermatology Association. Melanoma: Signs and Symptoms, ABCDE Rule. https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/symptoms

2. National Cancer Institute. Melanoma Treatment (PDQ), Patient Version. https://cancer.gov/types/skin/patient/melanoma-treatment-pdq

3. American Cancer Society. Signs and Symptoms of Melanoma Skin Cancer. https://www.cancer.org/cancer/types/melanoma-skin-cancer/detection-diagnosis-staging/signs-and-symptoms.html

4. Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-676. https://pubmed.ncbi.nlm.nih.gov/18616769.

5. Pizzichetta MA, Talamini R, Stanganelli I, et al. Amelanotic/hypomelanotic melanoma: clinical and dermoscopic features. Br J Dermatol. 2004;150(6):1117-1124. https://pubmed.ncbi.nlm.nih.gov/15214897