Health condition · Clinically reviewed
Melanoma & skin cancer, what to notice, dermoscopy diagnosis and modern immunotherapy.
Melanoma, basal cell carcinoma and squamous cell carcinoma. Melanoma is the most serious — but modern immunotherapy and targeted therapy have transformed outcomes.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, BAD and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK guidance including checkpoint immunotherapy and BRAF/MEK targeted therapy.
Key facts
Skin cancer at a glance.
The essentials, in plain English — what the three main types are, how melanoma is diagnosed, and how it’s treated in the UK today.
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Three main types
Basal cell carcinoma (most common), squamous cell carcinoma, and melanoma (most serious).
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How common
Melanoma UK: around 16,000 cases per year. Non-melanoma skin cancers are far more common.
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Spotting it early
The ABCDE rule (Asymmetry, Border, Colour, Diameter, Evolving) helps identify suspicious moles.
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Diagnosis
Dermoscopy is the standard first step, followed by excisional biopsy when melanoma is suspected.
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Surgery
Wide local excision is the mainstay of melanoma treatment, with clear margins based on depth.
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Modern therapy
Checkpoint immunotherapy and BRAF inhibitors have transformed outcomes for stage III/IV melanoma.
Why this guide matters
Notice early, treat modern.
Skin cancer is common — but the outcome depends enormously on how early it’s spotted and how well it’s treated. Three points shape everything else on this page.
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ABCDE saves lives
Simple monthly self-checks find melanoma at a thinner, more curable stage.
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Dermoscopy is the standard
A dermatoscope reveals features a naked eye can’t — every suspicious mole deserves one.
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Modern therapy has transformed outcomes
Checkpoint immunotherapy and BRAF inhibitors have changed stage III/IV melanoma prognosis fundamentally.
How the diagnosis is made
From a suspicious mole to a clear plan.
The steps a UK GP, dermatologist and skin-cancer MDT will normally follow, in order — so you know what to expect and why.
Phase 1 · Noticing
Self-check, GP review and dermoscopy
Phase 2 · Confirming
Biopsy and node sampling
Phase 3 · Planning
Staging and MDT decision
- 01
Noticing
Self-examination (ABCDE)
Check moles monthly for Asymmetry, irregular Border, varied Colour, Diameter over 6mm, or Evolving change.
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Noticing
GP or dermatologist review
Any suspicious lesion should be reviewed — the GP can refer under the 2-week-wait pathway if melanoma is suspected.
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Noticing
Dermoscopy
A handheld magnifier that reveals the microstructure of a mole — the standard first-line diagnostic in UK skin cancer clinics.
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Confirming
Excisional biopsy
When melanoma is suspected, the whole lesion is removed with a narrow margin so a pathologist can measure depth (Breslow).
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Confirming
Sentinel lymph node biopsy
For invasive melanoma above a threshold thickness — the first draining node is sampled to check for microscopic spread.
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Planning
Staging imaging
CT or PET-CT for higher-risk or node-positive melanoma to look for distant disease before planning treatment.
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Planning
Skin-cancer MDT
A multidisciplinary team (dermatology, plastics, oncology, pathology, radiology) agrees the final treatment plan.
Typical timeline: from GP referral to a full plan in weeks under the 2-week-wait pathway.
Symptoms
What skin cancer actually looks like.
The classic patterns of BCC, SCC and melanoma — and the features that mean it’s time to escalate to urgent dermatology.
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ABCDE changing mole
Asymmetry, irregular Border, varied Colour, Diameter over 6mm, and Evolving change over weeks or months.
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Basal cell carcinoma
A slow-growing pearly nodule with a rolled edge and fine surface vessels — the commonest skin cancer, rarely spreads.
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Squamous cell carcinoma
A crusted, scaly, growing lump — often on sun-exposed skin. Can spread if left untreated.
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Melanoma
A new or changing pigmented lesion showing any ABCDE feature — needs urgent dermatology review.
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Nodular / amelanotic melanoma
A fast-growing pink, red or skin-coloured nodule that doesn’t look pigmented — easy to miss, high-risk.
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Subungual / mucosal melanoma
Melanoma under a nail or on mucosal surfaces (mouth, genital) — rarer, and often diagnosed later.
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Nail-bed pigmentation change
A new brown or black streak in a nail — especially with pigment spreading onto the surrounding skin (Hutchinson’s sign).
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Red flag
A rapidly changing lesion, ulceration or bleeding — urgent 2-week-wait dermatology referral.
Treatment
How skin cancer is treated in the UK.
Surgery is the foundation, with a modern systemic ladder — immunotherapy and BRAF-targeted therapy — that has transformed outcomes in advanced melanoma.
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Wide local excision
The mainstay of melanoma treatment — the tumour is removed with a clear margin sized to the Breslow depth.
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Mohs micrographic surgery
Layer-by-layer excision with immediate microscopy — preserves tissue on the face and other cosmetically sensitive sites.
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Sentinel lymph node biopsy
A staging procedure for invasive melanoma — samples the first draining node to guide further treatment.
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Adjuvant immunotherapy
Pembrolizumab or nivolumab after surgery for high-risk stage III melanoma — reduces recurrence significantly.
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BRAF/MEK targeted therapy
For BRAF-mutant melanoma — combinations such as dabrafenib + trametinib produce rapid, durable responses.
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Combination immunotherapy
Ipilimumab + nivolumab for advanced melanoma — higher response rates with more immune-related side-effects.
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Radiotherapy
Used selectively for symptom control, unresectable disease, or after nodal surgery in higher-risk cases.
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Follow-up surveillance
Annual full-body photography (FBP) and clinical review for higher-risk patients to catch new or recurrent lesions early.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.
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NICE. Melanoma: assessment and management (NG14).
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NICE. Skin cancer: prevention, detection and management (NG12).
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British Association of Dermatologists (BAD). Skin cancer patient information leaflets.
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Melanoma UK. Patient information and support.
Red flags
When a skin lesion needs urgent attention.
Most skin lesions are benign. These are the situations where they might not be — and where a 2-week-wait dermatology referral is appropriate.
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Rapidly changing pigmented lesion
A mole that changes in weeks — colour, shape or size — needs urgent dermatology review under the 2-week-wait pathway.
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Bleeding or ulcerated mole
Spontaneous bleeding or ulceration in a pigmented lesion is a classic melanoma red flag.
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Non-healing skin lesion
A crusted or ulcerated lesion that hasn’t healed after four weeks needs skin cancer assessment.
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New pigmented nail streak
Especially with spread of pigment onto the surrounding skin (Hutchinson’s sign) — think subungual melanoma.
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Amelanotic (colourless) melanoma
A fast-growing pink or skin-coloured nodule can be melanoma — dermoscopy is essential.
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Systemic symptoms with skin lesion
Weight loss, night sweats or new lumps alongside a skin lesion suggest advanced disease — urgent assessment.
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Immunosuppressed patient
Transplant recipients and patients on long-term immunosuppression have much higher skin cancer risk and warrant a lower threshold to refer.
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Strong family history
Multiple first-degree relatives with melanoma or a known familial syndrome — surveillance and specialist review are recommended.
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Post-transplant skin cancer
Solid organ transplant recipients need regular dermatology surveillance and prompt treatment of any new lesion.
Living with it
Prevention, vigilance, and steady follow-up.
Four things that make the biggest difference day to day — sun protection, monthly self-checks, prompt escalation, and keeping your surveillance appointments.
A quiet reminder
Early detection changes everything.
A melanoma caught thin is a very different disease from one caught thick — the time between those states is often weeks, not years.
- 01 Sun
Protect the skin you have
SPF 30+ daily on exposed skin, hats and shade at midday, and no sunbeds — the single biggest modifiable risk.
- 02 Check
Monthly self-exams
A quick head-to-toe check once a month, with a partner or a mirror for hard-to-see areas.
- 03 Escalate
Don’t wait on a changing mole
If anything on your skin is changing, see a GP or dermatologist — most turn out to be benign, but the ones that aren’t need action fast.
- 04 Follow-up
Keep your surveillance visits
After a skin cancer diagnosis, follow-up appointments detect recurrence and new primaries early — when they are most treatable.
Frequently asked
Everything we get asked about melanoma and skin cancer.
Quick answers on the ABCDE rule, dermoscopy, Breslow depth, immunotherapy and when to worry.
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What is the ABCDE rule?
A simple checklist for suspicious moles — Asymmetry, Border irregularity, Colour variation, Diameter over 6mm, and Evolving change. Any one feature warrants review.
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Is melanoma always dark?
No. Amelanotic melanoma is pink, red or skin-coloured and can be missed because it doesn’t look like a “classic” mole. A rapidly growing new nodule is a red flag whatever the colour.
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What is dermoscopy?
A handheld magnifier that lets a clinician see the microstructure of a mole — the standard first-line diagnostic in UK skin cancer clinics.
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What does Breslow depth mean?
The thickness of the melanoma measured under the microscope, in millimetres. It’s the single most important predictor of outcome and guides surgical margins and further treatment.
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How has treatment changed?
Checkpoint immunotherapy (pembrolizumab, nivolumab, ipilimumab) and BRAF/MEK inhibitors have transformed outcomes for stage III and IV melanoma over the last decade.
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When should I see a GP urgently?
Any rapidly changing pigmented lesion, bleeding or ulcerated mole, non-healing skin lesion, or a new pigmented nail streak — ask about the 2-week-wait dermatology pathway.