Conditions We Treat

Melanoma

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Overview

Melanoma is a serious form of skin cancer that develops when pigment-producing cells, called melanocytes, begin to grow uncontrollably. While it is less common than other skin cancers, it is also more aggressive and has the potential to spread to other parts of the body if not detected early.

In Singapore, melanoma is relatively uncommon compared to Western countries, but it remains a concern, especially as awareness of skin health and sun protection grows. The condition can occur in people of all skin tones, including those with darker complexions who may develop melanoma on less sun-exposed areas such as the soles, palms or under the nails.

What is Melanoma?

Melanoma arises from melanocytes, which are the cells that give our skin its colour. These cells can cluster to form moles, most of which are harmless. However, when their DNA is damaged, they may begin to multiply abnormally, forming a malignant tumour.

The condition can develop anywhere on the body, including areas not typically exposed to the sun. It may start as a new mole or an existing one that changes in shape, colour or size.

What are the stages of Melanoma?

The stages describe how deeply cancer has grown and whether it has spread:

Stage	Description
Stage 0 (Melanoma in Situ)	The cancer cells are confined to the top layer of the skin (the epidermis) and have not invaded deeper tissue. It is considered highly curable when surgically removed early.
Stage I	The tumour is small (less than 2 mm thick) and may or may not have ulceration (a break in the skin). At this stage, melanoma is still localised and the likelihood of full recovery after excision is excellent.
Stage II	The melanoma is thicker (over 2 mm) and may show ulceration, but has not yet spread to lymph nodes or distant sites. Surgery remains the main treatment, sometimes followed by a sentinel lymph node biopsy to check for microscopic spread.
Stage III	The cancer has spread to nearby lymph nodes or tissues close to the primary tumour. Treatment may involve surgery to remove affected nodes, along with targeted therapy or immunotherapy to reduce the risk of recurrence.
Stage IV	The melanoma has metastasised to distant organs such as the lungs, liver, brain or bones. While advanced, significant progress in immunotherapy and targeted therapy has dramatically improved outcomes, allowing many patients to live longer and maintain a good quality of life.

What are the types of Melanoma?

Although melanoma can appear in different forms, each comes with unique features and growth patterns. This includes:

Superficial spreading melanoma – the most common type. It spreads along the top layer of the skin before invading deeper tissue.
Nodular melanoma – grows more rapidly and penetrates deeper early on. It may appear as a raised, dark or reddish lump.
Lentigo maligna melanoma – usually occurs in older adults on sun-damaged skin, such as the face or arms.
Acral lentiginous melanoma – more common among Asian and darker-skinned individuals. It develops on the palms, soles or under the nails.
Desmoplastic melanoma – a rarer form that may resemble a scar or patch of thickened skin rather than a mole.

What causes Melanoma?

Melanoma begins when the DNA inside melanocytes becomes damaged, causing the cells to grow and divide uncontrollably.

This DNA damage disrupts the normal control mechanisms that tell cells when to stop multiplying. As a result, mutated melanocytes start forming abnormal clusters that can invade surrounding tissue and, in advanced stages, spread to other parts of the body.

The main trigger for this DNA damage is ultraviolet (UV) radiation from sunlight or tanning beds. UV rays cause genetic mutations that accumulate over time, especially in people with less natural pigment protection. However, not all melanomas are UV-related, as some arise from genetic or internal factors that influence how cells behave.

Other contributing mechanisms include:

Genetic mutations – inherited or spontaneous changes in certain genes, such as BRAF, NRAS or CDKN2A, can promote uncontrolled cell growth.
Weakened immune surveillance – a weakened immune system may fail to recognise and destroy abnormal melanocytes early.
Chronic oxidative stress and inflammation – continuous exposure to irritants or injury can increase free radicals that damage cell DNA.
Hormonal or systemic influences – hormonal changes and certain medical conditions may alter melanocyte activity, increasing the risk of malignant transformation.

Who is at risk of developing Melanoma in Singapore?

Certain factors increase a person’s likelihood of developing it. This includes, but is not limited to:

Older adults – accumulated sun exposure and slower cellular repair mechanisms contribute to a higher risk.
Family history of melanoma – genetic predisposition can significantly increase risk.

History of severe sunburns – intense, blistering burns, particularly in childhood, can cause DNA damage.
Fair skin and light eyes – have less melanin, offering less natural protection against UV radiation.
Darker skin tones – although risk is lower, melanoma often appears in harder-to-detect areas such as nails, soles or palms and may be diagnosed later.
Individuals with many or atypical moles – a higher mole count raises the risk of abnormal cell changes.

What are the symptoms of Melanoma?

While early melanomas may seem harmless, subtle differences in colour, shape or growth pattern can signal something more serious.

Some of the common warning signs include:

A mole or pigmented spot that changes in size, shape or colour over time
A new dark spot that looks different from your other moles
A lesion that itches, bleeds or develops a crust
A mole with irregular borders or multiple shades of brown, black, red or even blue
A streak or dark band under the fingernails or toenails, which may indicate subungual melanoma
A mole or patch that feels raised, firm or tender to the touch

The ABCDE Rule of Melanoma detection

This guideline is a simple and effective guide to help patients recognise potential melanoma early. The five letters refer to:

Letter	Meaning	What to Look For
A	Asymmetry	One half of the mole does not match the other in shape or colour. Normal moles are typically symmetrical.
B	Border	The edges are uneven, blurred or scalloped, rather than smooth and well-defined.
C	Colour	Variations of brown, black, red, white or blue within a single mole may signal abnormal pigment activity.
D	Diameter	A mole larger than 6 mm (about the size of a pencil eraser) deserves attention, though smaller melanomas can occur too.
E	Evolving	Any change in size, shape, colour, elevation or new symptoms like bleeding or itching indicates the need for a skin check.

How is Melanoma diagnosed in Singapore?

Diagnosing melanoma typically begins with a comprehensive skin evaluation. Generally, our dermatologists will perform the following steps:

Visual examination – a dermatoscope allows our dermatologists to examine the mole’s structure and pigment pattern more closely, revealing subtle features not visible to the naked eye.
Skin biopsy – if melanoma is suspected, a small sample of the lesion is removed under local anaesthesia. This tissue is sent to a laboratory for histopathological examination, confirming whether cancerous cells are present and identifying the type and depth of melanoma.
Additional tests – if the melanoma is advanced, imaging tests or a sentinel lymph node biopsy may be performed to assess if the cancer has spread.

Understanding the Fitzpatrick Skin Type Scale

Dermatologists often use the Fitzpatrick Skin Type Scale to estimate how different skin tones respond to sunlight and UV radiation.

The scale indicates:

Fitzpatrick Skin Type	Skin Characteristics	Melanoma Risk
Type I	Very fair or pale skin, often with blue or green eyes and blonde or red hair Always burns, never tans Usually has freckles	Highest risk of UV-induced melanoma. Minimal natural melanin means less protection against DNA damage from sunlight. Early and consistent sun protection is crucial.
Type II	Fair skin that burns easily and tans minimally Often has light hair and eye colour	High risk of melanoma due to limited natural UV protection. Repeated sunburns in childhood or adolescence significantly increase lifetime risk.
Type III	Light to medium skin that may burn moderately but can develop a light tan Hair and eye colour vary	Moderate risk. Still susceptible to sun-related melanoma, especially with prolonged UV exposure or outdoor occupations. Regular self-checks and sunscreen use are advised.
Type IV	Olive or light brown skin that tans easily and rarely burns Common in Mediterranean and Asian populations	Lower overall UV risk, but increased risk of acral melanoma (on palms, soles or under nails), which can be missed due to subtle early signs.
Type V	Brown skin that rarely burns and tans easily Often seen in Southeast Asian, Middle Eastern or Latin backgrounds	Lower risk of sun-induced melanoma, yet higher likelihood of late detection due to less visible pigment changes. Vigilant monitoring of nails and non-sun-exposed areas is important.
Type VI	Deeply pigmented dark brown or black skin that never burns Common among African or Afro-Caribbean individuals	Lowest UV risk, but higher proportion of acral and mucosal melanoma, which may appear on the soles, palms or mouth. These types are often diagnosed later, affecting outcomes.

How is Melanoma treated in Singapore?

The treatment for melanoma depends heavily on the stage and location of the affected areas. Our dermatologist will also consider the patient’s overall health.

Once our dermatologist has determined the extent of your condition, treatment will encompass:

Surgical removal – early-stage melanomas are treated through wide local excision, removing the lesion and some surrounding normal skin to ensure clear margins. Surgery often cures melanoma when it is caught early.
Lymph node evaluation – if there is a risk of spread, nearby lymph nodes may be examined or removed.
Advanced treatments – for more extensive cases, additional therapies may include:
- Immunotherapy – boosts the body’s natural defences to fight cancer cells
- Targeted therapy – focuses on specific genetic mutations driving melanoma growth
- Radiation therapy – helps control melanoma that has spread to other parts of the body
- Chemotherapy – used less commonly today but may be indicated in certain cases
Long-term monitoring – regular follow-up visits are crucial to detect recurrence early. Patients are also taught how to perform self-examinations to spot new or changing moles.

Book an Appointment

Early detection saves lives and this is true for melanoma. It is one of the most treatable cancers when found early and many patients go on to live full and healthy lives after timely care. If you have noticed a new or changing mole, a darker streak under your nail or a patch that simply looks different from the rest, do not wait for it to worsen.

Our dermatologists use modern dermoscopic imaging and diagnostic tools to identify suspicious lesions accurately. We understand that waiting and uncertainty can be stressful, which is why our goal is not only a precise diagnosis but also compassionate and continuous support through every stage of your care.

Your peace of mind matters. Schedule an appointment today and let our dermatologists help protect your skin one step at a time.

Frequently Asked Questions

Can melanoma be cured?

Yes, melanoma can often be cured when it is detected early. Most early-stage melanomas are completely removed through surgery, with excellent long-term outcomes. The key is prompt evaluation, as the sooner it is diagnosed, the simpler and more effective the treatment.

How fast does melanoma spread?

Melanoma can grow and spread quickly compared to other skin cancers, which is why regular skin checks are so important. Some types may remain slow-growing for months, while others progress more rapidly. If you notice any changes in your skin, it is best not to delay getting it checked.

Does melanoma always start as a mole?

Not always. While many melanomas develop from pre-existing moles, some appear on previously normal skin. They may look like a new dark spot, patch or streak under a nail. That is why any new or unusual pigmentation should be assessed by a dermatologist.

Is melanoma painful or itchy?

Melanoma is not always painful, but changes such as itching, tenderness or bleeding can sometimes occur as it develops. Any new sensation or discomfort in a mole is worth checking.

How often should I have my skin checked?

If you have several moles, fair skin or a family history of melanoma, it is recommended to have a professional skin check once a year. Those with higher risk factors may need more frequent reviews. Regular self-checks at home are also encouraged between visits.

Can melanoma come back after treatment?

In most cases, surgical removal is curative, especially for early-stage melanoma. However, ongoing monitoring is important, as recurrence can occasionally occur. Our dermatologist will schedule follow-up visits to ensure any new changes are detected promptly.

How can I prevent melanoma?

Prevention begins with protecting your skin every day.

Use broad-spectrum sunscreen (SPF 30 or higher) and reapply regularly, especially after swimming or sweating.
Avoid excessive sun exposure, particularly between 10 a.m. and 4 p.m.
Wear protective clothing, wide-brimmed hats and sunglasses when outdoors.
Avoid tanning beds, as they emit concentrated UV rays.
Perform regular self-skin checks, paying attention to new or changing spots.

Related Services

Paediatric Dermatology

Cosmetic Dermatology