Amelanotic Melanoma

Amelanotic melanoma is a rare type of skin cancer that doesn’t have dark color (melanin). Instead, it may look pale, pink to red, skin-toned or even white. Because of this, it can look like a scar, a pimple or a harmless skin bump. This makes it harder to notice and may delay a diagnosis. 

As it doesn’t look dark, it often doesn’t follow the usual ABCDE signs of skin cancer. Instead, providers may look for different warning signs, like a spot (tumor) that’s elevated, firm or growing. These changes can happen quickly.

Because it can grow and spread faster, seeing a dermatologist early is important if you notice a new or changing skin spot.

Which types of melanoma can be amelanotic?

Amelanotic means “without color.” Many types of melanoma can lose their pigment, including:

• Acral lentiginous melanoma: This type appears on your palms, soles of your feet or under your nails. It may lack color, especially in early stages or when it affects your nail area.
• Desmoplastic melanoma: This type often has little or no pigment. It may look firm and skin colored. It can resemble a scar.
• Nodular melanoma: This type often appears without dark color. It tends to grow quickly and may not produce much pigment. This makes it harder to find early because it may not look like the classic pictures of melanoma.
• Superficial spreading melanoma: This is the most common type of melanoma. It can be amelanotic, but this happens less often than with nodular melanoma.

It’s important to get any new or changing skin bumps — dark or not — checked by a healthcare provider.

What does amelanotic melanoma look like?

Most melanomas have a dark color that’s easy to see on your skin. But these are different. You might notice a small bump or patch that’s:

• Changing shape
• Firm
• Getting bigger over time
• Pale, pink to red or skin-colored
• Raised from the skin around it

The bump might be painful or itchy. If you scratch it, it may bleed. The wound may take a very long time to heal or may not heal at all. Pain, itchiness and slow healing are signs that you should talk to a provider.

Where do symptoms occur?

Amelanotic melanoma can develop anywhere on your skin. But it appears more often found in areas that get a lot of sun exposure over time. These commonly include your:

• Arms
• Ears
• Face
• Legs
• Neck
• Scalp

It can also develop in areas that get little sun, like the palms of your hands, the soles of your feet or under your nails.

Amelanotic melanoma causes

This type of skin cancer happens when changes (mutations) occur in melanocytes. These are skin cells that make pigment. These changes cause cells to grow out of control to form cancer.

The main known environmental trigger for these changes is ultraviolet (UV) radiation from the sun or tanning beds. This can damage skin cell DNA. In this type of melanoma, cancer cells make little or no melanin. This is why the tumor lacks color and can be harder to notice.

Risk factors

Amelanotic melanoma can affect anyone. But your risk may be higher if you:

• Are above age 50
• Had skin cancer or melanoma before
• Have light skin or freckles

Complications

This can lead to several challenges, including:

• A higher risk of spreading to lymph nodes or other organs if a diagnosis is delayed
• More frequent skin breakdown or skin sores
• A higher chance of the cancer coming back after removal

How doctors diagnose amelanotic melanoma

Amelanotic melanoma can be harder to notice because it lacks color, so a provider will take several steps to diagnose it. First, a dermatologist will examine your skin closely. They may use a special magnifying tool called dermoscopy. This tool helps them see patterns in your skin, like blood vessels, that may suggest melanoma even without dark pigment.

To confirm the diagnosis, they’ll perform a biopsy. This is where your provider will remove part or all of the tumor. They’ll send the skin sample to a lab. A pathologist will look at the tissue under a microscope to check for cancer cells. They’ll confirm whether it’s melanoma.

What are the stages of amelanotic melanoma?

Staging helps your healthcare provider see if cancer is spreading and the tumor’s size:

• Stage 0 (melanoma in situ): The cancer cells are only in the top layer of your skin. They haven’t spread deeper.
• Stage I: The melanoma is limited to your skin. Tumors are thinner and have fewer high-risk features.
• Stage II: It’s limited to your skin. Tumors are thicker or have signs like skin breakdown (ulceration), but haven’t spread to lymph nodes.
• Stage III: Melanoma has spread to nearby lymph nodes or to nearby areas of skin.
• Stage IV: This is the most advanced stage. It means the cancer has spread to other parts of your body, like your lungs, liver, brain or lymph nodes.

This is an important step to help your provider plan treatment.

Amelanotic melanoma treatment

Treatment depends on how early a healthcare provider finds the cancer, whether it has spread and your overall health. Your provider might recommend:

• Surgery: Surgery is the main treatment. Your provider removes the tumor along with an area of healthy skin around it. This is to make sure all the cancer cells are gone. Sometimes, a skin graft helps the area heal. They may also perform a sentinel lymph node biopsy to see if the cancer has spread to other areas.
• Immunotherapy: If the cancer has spread or has a high risk of coming back, your provider may use medicines that help your immune system fight cancer. These treatments help your body better recognize and attack melanoma cells.
• Targeted therapy: Some melanomas have specific gene changes. If testing shows these changes, targeted medicines may help. These drugs focus on cancer cells and limit damage to healthy cells.
• Radiation therapy: Radiation may help in certain cases to attack cancer cells and shrink tumors.

When should I see my healthcare provider?

You should see a healthcare provider if you notice skin changes, especially if it’s a skin bump that’s:

• Changing shape
• Growing
• Not healing

If you notice a concerning bump, take a photo of it with a ruler next to it. Take another photo every few weeks using the same ruler to check for changes in size or shape. If you notice a change, it’s time to see your provider.

What can I expect if I have amelanotic melanoma?

After a diagnosis, what happens next depends mainly on the stage.

If it’s found early and hasn’t spread beyond your skin (stages I or II), surgery may be enough to remove it. You’ll still need regular skin checks and follow-up visits to make sure the cancer stays away. But there’s a risk that it could come back after removal.

If you have a later stage (stages III or IV) that has spread to your lymph nodes or other parts of your body, treatment is more involved. Your provider will explain what you can expect, as everyone’s outcome may be a little different.

Can amelanotic melanoma be prevented?

You can’t prevent all cases. But you can reduce your risk by protecting your skin and watching for changes. Helpful tips include:

• Limit sun exposure when UV rays are strongest (between 10 a.m. and 4 p.m.).
• Avoid tanning beds.
• Wear broad-spectrum sunscreen (SPF 30 or higher) every time you go outside when the sun is up and reapply as needed.
• Use protective clothing, wide-brimmed hats and UV-blocking sunglasses when outdoors.
• Check your skin regularly for new or changing spots.
• See a dermatologist for routine skin exams, especially if you’re at higher risk.