When you think of melanoma skin cancer, you likely picture an abnormal dark mole or lesion. But one type of melanoma — known as amelanotic melanoma — doesn’t look like other melanomas. This makes it hard to spot and diagnose correctly. Knowing the signs and symptoms of amelanotic melanoma can help you recognize a suspicious spot and get it looked at quickly.

In this article, we’ll cover what amelanotic melanoma is, what it looks like, and which symptoms you may experience. We’ll also discuss how doctors treat this form of melanoma and what your prognosis (outlook) looks like. If you have any questions about amelanotic melanoma, talk to your doctor or dermatologist (skin specialist).

Symptoms of Amelanotic Melanoma

Unlike other types of melanoma, amelanotic melanomas don’t make melanin (dark skin pigment, or coloring). This means that amelanotic melanoma lesions aren’t brown or black. Instead, they may be reddish or pink. The lesions may have brownish or gray edges that make them a bit more noticeable.

Doctors use the acronym ABCDE to describe melanoma lesions. Keep an eye on any suspicious spots and look for:

• Asymmetry — When looking at each half of the lesion, one side is different from the other.
• Border — The lesion has a ragged, uneven, or irregular border.
• Color — There are different colors within the lesion.
• Diameter — The lesion is about 6 millimeters across (about the size of a pencil eraser).
• Evolving — The lesion has changed over time in size, shape, or color.

It’s worth noting that some amelanotic melanomas may not meet the ABCDE criteria, which is why it’s essential for an expert to review any new or changing spots on your skin.

Amelanotic melanoma can become painful. Be sure to let your doctor know if you notice a new lump that begins to hurt, crust over, bleed, or ooze. Open sores that don’t heal on their own after a few weeks should also be checked.

What Causes Amelanotic Melanoma?

Melanoma is a form of skin cancer that develops in the melanocytes. These specialized skin cells make melanin. Researchers have found that in amelanotic melanoma, the melanocytes can’t make melanin.

They aren’t quite sure why this happens, but they have a few theories. One theory is that the melanoma cells lose the features that make them melanocytes. Without these characteristics, they can’t make melanin like they normally would.

Risk Factors for Amelanotic Melanoma

When the DNA in your melanocytes becomes damaged, the cells can turn cancerous. They begin growing uncontrollably, forming tumors or lesions on your skin.

There are several factors that raise your risk of developing melanoma. They include:

• Exposure to ultraviolet (UV) light from sun exposure or tanning beds
• A family history of melanoma skin cancer
• Lighter skin tone, blonde or red hair, or freckles
• Inherited conditions passed down through your family, like xeroderma pigmentosum
• Older age, as most melanoma cases are diagnosed at around 50 years of age
• A weakened immune system

How Is Amelanotic Melanoma Diagnosed?

If you’ve found a suspicious spot on your skin that looks like amelanotic melanoma, make an appointment with your doctor. They’ll perform a physical exam and take a close look at the lesion. Let your doctor know your symptoms and whether you have any family history of melanoma.

The only way to confirm an amelanotic melanoma diagnosis is with a biopsy. During this test, your doctor will remove as much of the lesion as possible. The sample is sent to a lab and looked at under a microscope for any melanoma cells.

If your doctor thinks the melanoma may have spread, they’ll also check your lymph nodes. These small, bean-shaped immune-system structures filter your blood and hold immune cells to fight infections. A doctor will conduct a sentinel lymph node biopsy, which entails removing the lymph node closest to the melanoma lesion to see if it has spread beyond the skin.

How Common Is Amelanotic Melanoma?

Amelanotic melanoma is a rare melanoma. A study published in 2014 noted that 2 percent to 20 percent of all melanomas are amelanotic.

Researchers have also found that amelanotic melanoma can occur in any type of melanoma. These types are defined by where it occurs on the body and how it grows. However, it seems that amelanotic melanoma occurs in some types more than others.

Around one-quarter of subungual melanomas are amelanotic. These skin cancers form underneath your fingernails and toenails. Desmoplastic melanomas often look like lumps or scars. Over half of these melanomas are amelanotic and are usually the same color as the surrounding skin.

Nodular melanomas create raised, rounded nodules or bumps on your skin. Some people have nodules that are pink — these bumps may be misdiagnosed as another type of skin cancer known as basal cell carcinoma.

How Is Amelanotic Melanoma Treated?

Amelanotic melanoma is treated like other types of melanoma. Your doctor will create your treatment plan based on your cancer stage and location.

Surgery

Most early-stage melanomas are treated and cured with surgery. In some cases, the biopsy to diagnose amelanotic melanoma removes the entire tumor. Since amelanotic melanomas can be hard to spot on light skin tones, your doctor may have a hard time finding the tumor border.

One surgical option is wide excision surgery, which removes the entire melanoma and a small border of skin surrounding it. This reduces the risk of cancer cells being left behind. A pathologist (cell specialist) will look at the removed skin sample to find the border of the tumor. They’ll confirm whether the entire tumor was successfully removed.

Immunotherapy

Immunotherapy is a type of treatment that activates your immune system to fight cancer. The U.S. Food and Drug Administration (FDA) has approved multiple immunotherapies for melanoma. Examples include:

• Immune checkpoint inhibitors (ICIs), such as pembrolizumab (Keytruda), nivolumab (Opdivo), and ipilimumab (Yervoy)
• Oncolytic virus therapy
• Interferon alfa-2b (Intron A)
• Interleukin-2

Targeted Therapy

If your cancer has metastasized (spread) to other parts of the body, you’ll need a systemic treatment. Targeted therapies work by targeting or blocking specific proteins that cancer cells use to grow and divide. Many of these drugs are given to people with specific gene mutations (changes) in their amelanotic melanoma.

Melanoma cells use BRAF and MEK proteins to send growth signals. There are several targeted therapies available to block these proteins.

BRAF inhibitors include:

• Dabrafenib (Tafinlar)
• Encorafenib (Braftovi)
• Vemurafenib (Zelboraf)

MEK inhibitors for melanoma include:

• Binimetinib (Mektovi)
• Cobimetinib (Cotellic)
• Trametinib (Mekinist)

BRAF inhibitors are usually combined with MEK inhibitors for better results.

Read more about specific medications in this list of treatments for melanoma.

Radiation Therapy and Chemotherapy

For other types of cancer, radiation therapy and chemotherapy are key parts of treatment. However, they’re only used in certain situations to treat melanoma. Your doctor can tell you if radiation therapy or chemotherapy will fit into your amelanotic melanoma treatment plan.

What Is the Prognosis With Amelanotic Melanoma?

According to the American Cancer Society, the five-year relative survival rate with melanoma is 94 percent. This means that people with melanoma are 94 percent as likely to be alive after five years when compared to the general population.

However, studies have found that the five-year survival rate with amelanotic melanoma is 88 percent. This means that after five years, 88 percent of people with this form of melanoma are alive. The survival rate is likely lower because it’s harder to accurately diagnose amelanotic melanoma.

It’s important to note that studies can’t predict how long you’ll live with amelanotic melanoma. Your doctor can help you better understand your individual outlook with the disease.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

Did early symptoms of melanoma send you to the doctor before your melanoma diagnosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.