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JAMA Patient Page
December 8, 2004


JAMA. 2004;292(22):2800. doi:10.1001/jama.292.22.2800

The skin, the largest organ of the body, is made up of living cells that grow and divide. Cancers can develop in the skin as well as in other parts of the body. When melanocytes (cells that give pigment [color] to the skin) become cancerous, this is called melanoma. Melanoma is less common than the other main types of skin cancer (basal cell and squamous cell cancers) but is much more likely to metastasize (spread to other organs) and to be fatal. The December 8, 2004, issue of JAMA includes an article about melanoma.

Melanoma warning signs

Melanoma experts advise looking for the ABCDs of melanoma:
A. Asymmetry—the different halves of the skin lesion do not look the same
B. Borders—irregular, shaggy, or ill-formed
C. Color—not the same throughout the lesion
D. Diameter—larger than 6 millimeters (1/4 of an inch, about the size of a pencil eraser)

The current JAMA article recommends the addition of
E. Evolving—changes in size, shape, shades of color, symptoms (itching, tenderness), or surface (especially bleeding)


Any suspicious moles or skin lesions should be examined by your doctor and may require referral to a dermatologist (physician with specialized training in diseases of the skin). Skin biopsy (removal of the lesion, or a piece of it, for testing) is a simple procedure and is done routinely in the doctor's office. For advanced melanomas, other testing may include chest x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or bone scan. These tests look for possible spread to other organs.


  • Avoid prolonged exposure to the sun, especially during peak hours of 10 AM to 4 PM.

  • Avoid tanning booths.

  • Wear sunglasses in sunlight because melanoma can occur in the pigmented areas of the eyes.

  • Wear a hat and clothing that covers the arms, legs, and the rest of the body.

  • Protect children from the sun and tanning booths because the risk of melanoma greatly increases in persons who had excessive sun exposure before age 18.

  • Use sunscreen when exposed to the sun for more than 10 minutes. The Sun Protection Factor (SPF) of sunscreen should be at least 15 (preferably higher) and definitely higher for children or fair-skinned individuals.

  • Examine your skin for changes in existing moles or development of new skin lesions. See your doctor if any skin area appears to have a melanoma warning sign (one of the ABCDEs).


Treatment options depend on the size, depth, and spread of melanoma. Melanomas need to be surgically removed. Other treatments for advanced or metastatic melanomas include chemotherapy, radiation therapy, and immunologic therapy.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. A Patient Page on detecting skin cancer was published in the February 17, 1999, issue.

Sources: National Cancer Institute; American Cancer Society; American Academy of Dermatology; National Comprehensive Cancer Network

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.