Amelanotic melanoma: 7 questions, answered

Most melanomas tend to appear as irregular black or dark brown splotches on the skin. But amelanotic melanoma is an outlier: it doesn’t share the same dark pigment typical of this disease. In fact, sometimes it doesn’t have much color at all.

So, how do you know if you have amelanotic melanoma? And how is it diagnosed and treated? We went to dermatologist Kelly Nelson, M.D., for answers.

What is amelanotic melanoma?

It’s a rare subtype of melanoma that’s known for its pale pigment or lack of pigment. It’s also sometimes called hypomelanotic melanoma.

Is amelanotic melanoma colorless?

Not exactly. When we think of the “poster child” for melanoma, it tends to have multiple colors and very irregular borders. 

“Amelanotic” means “without melanin,” so this type lacks the dark pigment that’s more typical for this disease. It’s still somewhat distinct from the surrounding skin, though. And it’s usually pink or light brown. 

That subtle difference can make it challenging for patients to identify. People tend to be more used to the “ABCDE” guide for spotting melanoma, which stands for asymmetry, border irregularity, color, diameter, and evolution. Amelanotic melanoma doesn’t necessarily have the same traits, so it’s harder to recognize.

So, how can I tell if I have amelanotic melanoma?

The first step is to see if you have anything else on your skin that looks similar. If you can find six or seven other spots just like it, the chances that they’re all skin cancer are pretty low for most people. 

But see a dermatologist right away if one spot:

• doesn’t look like the rest,
• is growing quickly or 
• is starting to bleed.

If you’re still on the fence, take a picture of the spot and then look at it again in three or four weeks. Skin issues that pop up all of sudden tend to be inflammatory, like bug bites or ingrown hairs. Those normally clear up in about three weeks. But cancer doesn’t resolve on its own. It only gets larger and more problematic.

Can amelanotic melanoma develop anywhere?

Yes. It can happen anyplace on the body. It’s not like acral lentiginous melanoma, which only has three specific locations where it might appear.

How is amelanotic melanoma usually diagnosed?

The best way to diagnose amelanotic melanoma is through dermoscopy, or looking at a questionable area on the skin through a special device called a dermoscope. That’s because most people aren’t even aware of amelanotic melanoma. But as a board-certified dermatologist, my eyes are trained to find it.

Dermatologists are also equipped to diagnose amelanotic melanoma before it gets to the point that it’s large, ulcerated and bothering the patient. So, if you notice something worrisome, get it checked out. And, if you’re someone at high risk who’s already getting regular skin checks every six or 12 months, your normal screening should pick it up.

How is amelanotic melanoma typically treated?

Amelanotic melanoma is treated like other melanomas. 

In the earlier stages, surgical removal is often the only treatment that’s necessary. In more advanced cases, we’ll look at genetic mutations and other markers to determine which patients are eligible for immunotherapy or targeted therapy. After that, we start looking at clinical trials.

Are there any risk factors that make people more likely to develop amelanotic melanoma?

This is a disease with a clear correlation to UV radiation. So, it tends to have the same risk factors as superficial spreading melanoma and other skin cancers in that group: 

• light skin color
• intense UV exposure
• age – as you get older, your chances of getting this type of skin cancer increase.

That’s why the best things you can do to prevent it are avoid tanning beds, wear sunscreen and sun-protective clothing such as hats and long-sleeved shirts outside, and seek shade between the hours of 10 a.m. and 4 p.m., when the sun’s rays are at their strongest. This advice applies to people of all different skin tones.

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