Melanoma is the most serious type of skin cancer, originating in pigment-producing cells called melanocytes. Early detection dramatically improves the chances of successful treatment. While visual changes in a mole are the most commonly discussed warnings, many people wonder if they should also check for physical sensations. This article addresses whether melanoma causes symptoms like persistent itching (pruritus) or pain, and explains the biology behind these sensory changes.
Itching and Pain as Melanoma Indicators
Melanoma is often asymptomatic in its earliest phases, meaning it may not produce noticeable discomfort or sensation. However, both persistent itching and pain or tenderness can be presenting symptoms that signal a change in the skin lesion. These sensory symptoms are not the most frequent sign of melanoma compared to other skin cancers, but their presence is a reason for concern.
Studies indicate that a minority of melanomas are associated with itching, with prevalence around 14.8 percent of cases. Pain is even less common, reported in only about 3.7 percent of melanoma cases in the same study. Despite the lower prevalence, a new or existing mole that begins to itch, feel tender, or hurt consistently is considered an evolving characteristic that warrants professional evaluation.
It is important to differentiate between an occasional irritation and a consistent, unexplained sensory change localized to the mole itself. The discomfort may manifest as a persistent prickling or stinging sensation, or a general tenderness when the area is touched. Any change in symptoms, including the development of new itchiness, bleeding, or pain, is included in the criteria for identifying a suspicious lesion.
Recognizing Other Key Visual Signs
Since sensory symptoms are not always present, the primary method for self-screening remains the visual inspection of the skin. This inspection is guided by the established ABCDE rule, a mnemonic that helps identify suspicious lesions. Regular self-examinations are an important step in catching changes early, which significantly increases the likelihood of a positive outcome.
The ABCDE rule components are:
- Asymmetry (A): One half of the spot does not match the other half.
- Border irregularity (B): The edges of the lesion are often scalloped, notched, or poorly defined.
- Color variation (C): Different shades of color are present within the same lesion, such as tan, brown, black, white, red, or blue.
- Diameter (D): Melanomas are typically greater than six millimeters when diagnosed, roughly the size of a pencil eraser, though smaller lesions with other concerning features should not be ignored.
- Evolving (E): Refers to any change over time in the mole’s size, shape, color, or elevation. Changes in symptoms, like new bleeding or the onset of itching or tenderness, are also considered part of this characteristic.
The Biology Behind Sensory Symptoms
A melanoma might start to itch or hurt due to the tumor’s uncontrolled growth and the body’s resulting inflammatory response. As the cancerous cells multiply rapidly, the tumor expands, causing stretching of the surrounding skin tissue. This expansion puts mechanical pressure on the fine nerve endings located within the skin layers, potentially leading to sensations of pain or tenderness.
In addition to physical pressure, the tumor cells themselves, along with immune cells attempting to fight the cancer, release various chemical messengers. These substances include inflammatory mediators, such as histamine and prostaglandins, which are known to activate cutaneous nerves. The activation of these nerves is the biological process that translates into the sensation of persistent itching or pruritus.
The association between pain and greater depth of invasion suggests that pain may arise from deeper processes, while itching is thought to emanate from the upper layers of the skin. The presence of immune cells like eosinophils and a marked degree of inflammation in the lesion are often associated with both itch and pain intensity. These biological changes mean that sensory symptoms are a direct result of the tumor’s interaction with the surrounding tissue and nervous system.
When to Seek Professional Evaluation
Any persistent or evolving change in a mole, whether visual or sensory, warrants a professional medical evaluation. A lesion that hurts, is itchy, or bleeds for more than a few weeks should be examined by a healthcare provider. Seeking evaluation is important even if the lesion is small or exhibits only one concerning feature.
Only a dermatologist can definitively diagnose melanoma. They typically use a specialized magnifying tool called a dermatoscope to examine the spot closely. If a lesion is suspicious, a skin biopsy is performed to analyze the tissue under a microscope. Prompt evaluation allows for the earliest possible diagnosis and treatment, which is linked to the best outcomes.