Can you get melanoma inside your throat or nose?

William Thomas, III, MD

Head and Neck Surgery, Otolaryngology

Melanoma, an aggressive kind of skin cancer that develops as a response to sun damage, can be found all over the body. Many people think melanomas are more likely on the arm, leg or back, but melanomas and other kinds of skin cancer are frequently found on the head and neck, even inside the throat and nose.

Head and neck surgeon William Thomas, MD, explained what signs to watch for.

Where does melanoma typically show up on the head and neck?

Melanoma that develops around the head and neck tends to be located along the top of the scalp (think where your natural hair part is located), due to sun exposure and a lack of sun protection. This is one of the reasons doctors often recommend you wear a hat while outdoors. Otherwise, unusual or changing moles, ulcers, or spots along the face and neck are possible, or even behind or inside the ears or mouth and throat.

Rarely, melanoma can develop inside the mouth, throat, the sinus cavity or inside your ears.

What are common signs of melanoma?

“Much like any other type of skin cancer, we tell patients to consider taking a look at a suspicious spot or mole with their ABCDEs in mind,” said Dr. Thomas. In the case of melanoma and deciding whether or not a mole is cancerous or needs a further look, you should look for:

• Asymmetry: Most moles are usually symmetrical in shape, meaning both sides should look essentially the same. If one side of the mole seems lighter than the other, or the border or shape is different on one side, the mole would be considered asymmetric.
• Border irregularity: Normal moles have a well-defined border. If the border of a mole on your head or neck is scalloped, fuzzy or poorly defined, this would be irregular.
• Color: Generally, a healthy mole will have a uniform color. A mole with multiple shades of brown from dark to light, or one that includes reds, blues or whites in the same area, merits closer attention.
• Diameter: Moles come in a variety of sizes, but they don’t usually get any larger than the size of a pencil eraser (about 6 millimeters). Any mole larger than that may need evaluation.
• Evolving: Any significant or sudden changes should be considered worth a closer look. This includes changing color, growing, being noticeably different than other moles on your body, a previously solid border becoming uneven and other changes. Any change in a mole is worth a closer look.

Melanomas that develop in the throat are far rarer, which makes their early symptoms (such as a painless mass, discoloration or an ulcerated or bleeding mass) easy to miss. Melanoma can develop in the sinuses and nose as well, with early symptoms involving frequent nosebleeds or feeling like one side of your nose is ‘blocked.’ When it comes to the ear, melanomas might appear as unusually long-lasting acne or a sore spot that doesn’t heal

How is melanoma diagnosed?

“In most cases, a melanoma will be initially found by the patient when they become concerned about a specific mole or spot on their body,” said Dr. Thomas. “Primary care doctors, dermatologists or even head and neck surgeons during a routine inspection might also locate melanomas, especially those located beneath the hair or in the nose or throat. Anything of significant concern may need biopsied.”

During a biopsy, the area where the mole or lesion is located is disinfected and numbed before the lesion and (sometimes) area around it is removed. Some patients may need stitches afterward, but most are able to bandage and care for the area while it heals. In the case of lesions in the throat or within the nose, a more serious examination may be needed.

A specialist, called a pathologist, will then examine the removed lesion under a microscope and determine whether the lesion is cancerous.

The results of the biopsy will be discussed with the patient. The physician may recommend a more thorough examination to see if any other lesions are present that need removed. Sometimes imaging is used to check for enlarged lymph nodes, which may also need biopsied. Lymph node biopsies help your medical team to know if your lymphatic system has been affected by the melanoma.

How is melanoma treated when it develops on the head and neck?

“Surgery is usually the best way to handle early-stage melanomas,” said Dr. Thomas. “If we’re concerned about the area around the initial lesion, we may need to remove more than just that first concerning spot. Especially when dealing with advanced stage melanoma, significant surgical treatment might be required, including removal of local lymph nodes.”

Additional chemotherapy or radiation treatments might be needed to help treat the melanoma.

When you develop melanoma on the head or the neck, this surgical removal can sometimes leave scarring. Skin cancer found around the ears, nose or throat often includes an ENT surgeon as part of the reconstructive surgery process.