Clinicians before the first wave of urbanization in Europe were aware about Melanoma. In fact, the first descriptions date to the 5th century BC, when Hippocrates coined the term "melas" (dark) and "oma" (tumor). Since the 17th century, surgeons recorded how they found and resected the black tumors. Between 1650 and 1760, the European medical literature,

including the work of Highmore (1651), Bonet (1651), and Henrici and Nothnagel (1757), made numerous references to “fatal black tumors” with metastases and black fluid in the body. The Scottish surgeon John Hunter, working at St George Hospital Medical School, London, is credited with the first surgical removal of a melanoma in the Western medical literature. In 1804, Rene Laennec realized that the dark color was the intrinsic feature of the rare skin tumor, not like the black carbon deposits typically found in the lungs of patients upon autopsy. He named the disease “melanose”, becoming the first one to distinguish melanoma as a separate disease. The deadly nature of melanoma was soon revealed: it can metastasize aggressively to cost the patient’s life in a short time.    

In the 1820s, William Norris noticed that some patients had family history of melanoma. He also found that, in some cases, both patients and their children had an excessive number of nevi. He further described that melanomas could be either pigmented or amelanotic and that they had a tendency to disseminate widely to many visceral organs. From these observations, he made several important hypotheses. First, the disease was hereditary in some cases. Second, it was linked to nevi. This was probably the first time that melanoma was found to originate from pigment cells, even though the relation between pigment cells and nevi had not been discovered yet. Third, Norris assumed that melanoma was induced by environmental factors. He guessed those factors to be industrial pollution, though was not sure about that. He also made the important observation that most of his patients had light-colored hair and pale complexions. Norris did not find the most etiological factor of melanoma, but he left very informative clues.   

Over the 19th century, there were more characterizing and diagnostic criteria of melanoma. In 1826, Thomas Fawdington described ocular melanoma. In 1838, Sir Robert Carswell, a distinguished practitioner of pathology, published a folio volume, Illustrations of the Elementary Forms of Disease, in which he coined the term melanoma. The book had detailed drawings of melanoma metastases, including those from the brain. In 1853, Sir James Paget, Consulting Surgeon to St Bartholomew’s Hospital, London, described the transition of melanoma from a radial growth phase to a vertical growth phase. This was the first report of progression of primary melanoma. In 1858, Oliver Pemberton detailed 60 melanoma cases collected from 1820 to 1857 (about two cases per year). He was also the first to describe melanoma in a black patient from Madagascar [19].

Nevertheless, melanoma is always a rare cancer since its characterization. It frequently puzzled doctors that these weird dark tumors seemed to arise suddenly from nowhere. Clinicians did their best to find all the factors that helped explain melanoma in their observation. The medical research community needed to wait another 50 years for the correct etiological factor of melanoma to be revealed.