Diagnosis
If you have any symptoms or warning signs of melanoma, see your doctor as soon as possible. Early diagnosis is very important for melanoma, as early-stage melanoma can usually be treated successfully. Your doctor will thoroughly examine your skin and ask about your general health, lifestyle, and family history. You may need to see a dermatologist (skin doctor), who will use a dermatoscope, a magnifying lens with a light, to look at the skin more closely. If your doctor thinks a spot may be melanoma, he will perform a biopsy to be certain. Here are some procedures your doctor may recommend to diagnose and stage melanoma:
Biopsy
A biopsy is the only way to be certain a spot on your skin is cancer. Your doctor will take a tissue sample from a suspicious area of your skin and have it sent to a lab to be examined under a microscope. There are a few different types of skin biopsies, depending on the type of skin cancer suspected.
Shave Biopsy
Your surgeon or dermatologist removes only the outer layers of the skin to be examined under a microscope. This technique is most commonly used to biopsy lesions suspicious for basal cell and squamous cell carcinomas. However, this type of biopsy can be used for suspicious pigmented lesions, particularly if it is a deep shave, often referred to as a saucerization.
Incisional Biopsy
Your surgeon uses a scalpel to make an incision and remove a part of the suspected tumor for examination.
Excisional Biopsy
Your surgeon uses a scalpel to remove the entire lump or spot for examination. Doctors usually perform excisional biopsies to remove small tumors.
Punch Biopsy
Your surgeon or dermatologist removes a cylinder of tissue from deeper layers of skin. This technique is often used to biopsy larger lesions, or those where a larger biopsy would complicate planning for definitive removal of the lesion.
Additional Procedures
Once the diagnosis of melanoma is made, the information obtained from the pathology report and the history and physical examination performed by your doctor will help determine the clinical stage of disease. Your dermatologist or primary care physician may refer you to doctors who specialize in the treatment of melanoma, such as surgical and medical oncologists. A specialized lymph node biopsy procedure may be recommended to aid in the staging process. This information will not only provide an estimation of prognosis, but also help your doctor make recommendations for stage-appropriate treatment.
Sentinel Lymph Node Biopsy
This specialized lymph node biopsy is performed to find out whether the melanoma has spread to the lymph nodes. Surgeons are able to pinpoint which lymph nodes the melanoma is most likely to spread to first (called sentinel lymph nodes). The surgeon then removes these sentinel nodes then sends them to a pathologist for examination under a microscope to determine if they contain melanoma cells. If they do not, then the melanoma is much less likely to have spread to other lymph nodes or other areas of the body.
Ultrasound
Ultrasounds bounce sound waves off of your internal organs in order to create echoes that form a picture. Your doctor may recommend an ultrasound to determine if the melanoma has spread to lymph nodes if he/she feels the lymph nodes might be enlarged based on his or her physical examination.
Computed tomography (CT) scan
A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan can reveal whether or not the cancer has spread to other parts of the body. Your doctor may order a CT scan to evaluate specific unusual symptoms, or in some cases of melanoma at high risk for spreading to other parts of your body.
Magnetic resonance imaging (MRI) scan
Magnetic resonance imaging (MRI) uses a strong magnet to create clear and detailed images of body parts. Magnetic waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. MRI does not involve exposure to radiation. As with CT scans, your doctor may order a MRI scan to evaluate specific unusual symptoms, or in some cases of melanoma at high risk for spreading to other parts of your body. MRI is frequently used to determine if melanoma has spread to the brain.
Positron emission tomography (PET) scan
For a PET scan, the doctor injects a radioactive substance into the patient's bloodstream. This substance collects in malignant (cancerous) cells in the patient's body. The doctor then uses a PET scanner to detect these areas of radioactivity and to define the exact location of cancer in the patient's body. The PET scan is not completely specific for finding cancer; it can show up areas of inflammation and infection as well. As with CT and MRI scans, your doctor may order a PET scan to evaluate specific unusual symptoms, or in some cases of melanoma at high risk for spreading to other parts of your body.
