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- Melanoma
- Melanoma Diagnosis
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View Clinical TrialsMelanoma Diagnosis
Early and accurate melanoma skin cancer diagnosis is important. This helps find out if the melanoma has spread and helps your doctor choose the most effective treatment.
MD Anderson has the most modern and accurate technology to diagnose melanoma and find out if it has spread. This helps increase the likelihood that your treatment will be successful. Our staff includes pathologists and diagnostic radiologists who are highly skilled in diagnosing melanoma.
Diagnostic Tests
If you have signs or symptoms of melanoma, your doctor will examine you and ask you questions about your health, your lifestyle and your family history. If your doctor suspects a spot may be melanoma, a biopsy will be done.
Melanoma Biopsy
Melanoma skin cancer cannot be diagnosed just by looking at it. If a mole or pigmented area of the skin changes or looks abnormal, your doctor may biopsy the mark, taking a tissue sample for a pathologist to examine. Suspicious areas should not simply be shaved off or cauterized (destroyed with a hot instrument, an electrical current or a caustic substance). A biopsy should be performed first to determine if the area is malignant.
Your doctor may use one of these melanoma biopsy methods:
Local excision/excisional biopsy: The entire suspicious area is removed with a scalpel under local anesthetic. Depending on the size and location of the suspicious area, this type of biopsy may be done in a doctor's office or as an outpatient procedure at a hospital. Your doctor will put in stitches to close the excision and cover the area with a bandage.
Punch biopsy: The doctor uses a tool to punch through the suspicious area and remove a round cylinder of tissue.
Shave biopsy: The doctor shaves off a piece of the growth.
The sample of skin is sent to a pathologist, who looks at it under a microscope to check for cancer cells. Your tissue may be judged normal or abnormal. Abnormal results may include:
- Benign (non-cancerous) growths such as moles, warts and benign skin tumors
- Squamous cell carcinoma (cancer)
- Basal cell carcinoma
- Melanoma
Because melanoma can be hard to diagnose, you should consider having your biopsy checked by a second pathologist.
Melanoma Side Effects
As with any time the skin is cut, there is a small risk of infection after a biopsy. You should call your doctor if you have a fever, an increase in pain, reddening or swelling at the infection site, or continued bleeding.
If your skin usually scars when injured, the biopsy may leave a scar. For this reason, a biopsy on the face might be better performed by a surgeon or dermatologist who specializes in methods that reduce scarring.
Before you have a skin biopsy, you should tell your doctor what medications you are taking, including anti-inflammatory medication, which may make your biopsy look different to the pathologist, or blood thinners like Coumadin or aspirin, which could cause bleeding problems.
Other Tests
After melanoma has been diagnosed, tests may be recommended to find out if cancer cells have spread within the skin or to other parts of the body. These may include:
Imaging tests, such as:
- Chest X-ray
- Lymphoscintigraphy
- Ultrasound
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
Visit the Prevention section of our website to find out steps you can take to avoid melanoma skin cancer.
Melanoma Staging
If you are diagnosed with melanoma skin cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis).
Melanoma staging is based on:
- Location(s) of the melanoma
- Primary melanoma tumor thickness as well as other microscopic features
- If it has spread to nearby lymph nodes – if so, how many and what size
- If it has spread (metastasized) to other parts of the body
- A blood test called lactate dehydrogenase (LDH) for stage 4 melanoma
Stages 1 and 2 are based mainly on the thickness of the primary melanoma and other microscopic features. Stages 3 and 4 are based on how far the melanoma has spread from the skin; stage 3 melanoma signifies regional spread and stage 4 melanoma is based on distant spread.
Stages of Melanoma
Source: National Cancer Institute
Stage 0 melanoma (melanoma in situ)
In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
Stage I melanoma
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Stage IA: The tumor is not more than 1 millimeter thick, with or without ulceration.
Stage IB: The tumor is more than 1 but not more than 2 millimeters thick, without ulceration.
Stage II melanoma
Stage II is divided into stages IIA, IIB, and IIC.
Stage IIA: The tumor is either:
- more than 1 but not more than 2 millimeters thick, with ulceration; or
- more than 2 but not more than 4 millimeters thick, without ulceration.
Stage IIB: The tumor is either:
- more than 2 but not more than 4 millimeters thick, with ulceration; or
- more than 4 millimeters thick, without ulceration.
Stage IIC: The tumor is more than 4 millimeters thick, with ulceration.
Stage III melanoma
Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.
Stage IIIA: The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration. Cancer is found in 1 to 3 lymph nodes by sentinel lymph node biopsy.
Stage IIIB:
- (1) It is not known where the cancer began or the primary tumor can no longer be seen, and one of the following is true:
- cancer is found in 1 lymph node by physical exam or imaging tests; or
- there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
or
- (2) The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration, and one of the following is true:
- cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or
- there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
or
- (3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true:
- cancer is found in 1 to 3 lymph nodes; or
- there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
Stage IIIC:
- (1) It is not known where the cancer began, or the primary tumor can no longer be seen. Cancer is found:
- in 2 or 3 lymph nodes; or
- in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
- in 4 or more lymph nodes, or in any lymph nodes that are matted together; or
- in 2 or more lymph nodes and/or in any lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
or
- (2) The tumor is not more than 2 millimeters thick, with or without ulceration, or not more than 4 millimeters thick, without ulceration. Cancer is found:
- in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
- in 4 or more lymph nodes, or in any lymph nodes that are matted together; or
- in 2 or more lymph nodes and/or in any lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
or
(3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
or
(4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
Stage IIID: The tumor is more than 4 millimeters thick, with ulceration. Cancer is found:
- in 4 or more lymph nodes, or in any lymph nodes that are matted together; or
- in 2 or more lymph nodes and/or in any lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
Stage IV melanoma
In stage IV, the cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), digestive tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.
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