How Is Melanoma Diagnosed?

See a physician right away upon noticing any abnormal skin changes. A physician will perform a series of exams and tests to determine whether or not the problem is the result of cancer and refer the patient to a dermatologist (a physician who specializes in the diagnosis and treatment of skin conditions) if he or she is concerned.

A diagnostic work-up may include one or more of the following:

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There are four common types of skin biopsies:

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Melanoma typically spreads first to the lymph nodes in the region of the melanoma and then to distant organs, such as the liver, lungs, and brain. If the melanoma appears to have spread, a physician may perform one or more of the following types of biopsies to determine how far it has spread.

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Imaging tests: Depending on the extent of the patient’s disease, a physician may perform one or more of the following imaging tests

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Staging is the process of determining how widespread or advanced the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients and provide them with a prognosis.

The stage of melanoma is based on several factors, including how deeply it has penetrated the skin, whether it has ulcerated (broken open), and whether the cancer cells have spread to nearby lymph nodes or other organs.

To determine the stage of the disease, physicians need to remove the entire melanoma. The regional lymph nodes are assessed by a clinical exam, and a sentinel lymph node biopsy is advised for melanomas that have certain microscopic characteristics that take into account their depth, whether they are ulcerated or not, and how rapidly they are proliferating. A fine needle aspiration biopsy may be performed instead if the regional lymph nodes are enlarged on the clinical exam. The physician may also perform a series of blood and imaging tests based on the results of these tests.

The clinical stage of melanoma is based on the findings of the physical exam, skin biopsy, lymph node biopsy, and any imaging or blood tests that are performed.

Stages of Melanoma

Stage 0: Cancer is present in the top layer of skin (epidermis only). This stage is also referred to as melanoma in situ.

Stage I - II: The melanoma is localized to the skin with no evidence of spread to the lymph nodes or other organs. Stage II melanomas have more adverse features compared to Stage I melanomas.

Stage III: The melanoma has spread to the regional lymph nodes.

Stage IV: The melanoma has spread to distant organs, such as the lungs, liver, or brain.

For more detailed information on stages of melanoma, visit the staging section of the American Cancer Society’s melanoma website.