Doctors often get asked how melanoma is diagnosed. Before a biopsy or a physical exam, they will typically ask about your symptoms. They might ask you when your mole or growth first appeared, if it is bleeding, oozing, crusting or painful, or if it has evolved or changed over time.
Then they will usually examine your mole and check your body for any other suspicious moles or growths. They may also feel your lymph nodes in your neck, underarms, or groin to see if they are enlarged as this is the next place melanoma spreads.
Dermoscopy to detect melanoma
If your doctor suspects skin cancer, next they may use a dermascope to examine the spot more closely. A dermascope is basically a special magnifying lens that gives doctors a clearer picture of the skin. The doctor will have a clear view on the mole.
View here images of melanoma
Biopsies to diagnose melanoma
If the presence of melanoma or skin cancer is still suspected, then a doctor will usually perform a biopsy. A biopsy is when part or all of the suspicious spot or growth is removed and analyzed under a microscope to determine if the cells are malignant or benign. There are a few different types of biopsies that can be performed:
Shave or tangential biopsy
This is used when the risk of skin cancer is determined to be low and only the top of the spot or mole is shaved off.
A punch biopsy is used to get a deeper sample of skin. A round device cuts around the spot or mole to remove all layers of the skin and the wound is then typically stitched back up.
An incisional biopsy removes only a portion of the spot or mole for analysis. This is done when, for certain reasons, the whole tumor cannot be removed.
An excisional biopsy is when the entire spot or mole is removed with a surgical knife along with the border of skin around it. This is usually the preferred method when melanoma is suspected so as to remove all of the cancer cells.
Sometimes biopsies of other areas, such as the nearby lymph nodes, are needed to determine if the melanoma has spread to other areas of the body. These types of biopsies may be done with the Fine Needle Aspiration method where a syringe is used to extract small pieces of the tumor or lymph node for examination.
Biopsies of internal organs are also sometimes needed if the cancer has already spread further, although sometimes these tumors can be discovered with CT or other imaging scans. Internal biopsies are much more complicated than simple skin biopsies and differ depending on the location.
Once melanoma is found, doctors will determine the stage and severity. To do this, they will typically first look at:
The thickness of a tumor will tell doctors how serious it is. Doctors will measure the tumor under a microscope using a tool called a micrometer. In most cases, the thicker the tumor, the worse the cancer.
How far has melanoma spread
Next, doctors will usually check to see if and how far the cancer has spread. They will often do a sentinel node biopsy to check if it has spread to the lymph nodes. Other tests may be done to see if the cancer has spread to the internal organs.
Determining a stage
There are four stages of melanoma which increase in severity.
In the first two stages, melanoma is only present in the skin and hasn’t spread to other areas of the body. These stages are the easiest to treat as the early melanoma is usually simply cut out and monitored for recurrence.
Once it hits stage three, the cancer cells have spread or metastasized to the lymph nodes, and by stage four they have spread to distant locations in the body, usually the organs, or distant lymph nodes and soft tissue.
Once it is in stage four, melanoma is much more difficult to treat and cure. Treatments for metastasized melanoma can include radiation therapy and chemotherapy. Based on the type and stage of the cancer, treatment options vary widely and should be discussed thoroughly with a doctor.
There are several other factors that your doctor may look at to determine the stage and severity of the melanoma, such as the state of the skin lesion (i.e. Is it bleeding? Is it an open sore?) or the amount of dividing cancer cells discovered during the biopsy.