Skin Cancer

Diagnosis and Staging of Melanoma

How is melanoma diagnosed?
Physical examination and biopsy are used to determine if a suspicious area on the skin is melanoma. In addition to a complete medical history, including family history, questions are asked about the mark on the skin, such as when it was first noticed, as well as if and how it has changed in size or appearance.

The lesion of concern, as well as the moles and skin on the rest of your body are examined. The size, shape, color, texture, and presence of bleeding or scaling are usually noted. A skin sample (biopsy) will be examined under the microscope if the lesion is clinically suspicious for melanoma. The biopsy procedure chosen depends on the site and size of the affected area.

Types of biopsies
The different types of biopsies include the following:

skin biopsy
Skin biopsies involve removing a sample of skin for examination under the microscope to determine if melanoma is present. The biopsy is performed under local anesthesia. The patient usually just feels a small needle stick and slight burning for about one minute from the local anesthetic, with a little pressure, but no pain when the biopsy procedure is performed.

excisional or incisional biopsy
An excisional biopsy is often used when a wider or deeper portion of the skin is needed. Using a scalpel (surgical knife), or punch biopsy tool, a full thickness of skin is removed for further examination, and the wound is sutured (with surgical thread). A deep shave biopsy may also be used for this purpose.

When the entire tumor is removed, the procedure is called an excisional biopsy. If only a portion of the tumor is removed, the procedure is referred to as an incisional biopsy. When possible, excisional biopsy is the preferred method when melanoma is suspected.

What is staging?
When melanoma is found, more tests may be done to find out if the cancer cells have spread to other parts of the body. This is called staging, and is often necessary before treatment for the cancer can begin.