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Melanoma

How Is Melanoma Diagnosed?

Last modified: 
29/06/2012 - 14:54

Contributing Author: Guy Slowik FRCS

Doctors often spot melanoma during a skin inspection. The doctor should look for growths by doing a complete examination of the entire skin surface during each yearly physical examination.

Many people detect melanoma themselves while doing regular skin self-examination. Early diagnosis is important-skin cancer would be almost 100 percent curable if all skin cancers were found and treated early.

Need To Know:

Regular skin self-examinations and examinations by the doctor are especially important for people who have a higher-than-normal risk for melanoma.

biopsy is the only certain way of diagnosing melanoma. In a biopsy, the doctor removes an area of the suspicious growth. Biopsies usually are done after the skin is numbed with a local anesthetic so there is almost no pain. Once the tissue sample is removed, a specialist examines it for cancer cells under a microscope.

The type of biopsy depends on the size of the skin growth and its location on the body. Several types of biopsy can be done when the doctor suspects melanoma:

  • An excisional biopsy excises, or cuts away, the entire growth with a margin of normal surrounding skin. The skin may be stitched together to close the hole. This procedure is more time-consuming and therefore usually needs to be scheduled. Generally, an additional wide local excision of normal surrounding skin will be required if the biopsy is positive. The width of the margin will depend on the thickness of the cancer.
  • An incisional biopsy, or core biopsy, removes only a sample of the growth, and the resulting hole is closed with stitches. Further treatment is necessary if the microscopic examination reveals cancer cells.
  • punch biopsy removes a small, cylindrical shaped sample of skin. It includes the epidermisdermis, and parts of the underlying tissue. It is done with a surgical tool that looks like a round hollow tube with sharp edges.
  • saucerization biopsy removes the entire lesion by cutting under the lesion in a "scoop like" manner. This leaves a large, deep depression in the skin, but can be performed immediately and provides the dermatopathologist with a complete specimen to better analyze the tumors architecture.
  • fine-needle aspiration biopsy is done with a very thin needle and syringe that looks like a hypodermic syringe used for giving injections. It removes a very small sample of tissue. This type of biopsy is not done on a suspicious mole or skin growth. Rather, it is done on other deeper tissue, such as nearby lymph nodes or an internal organ, to see if melanoma has spread.

Melanoma can spread quickly and produce large malignant tumors in the brain, lung, liver, or other organs. Sometimes melanoma that has spread to another organ is confused with primary cancer of that organ. Primary cancer is cancer that started in that organ.

Treatment of a primary lung or liver cancer is very different from treatment of melanoma that has spread to the liver or lung. That's why it is important to find out if cancer in an organ is primary cancer or a malignant melanoma that has spread there.

How-To Information:

How To Get A Second Opinion

Some people diagnosed with melanoma want to get a second opinion from a physician outside their treatment team. They ask a specialist in treating melanoma to review their diagnosis and treatment plan and offer suggestions.

Doctors do not feel insulted or angry when patients ask for a second opinion from an outside specialist. Most are eager to cooperate. Indeed, some health insurance companies require a second opinion and many will reimburse the cost of getting one.

There are many ways of finding a doctor to give a second opinion:

  • The dermatologist other doctor on the treatment team can refer the patient to a specialist.
  • A major hospital, nearby medical school, or local medical society can provide names of specialists who treat melanoma.
  • The National Cancer Institute's Cancer Information Service (1-800-4-CANCER) can offer suggestions.

Getting a second opinion may delay the start of treatment for a short period, perhaps a week or two. It is unlikely that such a delay will affect the chances of being cured.

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Melanoma

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.