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Melanoma: Diagnostics & staging

Diagnostics

A complete medical history with special attention paid to family history of melanoma among immediate family member such as father, mother, brother or sister, and a physical exam helps the physician determine the level of risk that your signs or symptoms are melanoma.

The only definitive way to diagnose melanoma is a biopsy of the abnormal area of the skin that can be analyzed in the lab. For small moles, a punch biopsy is used where the entire mole is removed along with a small border of normal skin. For larger moles an incisional biopsy is performed where only a part of the abnormal mole is removed and sent to the lab for analysis.

Staging

If melanoma is detected, the next step is to stage the disease. This means the melanoma is classified according it its severity. The stage refers to the thickness, depth of penetration, and the degree to which the melanoma has spread. Thickness of the lesion is critical to determining its severity. The thicker the lesion, the greater the severity of melanoma.

Staging provides a common language with which doctors can communicate about a patient's case. Knowing the stage is important in determining treatment options and in identifying clinical trials that may be suitable for a particular patient.

Staging system

The American Joint Committee on Caner developed the TNM system, widely accepted as the standard for cancer staging. The TNM Staging System is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis, or spreading to other areas of the body (M). Once the T, N, and M are determined, they are combined, and an overall "Stage" of I, II, III, IV is assigned.

Stage I and II melanomas are localized and offer the best chance to be cured. Stage III and IV melanomas are more advanced and have spread to other parts of the body.

Determining staging

Several tests can be performed to determine the staging the melanoma:

Fine needle biopsy that uses a thin, hollow needle to remove a small tissue sample from an organ or tumor. [ Learn more ]
Sentinel lymph node biopsy. It is important to determine if the melanoma has spread to the lymph nodes. To do this, surgeons biopsy only the sentinel nodes, those nodes that are first to receive the drainage from the malignant mole. If the sentinel node is cancer-free, chances that other lymph nodes were affected are very small so other nodes do not need to be removed unnecessarily. [ Learn more ]
Imaging may be used to check other areas of the body if it is believed the melanoma may have spread to other areas. This could include CT scan, MRI or PET scans.

Learn more about melanoma or request a consultation