Diagnosis and Staging of Melanoma

For those at risk for melanoma, The American Cancer Society (ACS) recommends having a skin exam as part of your routine checkups with your doctor. These screening exams involve a head-to-toe inspection of your skin by a dermatologist or some other health care professional.

For those at high risk factors like

- fair skin

- history of severe sunburns

- one or more dysplastic moles

- family history of melanoma

Frequent screening is high recommended in the above individuals.

Self examination includes:

- monthly self-exams

- observe your moles and freckles and report any changes

- use a full length mirror

- Check the fronts, backs and sides of your arms and legs. In addition, check your groin, scalp and fingernails, and your soles and the spaces between your toes.

Diagnosing melanoma

The best way to make a diagnosis of a melanoma is by a biopsy. This is easily done by a dermatologist and involves removing a small part (incisional biopsy) or the entire lesion (excisional biopsy). The sample is then analyzed by a pathologist.

An incisional biopsy is generally used for large moles (larger than 10 millimeters), or for those in places where scars would be more obvious. With an incisional biopsy, only the most irregular part of a mole or growth is taken for laboratory analysis. Incisional biopsies don't cause melanoma to spread.


Once the diagnosis of a melanoma has been made, the next step is to determine if it has spread either locally or systemically and this is termed staging

Melanoma is staged using these criteria:

Thickness and depth. The thickness and depth of the lesion is assessed by the pathologist using a microscope. The depth of penetration of the melanoma is more important than the superficial spread on top of the skin

Spread. To determine if the tumor has spread, you may undergo a PET scan, or CT scan. You may also undergo what is known as a sentinel lymph node biopsy

The nodes in the area of the melanoma are evaluated to determine if there is any spread - the first nodes to receive the drainage from malignant tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed.

Melanoma is staged using the numbers 0 through IV:

Stage 0. When the melanoma is in the very initial stages of growth it is known as in situ. The cancer is usually confined to the skin and cure is maximal when the lesion is excised. Finding and treating a cancerous tumor at this stage offers the best chance for a full recovery.

Stages I through IV. When the melanoma has spread, it is staged from 1-4

A stage I cancer is small, localized to the skin and has a very success rate after treatment. But the higher the stage number, the lower the chances of a full recovery. By stage IV, the cancer has spread beyond your skin to other organs, such as your lungs, liver and bone.

Although it may not be possible to eliminate the cancer at this stage, treatment with radiation or biological or experimental therapies may help alleviate signs and symptoms.

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