How can doctors tell if I have melanoma? To find out if you have melanoma, your doctor may refer you to a dermatologist (skin doctor) to check your skin thoroughly.
What stage is my melanoma? If you are diagnosed with melanoma, your doctor will do a process called staging . Staging is a way doctors describe the cancer and where it is in your body. It also helps doctors figure out the best way to treat the cancer. Your doctor may need to do more tests when they are staging your melanoma. Staging can be very complex and confusing. Ask questions about anything you don’t understand! Checking your lymph nodes Your doctor may want to check if the cancer has spread to nearby lymph nodes. They may offer a sentinel lymph node biopsy if the melanoma is thicker than 0.8 mm and/or ulcerated. This is a biopsy of the lymph node that the cancer is most likely to spread to first. Having this small surgery will help you and your doctor know more about your cancer, its stage, and what treatment might be right. The TNM system Doctors use a staging system called TNM , where they consider 3 factors to stage cancer:
An exam: Your doctor will ask you questions about the mole or concerning area of skin, such as, “How long have you had it?” and “What changes have you noticed?” Your doctor will look closely at the concerning area and check the rest of your skin for any changes. How is melanoma diagnosed?
A biopsy: If your doctor finds a suspicious area, they will take a sample of your skin so it can be looked at under a microscope. There are 3 types of skin biopsies:
In a shave biopsy , your doctor will remove a sample from the top layer of your skin with a small surgical blade. They do this if the mole or area appears to be only on the top layer of your skin. In a punch biopsy , your doctor will press a special tool with a round blade into your skin to remove the entire spot. They do this if the mole or area appears to be in deeper layers of skin.
If you have a mole or area of skin you are concerned about, see a dermatologist.
T Tumor thickness , which means how deep the cancer has grown into the skin in millimeters, also known as the Clark level . This may also include if the tumor is ulcerated (broken skin), which means if there are cells in the center of the tumor that are dying and peeling away. This can be a sign that the tumor is growing quickly. N Nearby lymph nodes , which means if the cancer has spread nearby through small tubes or lymph nodes. M Metastasis , which means if the cancer has spread to distant parts of the body such as another organ or lymph nodes far from the primary tumor location.
The Clark level measures how deeply the melanoma has grown into your skin. It uses roman numerals, just like staging does, but these are different. It is important not to mistake the Clark level number for the stage of melanoma.
In an excision biopsy , your doctor will use a surgical blade to remove an oval-shaped piece of skin. This removes the whole concerning area as well as a border of normal skin, called a margin. They do this if they think the mole or area is suspicious for melanoma.
Sending the sample to a lab: The biopsy sample is then sent to a lab where a trained doctor (a pathologist or dermatopathologist ) will look at it under a microscope to see if it is melanoma.
4 | Melanoma Patient Guide Stages 0-1
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