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Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Diagnosis

Because most melanomas arise on areas of skin that can be easily examined, the opportunity exists for early detection and successful treatment. Most trained clinicians can accurately diagnose melanoma in 80% to 90% of cases.

The clinical presentation (how the growth looks) and the patient's history of a new or changing growth raises suspicions of melanoma. In these cases a biopsy, or skin sample, is obtained for evaluation by a dermatopathologist (i.e., an expert at examining and diagnosing diseases of the skin).

Regular self-examinations, as well as periodic, thorough examinations by a dermatologist, may aid in early diagnosis. Many experts recommend a monthly self-exam, especially in high-risk patients (e.g., those who have a history of skin cancer).

• After or during a bath or shower, the skin should be examined in a bright room with a full-length mirror. A hand-held mirror may be used to help see the skin on the front, back, and sides of the body (including the underarms, backs of the legs and feet, skin between the buttocks, the genital area, soles of the feet, spaces between the toes, and the scalp). A blow dryer can be used to move the hair away so that the scalp can be seen.

• The location, size, shape, number, and color of all familiar moles, birthmarks, scars, and blemishes should be noted.

• Any new or unusual changes, such as a sore that does not heal or a mole that has grown or changed color, warrants concern and should be reported to a physician as soon as possible.

Epiluminescence microscopy (ELM) is a diagnostic test that can be used to help make a diagnosis. In this test, the doctor uses a hand-held device called a dermatoscope to examine the lesion. Certain diagnostic criteria are used to help determine if the lesion is benign or malignant.

In some cases, nearby lymph nodes are tested to determine if cancer cells have spread. In this procedure, called sentinel lymph node biopsy, dye is injected at the tumor site and eventually travels to the nearest lymph node and stains it. The lymph node is removed and examined under a microscope for melanoma cells to help determine the stage of the disease.

Sentinel lymph node biopsy is still somewhat experimental. Some maintain that it helps to remove tumor cells before they have a chance to spread to more distant sites, and others claim that migrating tumor cells can bypass these lymph nodes and that the procedure is unnecessary. Lymph nodes also may increase the ability of the immune system to fight the cancer and removing them might reduce this ability.

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