Step 1: Physical Examination

The patient should get a physical examination of the entire skin, the lymph node areas, and organs.

For more information on the Doctor's Examination click here

Step 2: Skin Biopsy

A skin biopsy is done. In a skin biopsy, a portion of the lesion, or the whole lesion is removed - along with an area of surrounding normal skin. If the whole lesion, is not removed, then the thickest part of the lesion is removed, including the full depth of the lesion. This is usually done in the doctor's office.

 The tissue sample from the biopsy is sent to a pathologist (a doctor specially trained in the microscopic examination and diagnosis of tumor and lymph node tissue samples) who will examine the specimen. He/she will do the following:

• Determine whether the lesion is benign or malignant. 
• Measure the thickness of the lesion (Breslow Depth).
• Check whether the lesion has ulcerated. In ulceration the epidermis (the outer layer of the skin) that covers a portion of the lesion is not intact.
• Look for cancer at the edges of the biopsy.

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Step 3: Lymph Node Biopsy

During the physical examination, if the lymph nodes nearest the melanoma site are found to be abnormally hard or large a needle biopsy (Fine Needle Aspiration) is performed with local anesthetic. A slender needle is placed through the skin and into the suspicious lymph node. A small tissue sample is removed when the needle is withdrawn.

If the node is found to contain melanoma all of the lymph nodes should be removed. This procedure is called a Therapeutic Lymph Node Dissection (TLND). A sentinel lymph node biopsy is not recommended

Under all other circumstances a sentinel lymph node biopsy (SLNB), will be done. This is a surgical procedure and is used to determine if cancer cells have spread to the lymph nodes nearest the area of the melanoma. Once it has been determined that the melanoma has spread to the lymph nodes all of the remaining lymph nodes should be removed. This procedure is called a therapeutic lymph node dissection (TLND)

For more information on Sentinel Lymph Node Biopsy click here

For more information on TLND see Stage III Treatment click here

Step 4: Tests to Make Certain

The doctor may order other various tests to confirm a diagnosis of melanoma and/or determine if or where the disease has spread:

• X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.

• Blood tests. Blood levels of LDH may be tested to help determine if the cancer has spread. 

Step 5: Additional Tests

Sometimes the following special scanning tests (similar to x-rays in that they provide special images of the inside of the body and require no surgery) may also be performed. These are usually not done if the melanoma has been detected in the nodes by a SLNB.

• Ultrasound. An ultrasound uses sound waves to create pictures of the internal parts of the body, including collections of lymph nodes (called basins) and soft tissue.

• Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed view that shows any abnormalities or tumors.

• Magnetic resonance imaging (MRI). An MRI is done with a special scanning machine that uses magnetic fields, not x-rays, to produce detailed images of the body.

• Positron emission tomography (PET) scan. In a PET scan, a special fluid made of sugar is injected into the body, which can be seen by a special scanner. Cancer cells usually absorb sugar more quickly than normal cells, so they may light up on the PET scan. PET scans are often used in addition to a CT scan, MRI, and physical examination.

For more on the Diagnosis of  Melanoma click here

For more on the Staging of Melanoma click here