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How Stage 0 is Diagnosed

Step 1: Physical Examination

The patient should get a physical examination of the entire skin area and the lymph node areas near the suspected melanoma. 

 

For more information on the Doctor's Examination click here

Step 2: Biopsy 

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 isn't 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 samples. The pathologist will do the following:

 

  • Determine whether the lesion is benign or malignant

  • Measure the thickness of the lesion (using the Breslow Depth)

  • Note how deeply it grows into the underlying normal tissue (Clark Level)

  • Check whether  the lesion is ulcerated. In ulceration, the epidermis (outer layer of the skin) that covers a portion of the lesion is not intact
  • Check the mitotic count to see how many cells are actively dividing
  • Look for cancer at the edges of the biopsy

 

For more information on Skin Biopsies click here

Step 3: Tests to Make Certain

Usually for Stage 0 disease, additional screening testing is not performed. Some doctors will screen with a chest x-ray and a blood test, but, because the chances of finding distant disease is very low, more invasive tests that have some degree of risk are not felt to be worth doing.

 

  • 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 may be tested to help determine if the cancer has spread.


For more on the Diagnosis of Melanoma click here

 

For more on the Staging of Melanoma click here

 




FAST FACTS

The following factors determine the stage of melanoma:

  • Tumor thickness:

    • Breslow Depth

  • Whether the tumor is with or without ulceration

  • Mitotic Count (Rate)

  • Whether the metastasis is microscopic (tiny tumors not visible to naked eye) or macroscopic (tumors large enough to be visible or  that can be felt)

  • Site of distant metastasis: skin vs other areas

  • Level of LDH (serum lactate dehydrogenase)