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How Stage I is Diagnosed

Step 1: Physical Examination

The patient should get a physical examination of the entire skin area and lymph node area 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 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). The pathologist will do the following:

 

  • Determine whether the lesion is benign or malignant

  • Measure the thickness of the lesion (Breslow Depth)

  • Estimate how rapidly the cells in the specimen are dividing using a measure known as the mitotic count (rate)

  • Check whether the lesion is 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

 

For more information on skin biopsies click here.

Step 3: Tests to Make Certain

If the results of the pathology show a very superficial melanoma the doctor may not need to order additional tests, as the possibility that the melanoma has spread beyond the original site is very, very low. If the biopsy report suggests that the primary melanoma is deep enough that it might have spread, the doctor will order other tests that may include the following:

 

  • Sentinel lymph node biopsy. This is a surgical procedure and is used to determine if cancer cells have spread to the lymph nodes in the area of the melanoma. See Sentinel Lymph Node Biopsy.

  • 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 4: 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 performed on melanomas that have a high probability of having spread to other parts of the body.

 

  • 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 staging of melanoma click here.

 

For more on the diagnosis of melanoma click here.



FAST FACTS

The following factors determine the stage of melanoma:

  • Tumor thickness

  • 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)

  • Level of LDH (serum lactate dehydrogenase)