The Doctor’s Examination
Here is what to expect when you schedule a visit to your doctor after detecting skin changes:
Complete Medical History
The doctor will first take a complete medical history to learn about your symptoms and risk factors. You will be asked your age, when you first discovered the area of concern on your skin, and if any features of that area have changed since your discovery. The doctor will ask about past exposures to known causes of skin cancer, such as sun exposure. You will also be asked whether you or your family have a history of atypical moles or skin cancer, particularly melanoma.
Complete Skin Examination
You will be asked to undress completely and be given a gown. The suspicious mole or lesion will be evaluated with the naked eye for size, shape, color, texture, and any evidence of bleeding, oozing, or scaling. The doctor will then perform a thorough and systematic examination of the rest of your body to check for other spots or moles that may be related to your skin cancer. This will include scalp, nails, palms, soles, ears, and areas not exposed to the sun, including beneath the breasts or under any rolls of flesh.
Lymph Node Evaluation
The doctor will palpate (feel) the lymph nodes nearest the suspicious lesion, (in the groin, or underarm, or neck). If the nodes are enlarged or unusually firm, additional tests may be recommended to evaluate whether cancer has spread to the regional lymph nodes.
A doctor who suspects that a skin spot is melanoma will perform a biopsy. In this procedure (usually performed with a local anesthetic to numb the area), the doctor removes the suspect lesion using techniques that preserve the entire lesion so that the thickness of the potential cancer and its margins (healthy tissue around the lesion that is removed to make sure no cancer cells remain) can be carefully examined.Read More About a Skin Biopsy
Any skin samples taken by a biopsy or an excision are sent for microscopic examination, and a pathology report is issued by the pathologist (a doctor who specializes in interpreting and evaluating cells, tissues, and organs to diagnose disease). The pathology report describes many aspects of the melanoma, including the size, the thickness of the lesion, the mitotic rate, and the presence or absence of ulceration, lymphatic response, regression, satellite lesions, and blood/nerve invasion.Read More About Pathology
Other Tests for Melanoma
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. The doctor may order various tests to determine if or where the melanoma has spread.
Your doctor may consider these factors when choosing a diagnostic test:
- Your age and medical condition
- The type of cancer
- Severity of symptoms
- Previous test results
Some standard diagnostic tests:
- Blood tests: No special blood tests are needed for localized melanoma and there are no reliable ones that can indicate specifically whether or not a melanoma has spread. Testing for elevated levels of LDH (serum lacate dehydrogenase), an enzyme found in the blood, may indicate the presence of metastatic disease.
- Chest x-ray: It is taken to make sure melanoma has not spread to the lungs, the lymph nodes in the mediastinum (space in the chest between the lungs), or the bones of the rib cage.
- 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.
- CT scan: A CT scan of the chest, head, abdomen, or pelvis, may be recommended if it is suspected that the melanoma has spread. A rotating x-ray beam takes a series of pictures of the body from many angles. A computer combines the information from all the pictures and makes a detailed, cross-sectional image of the body. Except for possible minor discomfort from the injection of intravenous dye to highlight certain tissues in the body that may otherwise be hard to see, this is a painless procedure.
- MRI (magnetic resonance imaging): Like the CT scan, MRI is only used when it is suspected that the melanoma has spread. It may be recommended in place of a CT scan. The only difference is that the cross-sectional images of the body are created by magnetic fields instead of x-rays. MRI is particularly useful for looking at the brain, spinal cord, and examining specific areas in the bone. It may also be used if the results from other imaging tests are unclear or there is a concern about exposure to radiation.
- PET scan (positron emission tomography): For a PET scan, radioactive glucose (a form of sugar) is injected into the body. Cancer cells usually absorb glucose more quickly than normal cells, so they may light up on the PET scan. However, since a number of normal body activities also use large amounts of glucose, false-positive results are fairly common and their results should be verified by other tests. Newer devices combine PET and CT scans.