How Stage III is Diagnosed

Step 1: Physical Examination

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

Learn more about the doctor's examination

Step 2: Skin Biopsy

First 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.
Learn about the skin biopsy

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 A small tissue sample is removed when the needle is withdrawn.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 fissection (TLND). A sentinel lymph node biopsy is not recommended.

If the lymph nodes are not abnormally large or hard there are  circumstances where the doctor will recommend that a sentinel lymph node biopsy (SLNB), be done. These include the melanoma being equal or greater than 1mm thick, any ulcerated tumor, and a high mitotic rate.

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 complete lymph node dissection (CLND).

Learn more about Sentinel Lymph Node Biopsy
Learn more about the TLND and other Stage III treatments

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

Often 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) are performed.

  • 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.
Learn more about the staging of melanoma
Learn about the diagnosis of melanoma

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