How Stage II 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.

Learn more about the doctor's examination

Step 2: Biopsies

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.

Once Stage II is determined, then a sentinel lymph node biopsy (SLNB), which is recommended for all patients with Stage II melanoma should 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.

The tissue samples from the biopsies are 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. The pathologist will do the following:

  • Determine whether the lesion is benign or malignant
  • Measure the thickness of the lesion (Breslow Depth)
  • 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
  • Look for cancer at the edges of the biopsy
  • Determine if cancer cells have spread to the lymph nodes nearest the area of the melanoma
Learn about the skin biopsy
Learn more about the Sentinel Lymph Node Biopsy

Step 3: 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 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.

  • 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 three-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, that can be seen in 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 about the staging of melanoma
Learn more about the diagnosis of melanoma

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