How Stage IV is Diagnosed

Step 1: Physical Examination

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

Step 2: Tests to Make Certain

The doctor may order various other 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 3: Additional Tests

Often 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.