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Types of Cancer > Melanoma > Symptoms, Diagnosis, and Staging
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| How Melanoma is Diagnosed |
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When skin shows the signs of developing melanoma, the first step towards diagnosing the condition is scheduling an appointment with a physician. At this appointment, the doctor will gather information about the patient's medical history and family history, and he or she will ask questions pertaining to the area of the skin in question, such as how long the symptoms have been present and what changes, if any, have occurred. The doctor will study the affected area and may also examine certain lymph nodes to see if any hardening or enlargement can be noted. If, after the initial exam, melanoma is suspected, further diagnostic tests will be ordered.
The most common type of test ordered to diagnose melanoma is a biopsy. When a biopsy is performed, a sample of the affected skin is taken and is studied under a microscope by a doctor who specializes in studying cancerous skin cells. There are a number of different types of biopsies that can be performed, and which biopsy is performed on a patient will depend on that individual's specific situation.
When dealing with melanomas, the most common type of biopsies performed are the incisional and excisional biopsies. With these types of biopsy procedures, a local anesthetic is generally used. The doctor then takes a surgical scalpel, removes a portion of the skin from the affected area and then sews the edges of the wound back together. The skin sample is then studied under the microscope. If an incisional biopsy is being performed, only a portion of the tumor will be removed for study. If an excisional biopsy is performed, the entire tumor will be removed. Shave biopsies and punch biopsies are other types of biopsies that can be performed to diagnose certain types of skin cancer, but they are not usually recommended when diagnosing cases where melanoma is suspected.
It is possible for melanoma cancer to spread quickly to other parts of the body, even when the melanoma tumor is still relatively small. Because of this, other parts of the body may need to be tested for cancer and if cancer is found, it needs to be tested to determine whether or not it is actually melanoma cancer since each type of cancer needs to be treated differently.
If a doctor suspects that the melanoma has spread to the lymph nodes, he or she may recommend a fine needle aspiration biopsy or a surgical lymph node biopsy. When a fine needle aspiration biopsy is performed, a very thin needle is inserted into the lymph node and a sample of the tissue is removed with a syringe. If a fine needle aspiration biopsy does not indicate melanoma but the doctor still suspects that melanoma may be present, a surgical lymph node biopsy can be performed. When a surgical lymph node biopsy is performed, the doctor surgically removes the entire lymph node to study it.
In advance cases of melanoma, a doctor will sometimes use sentinel lymph node mapping to trace the lymph nodes that have most likely been affected by the melanoma. This is done by injecting radioactive material directly into the melanoma tumor. After this has been done, the doctor will inject the melanoma with a blue die and a radio active chemical. By using a Geiger counter, the doctor can estimate exactly which lymph nodes the melanoma has most likely affected. The lymph node that becomes blue or radioactive is then removed and is studied for signs of melanoma. If melanoma is found, the remaining lymph nodes in that area will be removed. If no melanoma is found, then further lymph node removal will not be necessary.
Another useful tool that doctors use in diagnosing melanoma cancer is positron emission tomography. This is used when a doctor has reason to believe that melanoma has spread to other parts of the body, but is not yet sure which part of the body it has spread to. When using this procedure, a doctor will administer a glucose substance that contains a radioactive atom. Because cancer cells have such high metabolism rates, the cells will absorb large amounts of this substance quickly. A special camera is then used to detect the radiation and can locate where the cancer has spread to.
Exactly which diagnostic tests are used for any given patient will depend on that patient's specific case. Factors that will influence a doctor's decision of which diagnostic measures are appropriate will include how large the tumor in question is, whether or not the lymph nodes show signs of cancer, and what other signs and symptoms are affecting the patient in question.
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| Author: | Robert Dale, Certified Medical Writer |
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| Reviewer: | Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology) |
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| Publish Date: November 6, 2004 |
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