Melanoma tests

In this section you can find out about the different tests you may need to take to see if you have melanoma.

Waiting for the test results can be a stressful time. It may help to talk to a friend, family member or health professional, or to call Cancer Council 13 11 20.

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Listen to our podcasts on Tests and Cancer and Making Treatment Decisions


Physical examination

If you notice any changes to your skin, your doctor will examine you, looking carefully at any spots you have identified as changed or suspicious. The doctor will ask if you or your family have a history of melanoma. Using a handheld magnifying instrument called a dermoscope, the doctor will examine the spot more closely and consider the criteria known as “ABCDE”.

ABCDE signs of melanoma

Asymmetry

Are the halves of each mole different?

asymmetry

Border

Are the edges uneven, scalloped or notched?

border

Colour

Are there differing shades and colour patches?

colour

Diameter

Is the spot greater than 6 mm across?

diameter

Evolving

Has the spot changed over time (size, shape, surface, colour, bleeding, itching)?

evolving

Some types of melanoma, such as nodular and desmoplastic melanomas, don’t fit the “ABCDE” criteria, so your doctor may also assess whether the spot is elevated, firm or growing.


Removing the mole (excision biopsy)

If the doctor suspects that a spot on your skin may be melanoma, the whole spot is removed (excision biopsy) for examination by a tissue specialist (pathologist). This is generally a simple procedure done in your doctor’s office. Your GP may do it, or you may be referred to a dermatologist or surgeon.

For this procedure, you will have an injection of local anaesthetic to numb the area. The doctor will use a scalpel to remove the spot and a small amount (2 mm margin) of healthy tissue around it. The wound will usually be closed with stitches. It is recommended that the entire mole is removed rather than a small sample. This helps ensure an accurate diagnosis and accurate staging of any melanoma found.

A pathologist will examine the tissue under a microscope to work out if it contains melanoma cells. Results are usually ready within a week.

For information about what the pathology results mean, see below.

You’ll have a follow-up appointment to check the wound and remove the stitches. If a diagnosis of melanoma is confirmed, you will probably need further surgery, such as a wide local excision.


Checking lymph nodes

Lymph nodes are part of your body’s lymphatic system, which removes excess fluid from tissues, absorbs fatty acids, transports fat, and produces immune cells. There are large groups of lymph nodes in the neck, armpits and groin. Sometimes melanoma can travel through the lymph vessels to other parts of the body.

Your doctor may feel the lymph nodes near the melanoma to see if they are enlarged. To test whether the melanoma has spread, your doctor may recommend that you have a fine needle biopsy or a sentinel lymph node biopsy.

Fine needle biopsy

A thin needle is used to take a sample of cells from an enlarged lymph node. Sometimes an ultrasound helps guide the needle into place. The sample is then examined under a microscope to see if it contains cancer cells.

Sentinel lymph node biopsy 

If the Breslow thickness of the melanoma is over 1 mm or sometimes for people with melanoma between 0.8 mm to 1 mm, you may be offered a sentinel lymph node biopsy. This biopsy finds and removes the first lymph node/s that the melanoma would be likely to spread to (the sentinel node/s). It is usually done at the same time as the wide local excision.

A sentinel lymph node biopsy can provide information that helps predict the risk of melanoma spreading to other parts of the body. This information can help your doctor plan your treatment. It may also allow you to access new clinical trials.

To find the sentinel node/s, a small amount of radioactive dye is injected into the area where the melanoma was found. The surgeon removes the node that absorbs the injected fluid to check for cancer cells. If they are found in the sentinel lymph node, further tests such as ultrasound, CT or PET scans may be done during follow-up and systemic treatment may be offered.


Pathology report

If you have melanoma, the report from the pathologist will provide your treatment team with information to help determine the stage, plan treatment, and work out your prognosis. You can ask your doctor for a copy of the results, and discuss the results with them. The following factors may be included:

Breslow thickness 

This is a measure of the thickness of the tumour in millimetres to its deepest point in the skin. The thicker a melanoma, the more likely it could return (recur) or spread to other parts of the body.

Melanomas are classified as:

  • in situ – found only in the outer layer of the skin
  • thin – less than 1 mm
  • intermediate – 1–4 mm
  • thick – greater than 4 mm.

Ulceration 

The breakdown or loss of the outer layer of skin over the tumour is a sign of rapid tumour growth.

Mitotic rate

Mitosis is the process by which one cell divides into two. The pathologist counts the number of actively dividing cells to calculate how quickly the melanoma cells are dividing.

Clark level 

This describes how many layers of skin the tumour has gone through. It is rated I–V, with I the shallowest and V the deepest. Breslow thickness is much more important than Clark level in assigning a stage to a melanoma.

Margins 

This is the area of normal skin around the melanoma. If there is no tumour touching the margins, the pathologist will often describe how close the abnormal tissue (lesion) was from the edge.

Regression 

The report will note any lymphocytes (immune cells) within the melanoma and any evidence of whether some melanoma cells have been destroyed by the immune system and replaced with scar tissue.


Video: Cancer and common diagnostic tests

Learn more about what cancer is, how it spreads, and what primary and secondary cancers are. You can also find out about the tests that are commonly used to diagnose cancer, including CT/CAT scans, PET scans & MRI scans.


Click on the icon below to download a PDF booklet on melanoma


Printed copies are available for free - Call 13 11 20 to order

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To download an EPUB to your Kobo from a Mac:

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Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
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Sony Reader

To download an EPUB file on your Sony Reader™:

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Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
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  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
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Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&nodeId=200767340&qid=1395967989&sr=1-1
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Android and PC

You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.


This information was last reviewed in January 2019
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