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Melanoma (cont.)

How Do Specialists Diagnose Melanoma?

The diagnosis of melanoma is suspected when a skin lesion exhibits some or all of the criteria described in the symptoms and signs section above. Melanomas may develop on any area of the skin, including

  • the palms,
  • soles,
  • scalp, and
  • under fingernails.

Recently, handheld devices have been developed, utilizing magnification and polarized light, which can enhance the detection of dangerous pigmented lesions (dermoscopy). Suspicious lesions are surgically removed by the physician (a biopsy) in their entirety, if possible, and submitted to a pathologist who is an expert in the microscopic interpretation of skin disease. The diagnosis is made when the pathologist identifies certain microscopic features. Occasionally, certain lesions may not exhibit sufficient criteria to qualify as melanomas but may be "borderline" lesions. Then the pathologist may suggest that such worrisome lesions be re-excised with a margin of normal tissue surrounding the excision site.

If the diagnosis of melanoma is made, the pathologist will also describe its thickness in millimeters, how deep it has penetrated into the skin, if there is any invasion of nerves or blood vessels, and estimate its mitotic activity. New molecular testing of melanoma gene expression (DecisionDx-Melanoma) that can aid in the identification of tumors likely to metastasize early may soon become available. These test could help to guide treatment options.

What Are Treatments for Melanoma?

Patient Comments

The treatment of melanoma is dependent on the stage of the disease at the time of diagnosis. Staging is a technique often used to categorize various kinds of cancer according to the extent of the cancer in the hope that this will help the doctor to predict the behavior of the disease and select the best treatment.

  • Stage 1 melanomas (thin lesions <1 mm thick) that have not metastasized have an excellent prognosis and generally only require surgical removal of the tumor with an appropriate margin of normal tissue.
  • Thicker tumors or tumors that appear to have spread to other parts of the body have a much poorer prognosis. For melanomas of intermediate thickness with no evidence of metastatic spread, technique called sentinel lymph node biopsy has been developed which is useful in predicting the progression of the disease. This is performed by injecting a radioactive tracer and/or a dye at the site of the tumor and tracing it to the local lymph nodes that drain the site of the cancer. Once identified, these lymph nodes are removed and examined by the pathologist to determine if they have been invaded by the melanoma. Lack of invasion is a good sign.

Once a melanoma has metastasized to draining regional lymph nodes or to a more distant site, treatment options become more complicated and good outcomes become less common. Such treatments for metastatic melanoma include

  • regional lymph node dissection,
  • interferon injections,
  • radiation therapy,
  • immunotherapy,
  • regional limb profusion (chemotherapy limited to an extremity), and
  • systemic chemotherapy.
Medically Reviewed by a Doctor on 10/2/2015

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