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If a melanoma is supected, a skin biopsy is conducted.

This means that the doctor will take a sample of skin from the suspicious area for examination under a microscope.

There are different methods used to obtain the skin sample, depending on the size and location of the suspected area

• Punch biopsy – a special tool that rotates and cuts through layers of the skin to take a small sample is used.

• Incisional biopsy – removes a deeper skin sample using a surgical knife to cut through the full thickness of the skin. Only a portion of the tumor is removed.

• Excisional biopsy – removes a deeper skin sample using a surgical knife to cut through the full thickness of the skin.  The entire tumor is removed.  This is the preferred method when a melanoma is suspected.

A portion of normal appearing skin around the suspicious area is also recommended for removal.  This is referred to as the tumor margin and is done to ensure that no melanoma is left behind.

These biopsies each use a local anesthetic to numb the affected area.  They are simple and quick procedures that can be performed in the doctor’s office.  

The samples are examined by a pathologist under a microscope to confirm the presence or absence of melanoma.  When a biopsy is performed and melanoma is detected the depth of invasion is measured.  The deeper the melanoma the more likely it is to have spread to the surrounding and adjacent tissues. 

The first place melanoma or any cancer will travel is to the lymph nodes that drain the area.  Lymph nodes are part of the lymphatic system.  This is a series of nodes and vessels throughout the body that are responsible for cleaning body fluids.  Vessels drain to lymph nodes which act as filters capturing the cancerous cells.  To determine if the local lymph nodes are involved, a fine needle aspiration biopsy will be recommended.  This procedure utilizes a thin needle to remove a very small sample from a tumor. A CAT scan is sometimes used to guide the needle to the correct site.

Once a melanoma is diagnosed the stage of the disease must be determined. 

Staging is the process of finding out how far the cancer has spread or metastasized.  It includes describing the size of the cancer, as well as the extent to which the cancer has spread to other organs. 

Staging is very important.  Treatment recommendations and prognostic determinations are based on the stage of the cancer.

Stage 0

The tumor has not spread and is still limited to the outer layer of the skin.

Treatment for melanoma begins with the surgical removal of the melanoma.  Additional treatment is dependent on the stage of disease. (link to staging) 

As a general rule melanoma is a surgical disease.  Primary and metastatic sites are surgically removed, if possible. 

Radiation therapy is recommended when the cancer has extended locally or to regional lymph nodes.

Chemotherapy and immunotherapy are recommended for later stage disseminated disease

Follow-up of patients with melanoma, after completion of the initial treatment intervention, is essential. 

Depending upon the stage of the disease, it is suggested that the patient be evaluated 1-4 times a year for the first two years and then 1-2 times per year thereafter. 

Follow-up is aimed at the early detection of metastatic disease and new primary sites of melanoma.

Treatment for melanoma should always be rendered by healthcare professionals who have specialized in the care of patients with cancer.

A surgical oncologist, for example, is well versed on the behaviors of certain tumors and the necessary data to obtain to accurately stage the disease.

Expert teams of cancer care professionals can be found in both community and university centers.  Specialists in melanoma, however, are typically found in larger university settings. Here they can both care for patients and participate in research activities to identify new and more effective treatment strategies.

Patients with later stage or recurrent melanoma may be offered the opportunity to participate in clinical trials. (link to clinical trials)

Treatment for melanoma, as for any diagnosis of cancer, often involves the use of multiple modalities to fight the disease over many months and, sometimes, years. In whatever setting is most appropriate for you to receive treatment, an inter-disciplinary team of cancer professionals including, but not limited to, your attending physician, registered nurse, social worker, physical therapist and dietician should be accessible to advocate for you and to assist you and your family to navigate this experience.

This is equally true outside of the acute hospital setting.  Often treatment is delivered by intermittent visits to an outpatient center.  A short stay in a rehabilitation center is appropriate to assist patients to regain optimal function and stamina after surgery.  Home care services are utilized when the patient has a skilled need such as learning about new medicines or how to take care of a catheter. 

Hospice care is initiated when the doctor believes that a cure is no longer possible and the goals of care have shifted from treatment and cure to comfort and care. Each of these services across the health care continuum should offer you the talents of a team of skilled and compassionate professionals specializing in the care of patients with cancer.

The Joanna M. Nicolay Melanoma Foundation
...the voice for melanoma prevention, detection, care and cure.