Diagnosis of melanoma

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1 This information is an extract from the booklet Understanding melanoma and treatment with surgery, which is part of a series of booklets on melanoma. You may find the full booklet helpful. We can send you a free copy see page 6. Contents How melanoma is diagnosed Staging of melanoma Detailed staging of melanoma How melanoma is diagnosed Usually your GP will examine you first. If they think you may have a melanoma, they should refer you to a doctor with specialist training in diagnosing skin conditions (a dermatologist). Seeing a specialist If you have a suspected melanoma, you should be seen within a couple of weeks by a dermatologist. Your appointment will probably be at a skin clinic or at a pigmented lesion clinic (a special clinic for diagnosing melanomas early). Some people may see a plastic surgeon rather than a dermatologist. They are also experienced in melanoma. The specialist will examine your mole and ask you questions about how long you ve had it and any changes you ve noticed. They usually also examine the rest of your skin to see if you have any other unusual moles. Some specialists may look at your moles with a small, handheld instrument called a dermatoscope. This gives a bigger and clearer picture of the mole. Your specialist will know a lot from looking at your mole. Knowing whether the mole has changed over time and how is also important. If they think you may have a melanoma, they will advise you to have the whole mole removed. They may also take pictures (with your permission) of other moles that you have, so they can check whether they change. You may see a specialist skin cancer nurse, who will give you information and support. Questions about cancer? Ask Macmillan Page 1 of 6

2 Having your mole removed Your doctor will need to remove your mole to find out what it is. This is known as an excision biopsy. Before it s removed, your doctor will explain the procedure to you. You will have a small scar afterwards. You will be asked to sign a form saying that you give your permission (consent) for the mole to be removed. Once you re lying down comfortably, your doctor will inject a local anaesthetic into the area around the mole. This will numb the area so you don t feel any pain. They ll cut out the whole mole and 2mm of normal skin around it. Your doctor will close the wound using stitches. These will be removed after 5 14 days, depending on where the mole was. Some people may have stitches that dissolve, which don t need to be removed. The mole is then examined under a microscope by a pathologist (an expert in cells) to see if any melanoma cells are present. Waiting for test results Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your excision biopsy to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse can also provide support. You can also talk to one of our cancer support specialists on Staging melanoma The stage of a cancer is a term used to describe its size and whether it has spread. Knowing the stage of your cancer helps doctors decide on the best treatment for you. Page 2 of 6 Questions about cancer? Ask Macmillan

3 Melanomas are divided into four stages. We have given a simple summary of the stages. It may also help to talk to your specialists. They can give you more information about the stage of your melanoma. Stages 1 and 2 The melanoma is only in the skin and has not spread anywhere else in the body. Stage 3 The melanoma has spread to the nearest lymph vessels or nodes, but not to anywhere else in the body. Stage 4 The melanoma has spread to distant areas of skin or distant lymph nodes, or to other organs such as the lung, liver or brain. This is called advanced or metastatic melanoma. Breslow thickness When melanomas are staged, doctors also use a measurement to describe how thick (deep) the melanoma is. This is called the Breslow thickness (named after the doctor who introduced it). It measures in millimeters (mm) how far the melanoma cells have grown down into the layers of skin. Most people have melanomas that are 1mm thick or less. These are stage 1 melanomas and are often known as thin melanomas. They are very unlikely to spread. Most can be cured by a simple operation known as a wide local excision. If a melanoma is thick, it is more likely to spread into the lymph vessels or nodes closest to the melanoma. If this happens, additional surgery will be needed to remove the lymph nodes as well as the melanoma. Melanoma in situ Melanoma in situ is a term used to describe the very earliest stage of melanoma. It s also called melanocytic intraepithelial neoplasia. This means the melanoma cells are only in the very top layer of skin (epidermis) and haven t started to spread down into the dermis. Because the melanoma is only in the very top layer of skin, people with melanoma in situ do not usually have any risk of the melanoma spreading to other parts of the body. Questions about cancer? Ask Macmillan Page 3 of 6

4 Detailed staging of melanoma The staging system used for melanoma is the American Joint Committee on Cancer (AJCC) system. It uses the TNM system. T stands for tumour. This is the thickness (depth) of the melanoma (using Breslow thickness see page 3). It also describes whether the melanoma is ulcerated. A melanoma is ulcerated if the layer of skin covering the melanoma cannot be clearly seen. N stands for lymph nodes. It indicates whether the melanoma has spread to the lymph nodes and, if so, to how many. M stands for metastases. It indicates whether the melanoma has spread to other parts of the body (secondary or metastatic cancer). The AJCC system groups melanomas into an overall number stage between 1 and 4. Stage 1 melanoma Stage 1 melanomas are no more than 2mm thick and have not spread beyond the skin. Stage 1 melanoma can be divided into: Stage 1A The melanoma is 1mm thick or less, without ulceration, and it has a mitotic rate (see below) of less than 1/mm2. Stage 1B The melanoma is 1mm thick or less. It also has either ulceration or a mitotic rate of at least 1/mm2. OR the melanoma is between 1.01mm and 2mm thick, but doesn t have ulceration. Mitotic rate describes the number of cells that are in the process of dividing in a certain amount of melanoma tissue. A higher mitotic rate means that the cancer has a greater risk of spreading. Page 4 of 6 Questions about cancer? Ask Macmillan

5 Stage 2 melanoma Stage 2 melanomas have not spread to the lymph nodes or anywhere else in the body. Stage 2 melanoma can be divided into: Stage 2A The melanoma is between 1.01mm and 2mm thick, with ulceration. OR it is between 2.01mm and 4mm thick, without ulceration. Stage 2B The melanoma is between 2.01mm and 4mm thick, with ulceration. OR it is thicker than 4mm, without ulceration. Stage 2C The melanoma is thicker than 4mm with ulceration. Stage 3 melanoma Stage 3 melanomas have spread to the lymphatic vessels or lymph nodes closest to the melanoma, but not to anywhere else in the body. In stage 3, the thickness of the melanoma is not a factor, but the melanoma is usually thick. Stage 3 melanoma is divided into stages 3A, 3B or 3C, depending on factors such as: the number of lymph nodes involved whether the lymph nodes contain melanoma cells that can be seen by the naked eye or only under a microscope whether melanoma cells are found in the skin or lymphatic vessels near the melanoma. Stage 4 melanoma Stage 4 melanoma has spread to distant areas of skin or distant lymph nodes. Or it has spread to other organs such as the lungs, liver or brain. This is called advanced or metastatic melanoma. The way cancers are staged is complicated. If you have any questions about the stage of your melanoma, ask your doctor. Questions about cancer? Ask Macmillan Page 5 of 6

6 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding melanoma and treatment with surgery, or the other booklets in the melanoma series, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MARCH 2014 Planned review in 2016 Page 6 of 6 Questions about cancer? Ask Macmillan