Further Investigations

If you doctor suspects that you may have metastatic melanoma (melanoma which has spread to places within your body) he or she may suggest some further diagnostic procedures. These procedures include blood tests, Ultrasounds, CT scans, MRI and PET scans. Your doctor may also recommend that a fine-needle aspiration biopsy or sentinel lymph node biopsy be performed. These procedures assist your clinical team in understanding if the melanoma has spread and, if so, how far it has spread.

Blood Tests

If a diagnosis of melanoma is made, you may be asked to have blood tests. These tests provide information regarding your immune system, haemoglobin, liver and kidneys and how these are functioning. Unfortunately there is no blood test which can tell your Doctor with certainty if the melanoma has spread to other parts of the body.

Sentinel Node Biopsy

A sentinel node biopsy is a procedure aimed at finding out whether or not melanoma cells have reached your lymph system. The sentinel node is the lymphatic node which receives drainage directly from the primary tumour. A sentinel node biopsy involves identifying the sentinel node or nodes, removing the node/s and sending them to a pathology lab for testing. Read more about Sentinel Node Biopsy

Fine Needle Aspiration (FNA)

It may be recommended that you have a fine-needle aspiration (FNA). This procedure is used to collect cells to look for signs of cancer, infection or other conditions. This is a relatively simple procedure and can be performed at your doctor’s rooms. Your doctor will wipe the area with rubbing alcohol or iodine to sterilize the area. He or she will hold the lump steady with one hand and insert a very fine needle with the other hand. If you have received an injection of local anaesthetic you will not feel this, however you may feel a brief sting when the anaesthetic is injected. If you do not have local anaesthetic then you will feel some discomfort when the needle is inserted. Once the needle is inserted, your doctor will pull back on the plunger to extract some cells from the lump. He or she may have to move the needle in and out of the area in order to get enough cells for the procedure to be worthwhile. The cells are then put onto a slide which is sent away to the pathology lab for analysis. If your doctor is unable to easily feel the mass or hold it in place then you may need to have an imaging test such as an Ultrasound, MRI, PET or CT scan.

Ultrasound Scan

If your Doctor suggests an ultrasound scan, you will usually have to make an appointment at a Radiology Clinic to have this done. This is a non-invasive procedure and does not hurt. In this scan, high frequency sound waves are emitted from an ultrasound transducer to create an image of a specific part of the body. It can be used to examine the lymph nodes in the neck, axilla (armpit) or groin and can also be used to enable a Fine Needle Aspiration to be performed (Ultrasound assisted fine needle aspiration). There is no radiation involved in the procedure.

CT Scan

A CT Scan (also called a CAT scan) stands for’ computerised axial tomography’. The use of CT scans is common in order to detect the spread of melanoma. The CT scan delivers a series of “sliced” pictures of your body or parts of the body which can be viewed in 3D format from different directions. It is very useful when looking at solid organs like the brain and liver and lungs. It is important to be aware that a CT scan can only pick up abnormalities that are around a centimetre or more in size. You will be asked to lie on a narrow bed and a radiologist (radiology doctor) will insert a small needle into your arm. Through this needle, the radiologist will give intravenous contrast which is a fluid that helps to outline the organs which are being examined. You may experience some discomfort when the needle is inserted, but other than this, the procedure is painless. This procedure involves the use of radiation and cannot be used if you are pregnant.

Magnetic Resonance Imaging Scan (MRI or MR scan)

Magnetic resonance imaging uses the energy from large magnets to create “slice” and 3D images of the body and specific organs. The MRI scan uses no radiation. You will be asked to lie on a bed and will be passed through the scanner. This is quite a slow process and you may be asked to hold your breath from time to time. The machine itself is loud and so patients wear headphones and listen to music throughout the procedure. Before you are able to have this procedure you will be asked about any metal you may have in your body (e.g. plates, screws, piercings). This is because the powerful magnets may cause the metal to move which could be damaging to the body. The use of intravenous contrast is sometimes used in this procedure.

PET Scan

A Positron Emission Tomography scan, or PET scan, is a scan that is able to pick up emissions from a radioactive tracer. The “trace” is commonly a type of sugar which is injected via a needle. Cancer cells like melanoma avidly use free sugars available in the blood stream which concentrates the tracer in area that the cancer is growing. PET scan is an excellent technique when looking for melanoma which may have spread around the body. It is also used to confirm if an abnormality which has shown up on other scan is in fact melanoma. When combined with a CT scan at the same time (SCT PET scan) your Doctor is able to see exactly where in your body the abnormality/ties are located. This can be used to ensure accurate surgical treatment of melanoma.