Getting a Diagnosis

If you are worried that you have a melanoma, the first thing you need to know is that help is available.
Choose a qualified skin check provider for an examination. If the lesion is suspicious they will perform a  biopsy. 

 

What is a biopsy?

A biopsy is a quick procedure where part or all of the spot is removed and sent to a laboratory. This can be done by your doctor or you might be referred to a dermatologist or surgeon.

What happens after my biopsy?

 The results are sent back to your doctor with a report stating:

  • If melanoma is present and what stage it is at

  • The thickness of the melanoma

  • Other features such as mitotic rate, ulceration, regression and excision margins

What do we mean by stage of melanoma and why is it important to know?

The stage of melanoma in the body is about how far advanced it is. This is important because:

  • Melanoma stages are determined by the thickness, depth and spread in the body. How far advanced the melanoma is when diagnosed influences a person’s outcome.

  • For people who are treated early, when melanoma affects only the superficial layers of the skin, the prognosis is excellent and the disease is often curable. If the cancer spreads to other parts of the body it can be harder to treat.

Stages
Stage 0 - (melanoma in situ) abnormal cells found in the epidermis. 
Stage 1 - the melanoma is not more than 2mm thick
Stage 2 - more than 2 to 4mm thick with no spread to the lymph vessels or lymph nodes
Stage 3 - any thickness that has spread to lymph vessels or lymph nodes
Stage 4 - the melanoma has spread to other parts of the body

Further investigations

Sometimes your doctor may be concerned that the melanoma has spread to places within your body, and may want to conduct further procedures to find out more. These procedures can include blood tests, ultrasounds, CT scans, MRI and PET scans or another type of biopsy.

  • Blood tests provide information about your immune system, haemoglobin, liver and kidneys. There is no blood test that can tell with certainty if the melanoma has spread to other parts of the body.

  • Sentinel node biopsy is a procedure aimed at finding out whether or not melanoma cells have reached your lymph system.

  • Fine needle aspiration 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 clinic.

  • Ultrasound scan is a non-invasive procedure and does not hurt. High frequency sound waves are emitted from an ultrasound transducer to create an image of a specific part of the body.

  • CT scan delivers a series of ‘sliced’ pictures of your body that can be viewed in 3D format from different directions. It is very useful when looking at solid organs like the brain, liver and lungs.

  • MRI scan uses the energy from large magnets to create ‘slice’ and 3D images of the body and specific organs.

  • PET scan picks up emissions from a tracer, which is commonly a type of sugar that is injected via a needle. Cancer cells avidly use free sugars available in the blood stream, which concentrates the tracer in areas where the cancer is growing.

Understanding Medical Terminolgy


Adjuvant therapy
Supportive or additional treatment given to kill undetected cancer cells that may remain in the body after surgery, and may include chemotherapy, radiotherapy and new drugs, such as Keytruda or Opdivo.


Benign
Not cancer – does not invade nearby tissues or spread to other parts of the body.

Biological therapy
Treatment that can help the immune system fight disease more effectively. This form of treatment often involves the use of biological response modifiers. Also called immunotherapy or biotherapy.

Biopsy
The removal of a sample of tissue for examination under a microscope to check for cancer cells.

Breslow Thickness
The thickness in millimeters between the upper layer of the epidermis and the deepest point of tumour penetration. Breslow thickness is related to the 5-year survival rate after surgical removal of the tumour?


Clinical Nurse Specialist
(also melanoma clinical nurse specialist)
A specialist nurse, who provides support to you and your family/whānau and can help to co-ordinate your care.

Chemotherapy
Treatment with anti-cancer drugs. It may be administered through an IV or orally.

Clinical trials
Medical research studies conducted with volunteers. Each study is designed to answer scientific questions and to find better ways to prevent or treat cancer.


Dermatologist
A doctor who specialised in the diagnosis and treatment of skin problems.

Immune system
The body’s front line of defence against invading bacterial infections, viruses and allergens. White blood cells (lymphocytes) are stimulated to create antibodies to defend the body against foreign invaders. Lymph nodes are an important part of the immune system and there is good evidence that the immune system acts against cancer cells.


Lymphoedema
A condition in which excess fluid collects in tissue and causes swelling. It may occur in the arm or leg after lymph vessels or lymph nodes in the underarm or groin are removed.


Metastasis
The spread of cancer from one part of the body to another. Cells in the metastatic (second) tumour are like those in the original (primary) tumour. The plural of metastasis is metastases.

Multidisciplinary care
A team approach by health care practitioners to your cancer care


Oncologist
A doctor who specialises in treating cancer.


Palliative care
Treatment given to optimise quality of life, attending to physical, psychosocial, spiritual and cultural needs when the cancer is incurable and other treatment is no longer controlling it.

Pathologist
A doctor who identifies diseases by studying cells and tissues under a microscope.

Plastic surgeon
A surgeon who specialises in reconstructive, skin or cosmetic surgery.

Prognosis
The probable outcome or course of a disease; the chance of recovery.

Radiation therapy (also radiotherapy)
Treatment with high-energy rays from x-rays or other sources to kill cancer cells, also known as radiotherapy.

Remission
Disappearance of the signs and symptoms of disease. When this happens the disease is said to be "in remission". A remission can be temporary or permanent.


Sentinel Nodes
The first few lymph nodes in the lymphatic system into which a tumour drains and to which tumour cells are most likely to spread.

Skin graft
Skin that is moved from one part of the body to another.

Surgical Oncologist
A surgeon trained in the principles of cancer biology, cancer surgery and treatments, and often with a special interest in melanoma or other specific cancers.

Systemic treatment
Treatment using substances that travel through the bloodstream, reaching and affecting cancer cells all over the body.


Targeted therapies
A newer generation of cancer drugs that prevent the growth of specific types of cancer cells.


Wide Excision
Wide excision is a surgical procedure to remove the tumour with a margin of normal, healthy tissue. This procedure is commonly performed on skin cancers, including melanoma, and in breast cancer surgery, but can be used on any area of the body.