Melanoma Screening & Diagnosis

Melanoma screening & diagnosis at a glance

• Screening for melanoma, a rare but deadly form of skin cancer, is an evaluation of one’s skin to identify potential cancer.
• The first step in melanoma screening usually includes a self-examination for irregular skin spots, skin changes or marks, which are cause to see a doctor.
• Cancer screening with a physician includes a physical exam and procedures and examination of irregular skin patterns.
• Although screening can detect possible melanoma, the skin will need to be biopsied in order to confirm a diagnosis.
• Several forms of biopsies are available, depending on the size and suspected stage.
• Additional biopsies may be required to assess the stage and whether the cancer has spread so that a treatment plan can be developed. 

How is melanoma screening performed?

Melanoma screening procedures and guidelines vary because different organizations take different stances on the topic. Some physicians or organizations don’t recommend screening for melanoma at all because of the stress and associated costs when moles biopsied turn out to be noncancerous. The United States Preventive Services Task Force has concluded, “the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.”

The American Cancer Society recommends routine screening for breast, colorectal, cervical, uterine and prostate cancers, but not skin cancers. On the other hand, the Skin Cancer Foundation recommends more rigorous cancer screening guidelines.

Because of these discrepancies, the screening recommendations of your doctor may vary. Regardless, it’s important to be aware of any skin marks that occur and see a doctor if you suspect skin cancer of any sort.

Individuals can perform self-screening at home. During home screenings, it’s important to be aware of current marks or freckles so changes can be noticed. Stand in front of a full-length mirror when examining the skin. If a person notices any irregular spots, he or she should see a doctor as soon as possible.

Physical office exams can be done by one’s primary care physician, a dermatologist or by other trained professionals. If the patient is seeing a dermatologist, he or she may perform a technique known as a dermatoscopy, which uses a special microscope for the skin (dermascope) that provides a better view of the suspected area. When used early enough, dermatoscopy can be very helpful in detecting early stage melanoma.

How is melanoma diagnosed?

Although screening can suggest evidence of skin cancer such as melanoma, the only way to diagnosis melanoma is to perform a skin biopsy and study the skin cells under a high power microscope.

Before a biopsy, a doctor will typically discuss symptoms, such as when the mark emerged, whether it has changed in size, or if it’s itchy, painful or starting to bleed. If these are occurring, the doctor will then perform a biopsy. There are a few different types of biopsies available for melanoma including:

• Incisional – only the abnormal portion of the growth or spot is removed for examination
• Excisional – the entire piece of suspicious skin, as well as the bordering skin, is extracted
• Punch biopsy – a circular blade is used to penetrate the skin around a mole or suspicious mark and remove a round piece of the skin
• Tangential – also known as a shave biopsy, the top layer of skin from the mark is removed with a surgical blade (usually not used for suspected melanoma because it doesn’t go deep enough)
• Optical – a newer form of skin cancer biopsy in which reflectance confocal microscopy (RCM) exams the suspect tissue without removing a piece of the skin.

The type of biopsy depends on each patient’s situation. In many cases, physicians will want to remove the entire growth with either a punch or excisional biopsy. If the suspicious skin is too big to do so, an incisional biopsy will likely be performed. Once the skin is removed, it is sent to a lab to be examined under a microscope by a pathologist.

What happens if the melanoma biopsy comes back positive?

If a biopsy confirms melanoma, it’s important to act quickly as the cancerous cells may have spread from the skin to other areas such as the lymph nodes. Additional biopsies will likely be required to determine a further course of treatment.