• All About INTRON® A
  • What Is INTRON® A?
  • Why INTRON® A?
  • Getting Started
  • Treatment with INTRON® A
  • Managing Side Effects
• Understanding Your Condition
  • Malignant Melanoma
  • Skin Basics
  • What Is Cancer?
  • Types of Skin Cancer
  • Focus on Melanoma
• Give and Get Support
  • For People Living with Melanoma
  • For People Who Care
• Professional Resources
  • Indications
  • Why INTRON® A
  • Managing Therapy
  • Patient Support
  • Professional Resources
  • Contact Information

Diagnosis

Is it really melanoma?

There are two key parts of making a diagnosis of melanoma:

1. Biopsy
2. Staging

There may be more than one step or procedure in either one of these. You might also need to consult more than one special doctor.

Knowing about the biopsy and staging ahead of time may helpful.

The only way to know for sure if you have melanoma is with a biopsy.

If your doctor thinks that a mole looks suspicious, he or she will refer you to a dermatologist (a physician who specializes in diseases of the skin). If the dermatologist is concerned, a biopsy is the next step.

The doctor will try to remove the entire mole, or a small piece of the mole if it is large. This can usually be done in the doctor's office. Then a pathologist (another special doctor) looks at the skin that was removed with a microscope, to check for cancer cells. If the pathology report confirms that the mole is melanoma, your dermatologist will need to find out more, to decide what stage the tumor is. This is called "staging." For more information visit the National Cancer Institute Web site.

Staging the melanoma is very important because the choice of treatment has a lot to do with the stage of the melanoma.

In staging, your doctors will figure out exactly what the cancer is doing. Oncologists (doctors who specialize in cancer) consider three things when staging melanoma:

1. The thickness of the tumor (how deep the tumor has grown into the skin).
2. Whether the tumor is ulcerated (a hole forms on the surface and underlying layers of skin are visible), cracked, or bleeding.
3. If it has spread, where and how far.

In general:

• Thicker tumors are more serious than thin tumors.
• Ulcerated tumors are more serious than nonulcerated ones, even if they are thinner.
• Tumors that have spread to the lymph nodes are more serious than tumors that have not spread.

The stage of a melanoma helps determine what kinds of treatment a person will receive. For example, a person with an early stage of melanoma might only have surgery and no other treatment. A later-stage melanoma might call for additional treatment after the tumor has been removed, to reduce the chances of it coming back. For more information visit the National Cancer Institute Web site.

The table below shows the different stages of melanoma, what they mean, and what kind of treatment is usually done.

Note: 1 millimeter = 1/25 of an inch

Staging Classifications

IA

What it Means The tumor is less than 1 millimeter thick. The outer layer of skin does not look cracked or scraped (ulcerated). It has not spread to any lymph nodes or other organs.

Treatment The tumor and some surrounding tissue are removed surgically. Usually no further treatment is necessary.

IB

What it Means The tumor is either less than 1 millimeter thick and ulcerated, or 1-2 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs.

Treatment The tumor and some surrounding tissue are removed surgically. Usually no other treatment is necessary.

IIA

What it Means The tumor is either 1-2 millimeters thick and ulcerated, or 2-4 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs.

Treatment The tumor and some surrounding tissue are removed surgically. Usually no other treatment is necessary.

IIB

What it Means The tumor is either 2-4 millimeters thick and ulcerated, or more than 4 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs.

Treatment The tumor and some surrounding tissue are removed surgically. Immunotherapy may be given in cases of thicker tumors.

IIC

What it Means The tumor is more than 4 millimeters thick and is ulcerated.

Treatment The tumor and some surrounding tissue are removed surgically. Immunotherapy may be given.

IIIA, IIIB, IIIC

What it Means The tumor may be any thickness. It may or may not be ulcerated. The cancer cells have spread either to a few nearby lymph nodes, or to some tissue just outside the tumor but not to the lymph nodes.

Treatment The tumor and lymph nodes that have cancer cells are removed surgically. Immunotherapy may be given.

IV

What it Means The cancer cells have spread to the lymph nodes, other organs in the body, or areas far from the original site of the tumor. This is called metastatic melanoma.

Treatment The tumor and lymph nodes that have cancer cells are removed surgically. Radiation therapy, chemotherapy, or immunotherapy may be given to relieve symptoms.

The excisional biopsy

To find out how thick the melanoma is, the dermatologist or a surgeon will remove (or "excise") the entire tumor along with some skin around it, if this wasn't already done during the biopsy for diagnosis. At the same time, or in a later step, the surgeon may do a procedure called a sentinel lymph node (SLN) biopsy. This will help the doctor find out whether, and where, the melanoma has spread.

Other tests may also play a role in staging. These include:

• blood tests
• chest x-rays
• CT (computed tomography)
• MRI (magnetic resonance imaging)
• PET scan (positron emission tomography scan)

After all traces of the tumor have been removed, you may see a cancer specialist called an oncologist. If the melanoma has spread to other areas, or if there is a good chance the melanoma might come back, the oncologist may prescribe additional treatment.

Typical Steps in the Diagnosis of Melanoma

1. You find a suspicious mole or growth on your skin. You report it to your doctor.
2. The doctor refers you to a dermatologist, a skin specialist.
3. The dermatologist does an excisional biopsy and sends a sample of the growth to the lab. The pathologist at the lab checks the sample under a microscope to see if it is melanoma.
4. If it is melanoma, the dermatologist refers you to a surgeon for a sentinel lymph node or SLN biopsy. (Sometimes, the surgeon will remove the entire tumor and do the SLN biopsy at the same time, combining steps 3 and 4.)
5. If the dermatologist or surgeon has not yet removed the entire tumor and some surrounding skin, that happens next.
6. If tests show that melanoma has spread to nearby lymph nodes, the surgeon may remove those lymph nodes to help stop the cancer from spreading further.
7. If the melanoma has spread to the lymph nodes, you may have more tests including: blood tests, ultrasound, chest x-rays, or Magnetic Resonance Imaging (MRI) to check if the cancer has also spread to other organs.
8. After all surgery is completed, an oncologist may prescribe other treatments. These are called adjuvant treatments, and they may be in the form of immunotherapy, chemotherapy, or radiation therapy.