Visit your family doctor (GP) first. They will examine your skin carefully. They can then refer you to hospital for more testing by a skin specialist (dermatologist). The testing will include an excision biopsy.
A biopsy means taking a sample of cells and looking at them under a microscope. With an excision biopsy, the entire mole or affected tissue is removed and examined in the laboratory.
After melanoma is diagnosed, the pathologist will measure the depth, or thickness, of the cancer to see how deep it is within the layers of your skin. This is called the Breslow thickness.
If the depth of the melanoma is less than 1mm, it is called a thin melanoma and there is an excellent chance that your melanoma will not come back (recur) once it has been treated.
If the melanoma is thicker than 1mm, there is a chance it could have spread or might come back in the future.
Most people have melanomas that are 1mm thick or less
The pathologist will check:
If you are diagnosed with melanoma, we're here for you.
Our cancer nurses are here if you need information or just want to talk. They can help you to understand your diagnosis and what to expect, send you information and tell you about our services.
If the biopsy shows that the cancer has or might spread deeper than your skin surface, your doctor may need to do other tests to find out more about the extent or stage of the cancer and your general health. This can help them decide on the right treatment for you. Tests you might have include:
This test is to see if cancer cells have spread to lymph nodes close to the melanoma site. This is unlikely to happen if the melanoma is less than 0.8mm thick. If the melanoma cells go deeper than 0.8mm into your skin, your doctor may do a sentinel lymph node biopsy. This involves:
Read more about sentinel lymph node biopsies.
A scan to see if there is melanoma elsewhere in your body. Read more about PET scans.
A scan that can give a detailed picture of the tissues inside your body. Read more about CT scans.
A scan that uses sound waves to look at collections of lymph
nodes (called basins) and soft tissue. It is done in the X-ray
department of the hospital. The scan is painless and only takes a few minutes. Some gel is first put on the skin, which is then scanned to give more information about the cancer.
A scan that uses magnetic energy to create a picture of the
tissues inside your body. Read more about MRI scans.
Bone scans can sometimes be used to find cancer cells before they show up on an X-ray. Read more about bone scans.
While some results may come back quickly, others may take a few weeks.
Waiting for results can be an anxious time. It may help to talk things over with your doctor or nurse or with a relative or close friend. You can also call our Support Line on 1800 200 700 or visit a Daffodil Centre to speak to a cancer nurse.
Knowing the stage of your cancer is very important, as it helps your doctor to decide the best treatment for you. Melanoma staging looks at:
Your doctor often uses this information to give your cancer a number stage – from 1 to 4. A higher number, such as stage 4, means a more advanced cancer.
This is the earliest stage of melanoma. The melanoma cells are only in the top layer of the skin (epidermis).
Melanoma in situ does not usually spread to other parts of the body.
The melanoma cells are found only in the skin. It has not spread to lymph nodes or other organs.
The melanoma may have spread to nearby skin or to nearby lymph vessels or nodes.
The cancer has spread to distant parts of your body such as the lung, liver or brain.
Using the general stages 1-4, your doctor may also do a more detailed staging, adding letters (A-C) to the numbers. This will describe the thickness, the spread (if any) and if the skin is ulcerated (broken).
The melanoma is less than 0.8mm thick. The covering layer of skin over the tumour is not broken (not ulcerated).
The melanoma is less than 0.8mm thick and the skin is broken (ulcerated). Or it is between 0.8 and 1mm thick and may be either ulcerated or not ulcerated.
The melanoma is between 1 and 2mm thick and is ulcerated. Or it is between 2 and 4mm and is not ulcerated.
The melanoma is between 2 and 4mm thick and is ulcerated. Or it is thicker than 4mm and is not ulcerated.
The melanoma is thicker than 4mm and is ulcerated.
The melanoma has spread to 1 to 3 lymph nodes near the original tumour. The nodes are not enlarged and the melanoma can only be seen with a microscope. The melanoma can be of any thickness, but it is not ulcerated.
The melanoma can be of any thickness and is ulcerated. It has spread to 1 to 3 lymph nodes near the original tumour. The nodes can be enlarged or not enlarged.
OR
The melanoma can be of any thickness, but it is not ulcerated. The melanoma has spread to skin or lymph vessels around the original tumour. Nearby lymph nodes do not have melanoma cells.
Stage 3C describes one of the following:
The melanoma has spread to other areas of the body, such as the lung, liver or brain.
Knowing the stage of your cancer helps your team to plan the best treatment for you.
In certain cases, a pathologist will test the tumour for gene changes (mutations). Each gene mutation makes the cancer act in a different way. Almost half of people diagnosed with melanoma have a mutation in the BRAF gene.
Knowing which gene mutation affects your tumour helps the doctors to plan the best treatment for you.
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