This page is about tests to diagnose melanoma skin cancer. There is information about
If you have a mole, or abnormal area on the skin, that you think may be a melanoma, you will need to go to your GP. If there is any reason to think the mole may be becoming cancerous, you will need to have the area removed and looked at under a microscope. This is called an excision biopsy.
UK guidelines for GPs say that if you have a skin change that could be a melanoma, your GP should refer you to a specialist clinic or hospital to have the mole removed. Your appointment at the clinic should be within 2 weeks. At the clinic your doctor may use a dermatoscope to closely examine the abnormal area on your skin. A dermatoscope magnifies the area so that the doctor can see it better. The staff will photograph the abnormal area.
Having your mole removed
First you have an injection of local anaesthetic into the area where the mole is. The doctor then cuts out the whole mole and 2 mm of tissue all around. They send it off to the laboratory. You then have a few stitches put in. If the mole contained any cancerous cells you may need to have more tests. If it didn't, you will not need any more treatment.
If your mole contained cancerous or precancerous cells, a pathologist will carefully check the biopsy tissue in the laboratory. Your doctor will ask you to go back into hospital for an operation to remove more tissue from around the area of the melanoma.
Having more tissue removed
This operation is called a wide local excision. The surgeon removes more tissue from around the area of the melanoma, usually down to the level of the muscle. This is to remove any cells that may have been left in the area after the initial operation. You usually have this surgery under local anaesthetic. But in some circumstances your doctor may suggest a general anaesthetic. The operation is much the same as having the initial melanoma removed.
You can view and print the quick guides for all the pages in the Diagnosing melanoma section.
If you have a mole, or abnormal area on the skin, that you think may be a melanoma, you will need to go to your GP. Your doctor will look at the mole and ask you what you have noticed about it. UK referral guidelines say that your GP should refer you to a specialist clinic or hospital for removal of any mole that could be a melanoma. Your GP will refer you to a specialist who is a member of a skin cancer multidisciplinary team.
You should see the specialist within 2 weeks of seeing your GP. You might see the specialist in hospital at a dermatology outpatient clinic (dermatology means specialising in diseases of the skin). Or your GP might refer you to a pigmented lesion clinic if there is one in your area. A pigmented lesion clinic is a dermatology clinic that specialises in picking up suspicious moles and diagnosing melanoma.
At the first appointment the specialist will look at your mole and photograph it. You may need to have a second appointment.
The specialist may think that you do not need any treatment straight away, but may not be completely sure that the mole is harmless. They will ask you to come back in 3 months and they will check whether the mole has changed since they took the photograph.
If the specialist thinks the mole may be a melanoma you will have a second appointment to have the mole removed.
At the clinic you usually have a test called dermatoscopy (or dermoscopy) to help make the initial diagnosis. It is a painless test in which the doctor uses an instrument called a dermatoscope to closely examine the suspicious area on your skin. The doctor puts some oil on to your skin and then holds the dermatoscope in their hand, a bit like a magnifying glass. This can magnify the area by up to 10 times so that the doctor can see it very clearly.
When you go to have your mole removed, the nurse or doctor will ask you to lie down on a couch in the treatment room. First you have an injection of local anaesthetic into the area close to the mole. The doctor then cuts out the mole and 2mm of the surrounding tissue all around. They send it off to the laboratory for close examination under a microscope. You then have a few stitches put in to sew up the area where the mole was cut out. The stitches may dissolve on their own. If the stitches are not the dissolvable type you will need to go back to the clinic after a week or so to get them taken out.
You may get your biopsy results at the hospital or at your GP surgery. If the mole contained any cancerous cells you may need to have more tests. If not, you will not need any more treatment.
If your mole contained cancerous or precancerous cells, a tissue specialist (histopathologist) will look at the biopsy tissue very closely in the laboratory. Your doctor will ask you to go into hospital for an operation to take away more tissue. This aims to remove any abnormal cells that may have been left behind in the area close to the melanoma. It reduces the chance of the melanoma coming back in the future. The operation is called a wide local excision. There is information below and more detailed information on the surgery for melanoma page.
This operation is called a wide local excision. You may have it under local anaesthetic. But you will have a general anaesthetic if your surgeon is going to check the lymph nodes at the same time. This is called a sentinel lymph node biopsy.
The wide local excision operation is much the same as having your mole removed. But the surgeon will take more tissue away, usually down to the level of the muscle. How much tissue they take will depend on
- How much of the mole was left behind in the surrounding skin
- How deeply the melanoma has grown into the tissue beneath the skin
- The position of the melanoma on the body
- Whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)
Generally, this is a small operation. The doctor will put in stitches to close up the area where they remove the tissue. This will feel a little tight at first. But as it heals, the surrounding skin will stretch and the tightness should ease.
If the surgeon needs to remove a large area of skin and tissue they may need to use a skin graft. This means that they take skin from another area of the body and put it over the wound to allow it to heal.
Everyone with melanoma has a blood test to measure their vitamin D level. If your vitamin D level is low your doctor will give you information and advice about what to do.
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