Melanoma Diagnosis
This overview explains our diagnostic process to help you understand what to expect as you go through the early steps of your care.
Because melanoma is a diverse group of diseases, an accurate diagnosis is critical for your treatment plan. It helps us to recommend the most effective treatment options for you, in the right sequence.
WHAT TO KNOW ABOUT MELANOMA DIAGNOSIS
1Getting Started In Your Care
2Getting Your Diagnosis
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Consultation & Testing: What to Expect
3Planning Your Treatment
4Undergoing Treatment & Follow-Up
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Select your type of treatment below.
For everyone who comes to Stanford, we start your care by establishing or confirming a diagnosis.
First Visit
Consultation
Test Results
Complex Cases
We collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
a.Ìý Our goal is to review this information before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
b.Ìý When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather your medical records. We may need your help to do so, in case you need to sign a release form with your doctor. If we cannot obtain them in time, we may need to reschedule your appointment. You can speak with your patient coordinator or your doctor for more details.
c.Ìý ÌýSome types of medical records that you should keep include:
- Pathology reports from any biopsies or surgeries. For most skin melanomas, this is the most common outside record that is needed, along with the outside biopsy slides, which are reviewed by our dermatopathologists to confirm your diagnosis.
- Imaging test results, either on paper or stored on a DVD (although imaging and laboratory tests are not needed for most newly-diagnosed skin melanomas)
- Operative reports from any surgeries related to your melanoma
- List of medications, doses, and how long you took them
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
a.ÌýÌýÌýÌý Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
b.Ìý Ìý If needed, you may undergo further imaging tests, blood work, or an additional skin or lymph node biopsy biopsy. Ìý
a.Ìý ÌýAfter this testing, it typically takes a few days to review the results and confirm your diagnosis. While our new patient coordinators request your outside skin biopsy slides as soon as your doctor refers you to Stanford, getting your test results can take more than a week as your team is working hard to determine an accurate diagnosis for you.
b.Ìý Many health care professionals collaborate in the process and provide expert analysis, including your cutaneous, surgical and/or medical oncologist (cancer doctors), pathologist/dermatopathologist, and radiologist. Years of experience diagnosis melanoma every day means your dermatopathologist can accurately identify critical details, such as whether the cancer:
i.Ìý Invades into the skin or just involves the top layer of the skin (epidermis), including a measurement of the tumor thickness (called Breslow depth),
ii.Ìý Shows ulceration, where tumor cells push through the epidermis,
iii.Ìý Is aggressive or slow growing, which can be determined by looking at the type and number of growing and dividing cells, called mitotic figures,
iv.Ìý Shows features of certain melanoma subtypes that may affect treatment
c.Ìý Your care team will also determine the stage of your cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
Stanford melanoma experts from several specialties meet as a tumor board team that occurs as part of the structured parallel visits among your cutaneous, surgical, and medical oncologists. Based on the diagnosis, we recommend the best sequence of treatment for each patient.
Your doctor or a team of doctors (including cutaneous, surgical, and medical oncologists) will meet with you to discuss the recommended treatment plan. Together, you and your doctors decide on the options that are right for you.Ìý
We collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
a.Ìý Our goal is to review this information before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
b.Ìý When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather your medical records. We may need your help to do so, in case you need to sign a release form with your doctor. If we cannot obtain them in time, we may need to reschedule your appointment. You can speak with your patient coordinator or your doctor for more details.
c.Ìý ÌýSome types of medical records that you should keep include:
- Pathology reports from any biopsies or surgeries. For most skin melanomas, this is the most common outside record that is needed, along with the outside biopsy slides, which are reviewed by our dermatopathologists to confirm your diagnosis.
- Imaging test results, either on paper or stored on a DVD (although imaging and laboratory tests are not needed for most newly-diagnosed skin melanomas)
- Operative reports from any surgeries related to your melanoma
- List of medications, doses, and how long you took them
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
close First Visit
a.ÌýÌýÌýÌý Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
b.Ìý Ìý If needed, you may undergo further imaging tests, blood work, or an additional skin or lymph node biopsy biopsy. Ìý
close Consultation
a.Ìý ÌýAfter this testing, it typically takes a few days to review the results and confirm your diagnosis. While our new patient coordinators request your outside skin biopsy slides as soon as your doctor refers you to Stanford, getting your test results can take more than a week as your team is working hard to determine an accurate diagnosis for you.
b.Ìý Many health care professionals collaborate in the process and provide expert analysis, including your cutaneous, surgical and/or medical oncologist (cancer doctors), pathologist/dermatopathologist, and radiologist. Years of experience diagnosis melanoma every day means your dermatopathologist can accurately identify critical details, such as whether the cancer:
i.Ìý Invades into the skin or just involves the top layer of the skin (epidermis), including a measurement of the tumor thickness (called Breslow depth),
ii.Ìý Shows ulceration, where tumor cells push through the epidermis,
iii.Ìý Is aggressive or slow growing, which can be determined by looking at the type and number of growing and dividing cells, called mitotic figures,
iv.Ìý Shows features of certain melanoma subtypes that may affect treatment
c.Ìý Your care team will also determine the stage of your cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
close Test Results
Stanford melanoma experts from several specialties meet as a tumor board team that occurs as part of the structured parallel visits among your cutaneous, surgical, and medical oncologists. Based on the diagnosis, we recommend the best sequence of treatment for each patient.
Your doctor or a team of doctors (including cutaneous, surgical, and medical oncologists) will meet with you to discuss the recommended treatment plan. Together, you and your doctors decide on the options that are right for you.Ìý
close Complex Cases
At Stanford, we tailor the diagnostic phase of Melanoma care to each patient. If you need further testing to complete your diagnosis, your doctor and care team will work with you to determine which tests you need. Tests may include:
- Biopsy (Pathology)Ìý
In a biopsy, doctors try to remove most or all of the melanoma on the skin so a dermatopathologist can fully examine it under a microscope. - Genetics Assessment for Melanoma
Genetic testing is a medical test that identifies changes in genes, chromosomes, or proteins. For melanoma, genetic testing can show whether you have gene mutations that may be targeted by drug therapy (test done on the melanoma tumor) or whether you are at risk for hereditary melanoma (test is done on a sample of your blood or saliva). Not every patient requires genetic testing. - Lab Tests (Blood Draws)
Blood tests are not usually done for skin or lymph node melanoma, unless you are on adjuvant therapy for regional lymph node involvement. More advanced melanoma (involving others sites of the body) generally requires specific lab testing, especially if you are on systemic immunotherapy or targeted drugs. In this setting, blood tests can provide a variety of information, and help to plan your course of melanoma treatment. - Imaging Tests (Radiology)Ìý
To obtain the most precise understanding of your melanoma, your doctor may schedule you for different types of imaging tests that show if the melanoma has spread. If you have been screened elsewhere and received abnormal results, we may perform additional imaging, if needed.
What is melanoma?
Melanoma is a type of skin cancer that starts in the skin’s pigment cells (melanocytes), which give the skin its color. Melanoma is much less common than nonmelanoma skin cancer, but has a higher chance of spreading to other sites of the body (metastasizing). In general, though, skin cancers are highly treatable if they are detected and treated early, mainly with surgical removal.
Most melanomas form in the skin, the body’s largest organ. The skin’s layers include:
- Epidermis: The top layer. Ìý
- Dermis: This layer below the epidermis contains blood vessels and lymph channels.
- Subcutis: This layer is also called the hypodermis or subcutaneous fat and also contains lymph vessels.Ìý
How does melanoma skin cancer develop?Ìý
Melanoma occurs when melanocytes mutate (abnormally change) and grow out of control. This is often related to excessive exposure to ultraviolet (UV) light from natural sunlight or artificial sources, such as indoor tanning beds. The abnormal cells form a spot or lesion that’s usually visible and colored on top of the skin. The spot can be entirely new or evolve from an existing mole on the skin, although melanomas don’t arise from pre-existing moles.
The vast majority of melanomas on the skin (called cutaneous melanomas) are diagnosed before they grow into surrounding areas or spread to other parts of the body (metastasize). Others may grow into nearby tissues (mainly regional lymph nodes) or metastasize to distant sites, like the lungs, liver, or brain.
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Understanding Melanoma
Melanoma Symptoms
People often notice melanoma when it forms a new or changing spot (lesion) on the skin’s top layer. The spot may look or feel different from other moles or freckles, especially if it:
- Is asymmetrical (one half doesn’t match the other)
- Has an uneven border
- Has unusual colors (varying shades of tan, brown, black, or pink)
- Changes in diameter (grows larger)
- Looks like it’s becoming elevated
- Doesn’t match a person’s other moles
Melanomas usually appear on sun-exposed areas of the skin, especially the face, ears, neck, chest, back, and lower legs. However, they can also develop in the eye, on the palms of the hands and soles of the feet, and beneath fingernails and toenails. Melanomas that aren’t related to UV light (like acral melanomas) are the most common type in people with darker skin tones. (Talk to your doctor if you see any new or changing lesions in these areas or anywhere on your skin.Ìý
Melanoma Risk Factors
Certain factors can increase your risk of developing melanoma. Having one or more risk factors does not mean you will develop skin cancer, and some people with no risk factors develop the disease.
Early and ongoing exposure to ultraviolet (UV) light from the sun and tanning beds is the most common cause of melanoma in people with lighter skin tones. Other risk factors include:
- Sun sensitive skin/tendency to sunburn, such as people with red hair
- Presence of many moles, especially larger moles
- Family history of melanoma
Melanoma Skin Cancer TypesÌý
Types of melanoma include:
- Superficial spreading melanoma: This is the most common type of melanoma, especially in people younger than 50 and those with many moles.
- Nodular melanoma: This melanoma type can appear as an elevated pink, tan, or brown bump that tends to grow and bleed.
- Lentigo maligna melanoma: This type most often appears in people older than age 60 or on chronically sun-damaged areas of the face, ears, scalp, neck, and arms.
- Acral lentiginous melanoma: This type of melanoma is the most common in darker-skinned people, who are less sensitive to the sun than those with lighter skin. It typically develops on the palms of the hands, soles of the feet, or beneath fingernails or toenails.
- Ocular melanoma: This rare melanoma subtype develops in the deeper layers of the eyes.
Melanoma Skin Cancer StagesÌý
Staging is a process that reveals if cancer has spread beyond the skin to other sites of the body, and, if so, how far. Understanding the melanoma’s stage helps your medical team determine your prognosis (probable outcome based on large data sets of similar stage cancers) and the optimal treatment plan.
For melanoma, Stages 0 and 1 describe early stages of disease, and Stages 2 through 4 indicate more advanced stages. In general terms, melanoma skin cancer stages are:
- Stage 0: Called melanoma in situ; cancerous cells are confined to the top layer of the skin (the epidermis). Ìý
- Stage 1: Cancer is considered invasive. It has spread deeper into the skin (up to 2 mm thickness in the dermis) but not to the lymph nodes or other body parts. The tumor’s thickness determines the surgical treatment.
- Stage 2: The tumor is thicker than 2 millimeters but has not spread to the lymph nodes or other body parts. Stage 2 tumors may have ulceration (breakdown of the skin’s surface).
- Stage 3: Cancer is in nearby (regional) lymph nodes but not distant lymph nodes or organs.
- Stage 4: Cancer has spread to distant lymph nodes or other organs (like the liver, lungs, brain).Ìý
Diagnosis
To establish or confirm a diagnosis, your doctor reviews your health records and completes a physical exam, particularly of your skin and lymph nodes. Your doctor may recommend certain tests, including:
During a biopsy, your doctor (usually a dermatologist) removes as much of the visible skin tumor as possible. A dermatopathologist examines the tissue under a microscope to determine whether the cells are normal or cancerous.Ìý
Your doctor may recommend genetic testing if you have a family history of melanoma or a confirmed gene mutation related to melanoma. Genetic testing can show whether you have gene mutations that may be targeted by drug therapy (test done on the melanoma tumor) or whether you and your family members are at risk for hereditary (familial) melanoma (test done on a sample of your blood or saliva).
If your doctor suspects the cancer is advanced (has spread), specialized imaging tests are performed to provide detailed pictures of organs below your skin’s surface. A radiologist interprets the images to identify cancer spread.ÌýÌý
Also called blood tests or draws, a small blood sample is removed to analyze for markers of disease spread. Your doctor orders a blood draw if you have a more advanced stage of melanoma or are taking drugs for melanoma that has spread to lymph nodes or other body sites. Blood tests provide a variety of information that helps doctors plan your treatment.
