How is melanoma skin cancer diagnosed?

If an abnormal area of ​​skin to cause skin cancer suspected, your doctor will use a certain medical examinations and tests to find out whether it is melanoma, non-melanoma skin cancer, or some other skin condition. If melanoma is found, other tests may be done to determine whether it has spread to other areas of the body.

Medical history and physical examination

Typically, the first step is your doctor your medical history. Your doctor may ask when it first appears on the skin tag, if it has changed size or appearance, if it has caused any symptoms (pain, itching, bleeding, etc.). You can also ask about skin cancer (including sunburn) known reason, if your family had skin cancer risk.

In the physical examination, the doctor will note area (S) of the size, shape, color, texture, whether there is bleeding or scaling. You can check the rest of your body spots and moles, may be associated with skin cancer.

Doctors may also be in the groin, armpit or neck abnormal sensation under the skin near the lymph nodes (small bean-shaped collections of immune cells). Melanoma proliferation, it often go to the nearby lymph nodes. Lymphadenopathy may indicate the existence of any melanoma may have spread.

If you are seeing your doctor suspected melanoma, you may be referred to a dermatologist (skin doctors professional), who will be in the region more closely.

Along with the standard physical examination, many dermatologists use a technique called dermatoscopy (also known as dermoscopy, epiluminescence microscope [Yulin], or the surface of the microscope), more clearly see spots on the skin. Doctors use a skin mirror, which is a special magnifying lens and a light source near the skin. Sometimes, a thin layer of oil to use with this instrument. Your doctor may be taken on-site digital photos.

When you use by experienced dermatologists, this test can improve the early detection of skin cancer accuracy. It can often help to ensure that your spots on the skin, may be benign (non-cancerous), without the need for biopsy.

Skin biopsy

If the doctor thinks a point may be melanoma, he or she will take a sample from a suspect the skin looked at under the microscope. This is called a skin biopsy.

Different methods can be used a skin biopsy. Your doctor will choose an affected area, which is on your body, and other factors on the basis of size. Any biopsy is likely to retain at least a small scar. Different methods may lead to different types of scars, so ask your doctor about the scar biopsy ago. No matter what type of biopsy is done, it should be suspected area, remove as much as possible, so you can accurately diagnose.

Skin biopsies using a local anesthetic agent (local anesthetic), this is a very small needle-injection region. You may feel a small prick and drug injecting a little bit of tingling, but you should not feel any pain biopsy.

Shave Biopsy

For this type of biopsy, the doctor first with a local anesthetic numbs the area. The doctor then shave off the top layer of skin, with minor blade. Generally only the outer layer of the epidermis and dermis portion is removed, but deep, and, if necessary, can be taken. Bleeding from the biopsy site, and then apply ointment or small current stopped burning wound.

Shave biopsy is useful in the diagnosis of a variety of skin diseases and sampling mole melanoma risk is very low. Superficial shave biopsy is generally not recommended, if melanoma is suspected shave biopsy sample, except to go deep enough to make the following suspicious areas. Otherwise, it might not thick enough to measure how deep the melanoma has invaded the skin.

Punch biopsy

Remove the skin punch biopsy samples deeper. Doctors use a tool that looks like a tiny round cookie cutter. Once the skin numb the local anesthetic, the doctor rotary punch biopsy of the skin on the surface of the tool, until it passes through all layers of the skin, including the dermis, epidermis and the subcutaneous tissue of the upper part. The edge of the biopsy site, and then sewn together.

Incision biopsy

To check the deeper layers of the skin may have grown into a tumor, the doctor may use cut or excisional biopsy. Numb the area with a local anesthetic, use a scalpel to cut through all layers of the skin. Wedge or silver skin examination, and remove the edges of the wound stitched together.

Incision biopsy removes only part of the tumor. Excisional biopsy removes the entire tumor, which is usually suspected melanoma biopsy method of choice if it can be done. But it is not always possible, therefore, may require other types of biopsies.

Melanoma biopsy may have spread

In some cases, it may require a region other than the skin biopsy. For example, if you have been diagnosed with melanoma in the skin, may be nearby lymph node biopsy to see if the cancer has spread so far (or farther).

In rare cases, you may need to biopsy to figure out what type of cancer it was. For example, some melanoma may spread rapidly, so they reach the lymph nodes, lungs, brain, or other areas, while the original skin melanoma is still small. Sometimes, these tumors were found before melanomas found on the skin. In other cases, they may be found shortly after cutaneous melanoma has been removed, so it is not clear, which may be the same cancer.

In other cases, it may be found somewhere in the body melanoma, did not find a spot on the skin. This may be because some of their own skin lesions go (without any treatment), its cells have spread to other parts of the body. Melanin also began in the internal organs, but this is very rare, if melanoma spread widely throughout the body, it may be unable to distinguish the tumor is first.

Thus, when it has spread in certain organs of metastatic melanoma cancers begin in the institution may be confused. For example, melanoma has spread to the lungs, may be confused with primary lung cancer (lung cancer at the beginning).

Special tests can do a biopsy specimens, it can tell whether it is melanoma or some other type of cancer. This is important, because the treatment of different types of cancer in different ways.

These types of samples than that used for skin biopsies, may be more complicated.

Fine needle aspiration biopsy

A fine needle aspiration biopsy (FNA) does not use suspicious mole, but it can be used near a large lymph node biopsy in melanoma, to find out whether melanoma has spread to them. For this type of biopsy, doctors use a thin, hollow needle and syringe to remove very small fragments of tissue from the tumor. Needle is smaller than for a blood test needles. Local anesthesia is sometimes used to numb the area. Test rarely causes much discomfort, leaving no scars.

If the lymph nodes near the surface, doctors often feel not good enough to guide the needle. For a suspicious lymph node or tumor deep in the body of the internal organs such as the lungs, liver, ultrasound or computed tomography (CT) scan (a special type of X-ray, see the following "test image") is typically used to guide place the needle.

FNA biopsy invasive biopsy is not a number of other types, but they do not always provide enough sample to tell if there is melanoma. In these cases, you may need more invasive different biopsy.

Lymph node biopsy surgery

This procedure can be used to remove the lymph nodes, a small incision through the skin. Commonly used local anesthetic, if nodes near the surface of the body, but a person may require sedation or even asleep (general anesthesia), if the node deep in the body.

If the size of the lymph nodes showed that melanoma has spread, but the node FNA biopsy was not done, or did not find any melanoma cells, this type tend to do a biopsy.

Sentinel lymph node biopsy

If you have been diagnosed with melanoma, have any questions about functions (such as at least a certain thickness), sentinel lymph node biopsy to determine whether it has spread to nearby lymph nodes, which in turn may affect the treatment plan is often done. This test can be used to find the lymph nodes, melanoma will probably go in the first place, and if it has spread. That's why these are called sentinel lymph nodes (they stood sentinel, or watch, the tumor, so to speak).

To locate the sentinel lymph node (or nodes), a small amount of radioactive material injected doctors (sometimes blue dye) into the area of ​​melanin. After an hour or so, the doctor will examine the various lymph node regions radioactive probe (like a Geiger counter). A small incision is made in determining lymph node area. Lymph node, and then check and found that () turns blue or radioactive. The sentinel lymph node is removed and looked at under a microscope.

If the sentinel node does not contain melanocytes, no more lymph node surgery is necessary, because it is unlikely that melanoma has spread beyond this point. If the melanoma cells were found in the sentinel lymph node, to remove the remaining lymph nodes in this area, and watching. This is called a lymph node dissection (see "melanoma skin cancer surgery").

If melanoma is near abnormally large lymph nodes, sentinel lymph node biopsy may not be needed. Expand node biopsy only.

Laboratory testing biopsy specimens

Do you have any biopsy samples will be sent to a laboratory pathologist (who is specially trained physicians to diagnose disease) on melanoma cells under a microscope to see them. Typically, the skin sample sent dermatologist, a doctor who has special training samples from the skin for diagnosis.

If you are not sure to tell your doctor if the sample contains melanocytes, just looking at it, you can do a special test cell, to endeavor to confirm the diagnosis. The names of these tests, such as immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), comparative genomic hybridization (CGH).

If the sample contains melanin, a pathologist will look at some important features, such as tumor thickness and mitotic rate (actively dividing cells) part. These features help determine stage melanoma (see section "How is melanoma staged?"), Which in turn affect treatment options and prognosis (outlook).

People who have advanced melanoma, biopsy samples for testing, if cells have the BRAF gene mutation. About half have BRAF mutations in melanoma. Some of the newer drugs for the treatment of advanced melanoma only possible work if cells have the BRAF gene mutations (see "targeted therapy of melanoma skin cancer"), so this test is very important to help to determine the treatment programs.

Imaging

Tested using the X-ray imaging, magnetic, or radioactive substances inside the body create a picture. They are mainly used to find melanoma may spread to lymph nodes or other organs in the human body. They do not need people very early melanoma, which is unlikely, has spread.

Imaging can be done to help determine how to handle the work or looking after cancer treatment may be signs of recurrence.

Chest X-ray

This test can be done to help determine whether the melanoma has spread to the lungs.

Computed tomography (CT) scan

CT scan is a type of X-ray test to produce detailed, cross-section of your body image. Unlike X-rays, CT scans can show soft tissue (such as organs) in detail. This test can help tell if enlarged lymph nodes or organs, such as the lungs or liver suspicious spots, which may be due to the spread of melanoma. It can also help show spread to the lungs than a standard chest X-rays.

Take a picture, but as a normal X-ray, CT scanner takes a lot of pictures, because it wraps around you. A computer, then these pictures to the part of your body, is currently studying the detailed images.

Before scanning, you may be asked to drink a contrast solution and / or intravenous (IV) injection of contrast agent, helps to better outline abnormal areas of the body. You may need intravenous injection of contrast agent through the line. Injection can cause some flushing (a feeling of warmth, particularly in the face). Some people are allergic and hives or rarely, more serious reactions such as difficulty breathing and low blood pressure. Be sure to tell your doctor if you have any allergies or has been used in any X-ray contrast material reactions.

Than ordinary X-ray CT scans take longer. You need to lie still on a table while they're doing. During the test, the table slide in and out of the scanner unit completely around the annular form. You might feel a bit confined to lie when you have a picture being taken ring. Spiral CT (also known as spiral CT), using faster machines to produce a more detailed picture is now used in many medical centers.

CT-guided needle biopsy: CT scans can also be used to help guide the biopsy needle is inserted into the body of a suspicious area. In this process, you stay in the CT scan table, and radiologists will biopsy needle through the skin and toward the suspect areas. CT scans repeated until the needle is in the public. Biopsy samples were then removed and looked at under a microscope.

Magnetic resonance imaging (MRI)

Like CT scans, MRI scans give detailed images of the body's soft tissues. However, MRI scans use radio waves and strong magnetic fields, rather than X-rays. The energy from the radio waves absorbed by the body, and are released into the body tissue by a different pattern formed, and by certain diseases. A computer model into a very detailed image of parts of the body. Contrast agent may be injected, as a CT scan, but not frequently used.

In looking at the brain and spinal cord MRI scan is very helpful.

MRI scans take longer than CT scans - often up to an hour. You may have to lie in it, which is a narrow tube circumference can offend people, fear of enclosed spaces. Newer, more open MRI machines can sometimes be replaced. MRI machine makes a loud buzzing sound, you will find disturbing. Some places offer help stop this noise earplugs.

Positron emission tomography (PET)

For a PET scan, you will receive a radioactive substance (usually a type of sugar and glucose, known as FDG) injection. The amount of radioactivity used is very low. As the rapid growth of cancer cells in the body, but they will absorb a lot of the radioactive sugar. After about an hour, you are moved to a table in the PET scanner. You lie on the table for about 30 minutes, while a special camera creates a picture of radioactive substances in the body region. Image not delicate, such as CT or MRI scan, but it can provide useful information for your entire body.