Cancer Melanoma Evaluation
The evaluation of malignant melanoma begins with a history and physical exam.
Physical findings in moles that may indicate malignant melanoma include:
- Irregular border
- Mixed color
- Irregular shape
- Rapid change in size or shape
- Rapid change in color, such as black
- Size larger than 6 mm (about the size of a pencil eraser)
Tests that may be used to evaluate malignant melanoma include:
- Skin biopsy:
- A skin biopsy is required to confirm the diagnosis of malignant melanoma.
- This allows the pathologist to stage the cancer and can provide vital information about the cancers risk for spread.
- Sentinel lymph node biopsy:
- The sentinel node is the lymph node that is at highest risk for melanoma spread (should it occur).
- Once the sentinel node is identified, a lymph node biopsy is performed to look for cancer.
- If the sentinel node does not contain cancer, then the other lymph nodes should be free of cancer.
- Not all melanomas need to have a sentinel node biopsy performed.
More advanced tests to look for distant spread of cancer in the body include:
Cancer Melanoma Staging
Staging a melanoma is an important process because it guides treatment decisions and helps to predict outcome. There are a number of factors that are considered when staging melanoma.
- Tumor thickness:
- Usually reported using Breslow's thickness scale (measured in millimeters)
- Breslow's thickness is the single most important feature determining outcome and treatment.
- Clark's level of invasion:
- Determined by the doctor looking at the cells under the microscope
- The deeper the penetration into the layers of the skin the higher the Clark's score.
- Presence of ulceration:
- Ulcerated lesions are more prone to spread
- Level of mitosis in the melanoma:
- Mitosis is a process that cells go through in order to multiply.
- Higher levels of mitosis indicate a faster growing melanoma
- Tx: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Melanoma in-situ:
- Limited to the superficial layer of skin, without spread to deeper layers.
- T1: Melanoma is less than or equal to 1 mm thick; with or without ulceration
- T1a: Melanoma is less than or equal to 1 mm thick with no ulceration and Clark's level 2 or 3
- T1b: Melanoma is less than or equal to 1 mm thick with ulceration and Clark's level 4 or 5
- T2: Melanoma is 1 to 2 mm thick; with or without ulceration
- T2a: Melanoma is 1 to 2 mm thick with no ulceration
- T2b: Melanoma is 1 to 2 mm thick with ulceration
- T3: Melanoma is between 2 and 4 mm thick; with or without ulceration
- T3a: Melanoma is between 2 and 4 mm thick with no ulceration
- T3b: Melanoma is between 2 and 4 mm thick with ulceration
- T4: Melanoma is over 4 mm thick; with or without ulceration
- T4a: Melanoma is over 4 mm thick with no ulceration
- T4b: Melanoma is over 4 mm thick with ulceration
Additional staging factors include:
- Presence or absence of regional lymph node spread
- Presence or absence of distant metastasis:
- Spread to another organ such as the lungs, liver, brain, bone, GI tract, pancreas, lymph nodes, and to distant sites on the skin.
Continue to Cancer Melanoma Treatment
- Brown TJ, Nelson BR. Malignant melanoma: a clinical review. Cutis. 1999 May;63(5):275-8, 281-4. 
- Ruiz-Maldonado R, Orozco-Covarrubias ML. Malignant melanoma in children. A review. Arch Dermatol. 1997 Mar;133(3):363-71. 
- Schuchter LM. Review of the 2001 AJCC staging system for cutaneous malignant melanoma. Curr Oncol Rep. 2001 Jul;3(4):332-7.