Skin Cancer (Cutaneous Oncology) Program

Patient and Family Education

Melanoma

Symptoms and Diagnosis

Melanoma may not cause any significant symptoms until late in the disease. However, if a person notices changes in the appearance of an existing mole or the development of a new skin lesion, this should be examined by a doctor. The simplest way to think about changes in moles or to identify lesions that may be melanoma is by using the ABCDE method which describes some of the characteristic features of melanoma lesions.

A = Asymmetry: Lesions in which one side does not look like the other.
B = Borders: Irregular or ragged edges to a lesion.
C = Color: Changes in color that are noted or lesions that contain a variety of colors.
D = Diameter: Lesions that are greater than 6mm (approximately ¼ inch). This is approximately the size of a pencil eraser.
E = Enlarging: Lesions that have increased in size.

When a person with a skin lesion that is potentially a melanoma is seen by a doctor, the doctor will perform a history and physical examination. The doctor will ask questions related to the risk factors for melanoma and will focus on specific changes in the mole or lesion that is of concern. The physical examination will include a full body skin exam, as well as examination of any swellings in the neck, the underarm area, and the groin, which may indicate spread of the disease.

In order to make a diagnosis of melanoma, a piece of tissue from the skin lesion must be taken and evaluated. This is done by performing what is called a biopsy. There are generally two ways in which a biopsy may be performed for melanoma:

Punch biopsy: A punch biopsy is performed using a circular cutting device that takes out a cylinder of skin tissue. The biopsy device cuts through all layers of the skin using a circular motion down to the fat layer which is called the subcutaneous (below the skin) tissue. When performing a punch biopsy, a small amount of numbing medicine is injected into and around the lesion and then the core of tissue encompassing the lesion is removed. The skin defect is usually closed with 1 or 2 sutures. Punch biopsies are generally used in cases where the entire lesion may be removed by the punch biopsy device.

Excisional or incisional biopsy: An excisional or incisional biopsy is performed by using a scalpel (knife) to remove a sample of tissue. An excisional biopsy is generally used when the lesion is bigger than the usual punch biopsy devices but not so large that it will leave a large skin defect. An incisional biopsy is generally used for larger lesions when only a portion of the tissue is going to be sampled. In both cases, the biopsy area is injected with numbing medicine and then a piece of skin tissue is removed. As with the punch biopsy, the tissue sample will include all layers of the skin down to the fat layer. The biopsy site is then closed with several sutures.

Once a piece of the skin tissue is obtained, it is sent to a doctor who is specialized in looking at body tissues and can determine whether melanoma is present.

This page was last updated on: October 19, 2009.