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Medical Attention
melanoma medical attention

Medical Attention

Many people don't realize that something small on their skin can kill them if not treated promptly. The main goal is recognizing and quickly removing any lesions that are suspicious for melanoma. Many lesions that are removed will not prove to be malignant.

If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, who will look at the area more closely. If the doctor thinks a melanoma might be present, he or she will take a sample of skin from the suspicious area for exam under a microscope. This is called a skin biopsy. Different methods can be used for a skin biopsy. After identifying a suspicious lesion, a properly performed biopsy is essential. In the event that melanoma is diagnosed, the interpretation of the biopsy under a microscope will determine the prognosis and treatment plan. An accurate pathology report depends on the quality of the biopsy. It is not unusual to miss the diagnosis due to a poorly performed or inappropriately performed skin biopsy.

Incisional and Excisional Biopsies

If the doctor has to examine a tumor that may have grown into the deeper layers of the skin, he or she will perform an incisional or excisional biopsy. An incisional biopsy removes only a portion of the tumor. An excisional biopsy removes the entire tumor, and is usually the preferred method of biopsy for suspected melanomas. After numbing the area with a local anesthetic, a scalpel is used to cut through the full thickness of skin. A wedge or sliver of skin is removed for further examination, and the edges of the wound are sewn together.

Shave Biopsy

For this type of biopsy, the doctor first numbs the area with a local anesthetic. The doctor then "shaves" off the top layers of the skin (the epidermis and the outer part of the dermis) with a surgical blade. A shave biopsy is useful when the risk of melanoma is very low. But it is not generally recommended if a melanoma is suspected because a shave biopsy sample may not be thick enough to measure how deeply the melanoma has invaded the skin.

Punch Biopsy

A punch biopsy removes a deeper sample of skin but is more limited in the diameter of the sample that can be taken. The doctor uses a tool that looks like a tiny round cookie cutter. Once the skin is numbed, the doctor rotates the punch biopsy tool on the surface of the skin until it cuts through all the layers of the skin, including the dermis, epidermis, and the upper parts of the fat layer.

All skin biopsy samples are looked at under a microscope. The skin sample is sent to a pathologist, a doctor who has been specially trained in the microscopic examination and diagnosis of tissue samples. Often, the sample is sent to a dermatopathologist, a doctor who has special training in making diagnoses from skin samples. The results are often available in about a week. Never leave the doctor's office with instructions "no news is good news". Insist that you want to be notified of the biopsy results.

Information on this page has been cited from the Melanoma Research Foundation (www.melanoma.org) - 2011