NCCN Guidelines for Patients® | Melanoma - page 51

NCCN Guidelines for Patients
: Melanoma
Version 1.2013
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Part 6: A step-by-step treatment guide
Clinical stage:
A rating of
the extent of melanoma
in the body based on the
physical exam, imaging
tests, and biopsy of the
primary melanoma tumor
An area of
abnormal tissue that has
been damaged by disease
or injury
The normal-
looking tissue around the
edge of a tumor removed
during surgery
Shave biopsy:
that removes a thin tissue
sample from the top of a
tumor to test for cancer
See pages 18–20 for
biopsy and pathology
report details.
Part 6.1.1 describes the initial tests recommended for when your doctor thinks you
might have melanoma skin cancer. These tests help your doctor to confirm if you
have melanoma and plan treatment. Your doctor will use these tests to determine
the clinical stage of the melanoma.
Your doctor may test for melanoma if an area of your skin is a darker color and
doesn’t look normal. The lesion may be a mole, blemish, or spot. To confirm if you
have melanoma, all or part of the skin lesion must be removed and tested for cancer
cells. This is called a skin biopsy.
An excisional skin biopsy with 1 to 3 mm margins is preferred for diagnosis. An
excisional skin biopsy removes the entire lesion. The direction and width of the
surgical cut should be done in a way that it won’t affect future treatment. If this can’t
be done, your doctor may perform an incisional skin biopsy or punch biopsy instead.
These biopsies only remove part of the lesion. An incisional skin biopsy or a punch
biopsy may be used for a very large lesion. They may also be used for a lesion
that’s on a part of the body where it can’t be easily removed. If melanoma is unlikely,
your doctor may do a shave biopsy instead. However, this biopsy may not go deep
enough to measure the full thickness of the lesion.
6.1.1 Skin biopsy
Skin biopsy
Area of skin
that is a
darker color
and does not
look normal
• Excisional biopsy
• Incisional biopsy,
• Punch biopsy, or
• Shave biopsy
Pathology report
Results not
clear, retest
to confirm
• Breslow thickness,
• Ulceration status,
• Dermal mitotic rate,
• Surgical margin status,
• Clark level for
lesions ≤1 mm,
• Microsatellitosis if present, and
• Pure desmoplasia if present
6.1 Melanoma testing
mm =
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