NCCN Guidelines for Patients
Part 6: A step-by-step treatment guide
After the skin biopsy, the tissue sample will be sent to
a pathologist to be tested for cancer cells. A pathologist
who has experience with skin lesions should examine
the biopsy sample. A pathology report is a document with
information about tissue removed from your body during a
biopsy or surgery. The pathology report should include a
number of important results from the biopsy examination
(see page 20). If the biopsy test results are unclear, the
pathologist may perform other tests on the tissue sample.
Your doctor may also order another biopsy.
For recommended tests after the biopsy, see
the next section, Part 6.1.2.
Part 6.1.2 shows the tests recommended after your doctor
has confirmed that you have melanoma. For your medical
history, your doctor will ask about general symptoms,
changes in the look and size of the tumor, and any lifetime
medical conditions. Your doctor will also assess your risk
for melanoma. A risk factor is anything that increases the
chance of getting a disease. Your risk is higher if you have
had melanoma before, have a history of unusual moles,
or if any of your immediate family members have had
During the physical exam, your doctor will note the current
size, shape, color, and texture of the tumor. Any bleeding
and scaling will be recorded. Your doctor will feel your
lymph nodes and organs near the lesion to check if they
are normal in size and firmness. A complete skin exam will
be done to check for other unusual spots or moles.
Based on the biopsy test results, pathology report, and
physical exam, your doctor will determine the clinical stage
of the melanoma. Which tests and treatments you receive
next depends on the clinical stage of melanoma.
For stages 0, I, and II, see Part 6.2. For stage
III, see Part 6.3. For stage IV, see Part 6.5.
6.1.2 Medical history and physical exams
• Medical history,
• Physical exam with focus on nearby lymph
nodes and organs,
• Complete skin exam, and
• Assessment of risk factors for melanoma