NCCN Guidelines for Patients® | Melanoma

21 NCCN Guidelines for Patients ® : Melanoma, 2018 2  Tests for melanoma Tumor tissue tests With local anesthesia, you’ll feel a small needle stick and a little burning with some pressure for less than a minute. Then, there will be a loss of feeling in that area for a short time. You may feel a little pressure during the biopsy, but no pain. After the biopsy, your doctor may close the wound with sutures (for a punch or elliptical biopsy) and a bandage. There are usually no side effects, but scars can form after biopsies. If you are on blood thinners, adjustments may be needed before a biopsy can be done. At the lab Your doctor will send the biopsy tissue sample to a lab so a pathologist can examine it with a microscope for cancer cells. A pathologist is a doctor who’s an expert in testing cells and tissues for disease. A pathologist who has experience with skin lesions should examine the biopsy sample. If the pathologist finds melanoma cells, he or she will assess if the cells are growing into the dermis and measure how deeply they are growing. The pathologist will also assess other features of the melanoma and describe them in the pathology report. If test results of the first biopsy are unclear, your doctor may perform another biopsy. Or, the pathologist may do other tests on the tissue sample. If the pathologist finds cancer cells in the biopsy sample, your doctor may order more tests. Though rare, depending on the extent of the melanoma, other tests may be done to see if it has spread. Cancer that has spread from the first tumor to other sites in the body is called a metastasis. Metastases are more likely if the skin tumor has grown deep into the dermis—the second layer of skin. The next section describes how pathology results help to stage melanoma and the possible tests that may be used to check for metastases. Figure 7. Punch biopsy A punch biopsy uses a sharp hollow device—like a cookie cutter—to remove a deeper sample of both skin layers. As with a shave biopsy, it can be partial or excisional. Illustration Copyright © 2017 Nucleus Medical Media, All rights reserved.