NCCN Guidelines for Patients® | Melanoma

52 NCCN Guidelines for Patients ® : Melanoma, 2018 5  Treatment guide Melanoma testing Part 5 is a guide through the treatment options for people with melanoma. This information is taken from the treatment guidelines written by NCCN experts of melanoma. These treatment guidelines list options for people with melanoma in general. Thus, your doctors may suggest other treatment for you based on your health and personal wishes. Fully discuss your treatment options with your doctor. Melanoma testing Guide 7 shows the initial tests that are recommended when your doctor thinks you might have melanoma skin cancer. These tests help your doctor to confirm (diagnose) melanoma and plan treatment. Your doctor may test you for melanoma if an area of your skin is darker in color and doesn’t look normal. The abnormal-looking area—called a 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. (See Part 2 on page 18 for skin biopsy details.) An excisional biopsy can be done with an elliptical, deep shave/saucerization, or punch technique. (See page 20 for details.) Narrow surgical margins (1–3 mm) are preferred in order to remove the entire skin tumor for diagnosis. An excisional biopsy removes the entire lesion along with a small amount of normal-looking skin around its edge. The normal- looking skin removed is called the surgical margin. This type of biopsy is preferred for a diagnosis of melanoma. 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 biopsy or partial biopsy instead. This type of biopsy only removes part of the lesion. A partial biopsy may be used for a very large lesion or for a lesion that’s on a part of the body where it can’t be easily removed. Guide 7. Skin biopsy Signs or symptoms Skin biopsy Pathology report • Area of skin that doesn’t look normal • Assess melanoma- related risk factors ª Excisional biopsy ª • Breslow thickness • Ulceration status (present or absent) • Dermal mitotic rate • Surgical margin status • Microsatellitosis (present or absent) • Pure desmoplasia if present Incisional biopsy Punch biopsy Shave biopsy