53 NCCN Guidelines for Patients ® : Melanoma, 2018 5 Treatment guide Melanoma testing Superficial shave biopsies are not recommended to confirm (diagnose) melanoma since they may not go deep enough to measure the full thickness of the lesion. The exception is in the setting of the lentigo maligna type of melanoma in situ, where a broad shave biopsy may help to accurately diagnose the lesion under the microscope. 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. Read page 22 for details on what should be included in the pathology report. If test results from the first biopsy are unclear, your doctor may perform another biopsy. Or, the pathologist may do other tests on the tissue sample. Medical history and physical exams After your doctor has confirmed that you have melanoma, he or she will talk with you about the diagnosis and may order more tests. Your doctor will ask about your medical history, including your general health, 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 many moles or atypical-appearing moles, fair skin, prior sunburns, red hair and very fair complexion, prior tanning bed use, or if you or any of your family members have had melanoma. During the physical exam, your doctor will note the current size, shape, color, and texture of the melanoma tumor. Any bleeding 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 melanoma. The clinical stage is a rating of the extent of melanoma in your body based on tests done before surgery. Which tests and treatments you will have next depends on the clinical stage of melanoma. (Read Part 3 on page 28 for more details on melanoma stages.) Next steps For stages 0, I, and II melanoma, see Guide 8 on page 54. For stage III melanoma, see Guide 11 on page 58. For stage IV melanoma, see Guide 20 on page 71.