NCCN Guidelines for Patients® | Melanoma - page 52

NCCN Guidelines for Patients
Melanoma, Version 1.2014
Treatment guide
Melanoma testing
5.1 Melanoma testing
Chart 5.1.1
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
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. (Read Part 2 on page 17 for skin biopsy
An excisional biopsy with 1- to 3-mm surgical margins
is preferred 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.
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 punch biopsy instead. These
biopsies only remove part of the lesion. An incisional
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
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 19 for details on what should be included 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
Skin biopsy
Pathology report
Area of skin that’s
a darker color, or
doesn’t look normal
• Excisional biopsy
• Incisional biopsy,
• Punch biopsy, or
• Shave biopsy
Chart 5.1.1 Skin biopsy
• Breslow thickness,
• Ulceration status,
• Dermal mitotic rate,
• Surgical margin status,
• Clark level for lesions <1 mm,
• Microsatellitosis (present or absent),
• Pure desmoplasia if present
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