Diagnosis and Treatment

If you have a skin lesion or abnormality but do not yet know the cause, your doctor may order tests to gather more information. Common tests include a physical exam and biopsy. Once your tests are complete, your doctor will discuss the results, confirm your diagnosis and decide on next steps with you.

Diagnosing your tumor

  • Medical history - We will review your medical history to look for clues that might show what type of lesion or tumor you have and what caused it.
  • Skin exam - Your doctor will examine your skin for moles, birthmarks or other pigmented areas that look abnormal in color, size, shape or texture.
  • Imaging studies - For many skin cancers that have begun to spread, radiological imaging studies are the most valuable initial tool that we have. We will review any prior X-rays, CT (CaT) scans, MRIs or other scans you have received. You may be asked to undergo more imaging.
  • Blood chemistry studies - Sometimes sending a blood sample to a D-H lab for analysis is useful in determining how far a cancer may have spread.
  • Biopsy - A biopsy is used to remove the abnormal tissue and a small amount of normal tissue around it. The tissue sample will be examined by a pathologist for evidence of cancer cells.
  • Molecular testing (e.g., V600EBRAF) - Almost half of all melanoma patients have a mutation in a gene called BRAF. In clinical trials, metastatic melanoma patients are being tested for the BRAF mutation to determine the best treatment.

Treating your tumor

Your treatment will vary based on your diagnosis and preferences.

Many lesions are treated by continued observation, physical exam, and imaging studies. Some benign tumors need surgery and/or the use of additional treatment such as chemotherapy and radiation, but this is rare.

Malignant tumors generally need some combination of surgery, chemotherapy and radiation.

  • Surgery is the physical removal of the tumor. Malignant tumors are removed along with a region of healthy tissue around the tumor to ensure that no tumor is left behind. The lymph nodes that are closest to the melanoma may also be removed to test for evidence of cancer.
  • Radiation therapy is the application of ionizing radiation to the tumor to cause damage to the tumor’s DNA and prevent the tumor cells from dividing.
  • Immunotherapy uses the immune system to fight the cancer.
  • Targeted therapy is a type of treatment that uses drugs that target cancer cells while causing less harm to healthy cells.
  • Chemotherapy is the infusion of medications that are toxic to the tumor with the goal of killing the tumor. Chemotherapy is becoming less commonly used for melanoma as newer effective immunotherapies are developed.