The doctor will ask about your symptoms and medical history and perform a physical exam. Many cases of melanoma are found during routine physical exams or when doing a skin self-exam.
Skin Exam and Mole Biopsy
The doctor will examine your skin and moles. If any of your moles look like they may be cancerous, the doctor will take a biopsy (tissue sample) and send it to a laboratory for testing. A pathologist will examine the tissue sample under a microscope to check for cancer cells. Other moles will be monitored over time.
Lymph Node Exam and Biopsy
The doctor may also examine lymph nodes in the groin, underarm, neck, or areas near the suspicious mole. Enlarged lymph nodes suggest that the melanoma
have spread beyond the mole. The doctor may need to remove a sample of lymph node tissue (a biopsy) to test for cancer cells.
It is important to know whether the melanoma has extended beyond the tumor site to involve lymph nodes as this changes both the stage of the tumor and the treatment required.
Once melanoma is found, tests are performed to find out the thickness of the primary lesion and whether the cancer has spread and, if so, to what extent. This information helps your doctor to determine which treatment is best for you. Melanoma, like other cancers, is classified according to stages. The lower the stage, the more likely the tumor is to be cured and the easier it is to treat.
Staging is a careful attempt to determine the extent of the cancer invasion. It considers the thickness of the tumor, presence of cancer cells in local lymph nodes, whether the cancer has spread beyond its primary localization and, if it has, what body parts are affected. Additional tests to determine staging may include:
The following stages are currently used to classify melanoma:
Stage 0 –
The abnormal cells are found only in the outer layer of skin and do not invade deeper tissue.
Stage I –
Cancerous cells are in the outer layer of the skin (epidermis) and/or the upper part of the inner layer of skin (dermis), but have not spread to nearby lymph nodes. The tumor is less than 1.5 millimeters (mm) (1/16 inch) thick.
Stage II –
The tumor is 1.5 mm to 4 mm (less than 1/6 in) thick and has spread to the lower part of the dermis, but not into the tissue below the skin or into nearby lymph nodes.
Stage III –
The tumor may be larger or smaller than 4 mm thick, may have spread to lower layers of the skin, may have additional tumor growths within 1 in of the original tumor, may have spread to surrounding lymph nodes, and may be actively spreading to nearby areas of the body.
Stage IV –
The tumor has spread to other organs or to lymph nodes far away from the original tumor.
American Cancer Society
website. Available at:
National Cancer Institute
website. Available at:
Last reviewed January 2007 by David L. Horn, MD, FACP
Copyright © 2007
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