Diagnosing Skin Cancer

Diagnosing Skin Cancer

Skin cancer can usually be treated successfully if caught early. The five-year survival rates for patients whose melanoma has not spread (“in situ” or “localized”) is expected to be 98 percent. Most melanomas (83 percent) are diagnosed at this localized stage. For those whose cancer has spread to nearby (“regional”) lymph nodes, the five-year survival rate is 60 percent, and if it has spread to distant parts of the body, 14 percent. 

Note: a five-year survival rate means a diagnosed patient is disease-free, in remission, or in treatment five years after their initial diagnosis. 

Your initial diagnosis

Most likely, if you are being seen at Seattle Cancer Care Alliance, you have already been diagnosed with cancer. Your referring doctor based his or her diagnosis on a number of initial screenings, examinations, and diagnostic tests, which may have included the following:

  • Medical and family history and physical exam. This appointment includes a series of questions about your age, family history, personal cancer experiences, sun exposure, and other risk factors. Your doctor will ask about your symptoms, when the skin lesion first appeared, and if it has changed in size or appearance. Your doctor will do a complete examination and check the lesion in question, any other suspicious moles or marks, and for enlarged lymph nodes near the lesion. 
  • Biopsy. Certain biopsies provide information about a suspected or known skin cancer. A biopsy involves taking a tissue sample of the suspicious area and sending it to the lab. Next, a pathologist—a specialist who identifies diseases by studying cells and tissues under a microscope—examines your sample. The size and location of the problem helps determine the type of cancer you may have. All biopsies will leave a scar, so discuss your concerns with your doctor beforehand. Common types of biopsies include: 
    • Shave biopsy. A sterile razor blade is used to “shave-off” the abnormal-looking growth. 
    • Punch biopsy. A special instrument called a punch or trephine is used to remove a circle of tissue from the abnormal-looking growth. 
    • Excisional biopsy. A scalpel is used to remove the entire growth.

Second opinions 

Melanoma can be hard to diagnose, so it is reasonable to want to get a second opinion. To fully understand your cancer and discuss the most advisable treatments with you, your skin cancer team will review your referring doctor’s findings and order one or more of the following tests:

  • Wide local excision. This is a surgical procedure to remove some of the normal tissue surrounding the area where melanoma was found, in order to check for cancer cells. 
  • Lymph node mapping and sentinel lymph node biopsy. This is a procedure in which a radioactive substance and a blue dye are injected near the tumor. The substance flows through lymph ducts to the sentinal node or nodes (the first lymph node or nodes where cancer cells are likely to spread). The surgeon removes only the nodes where the substance appears. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. 
  • Computerized tomography. Usually called a CT scan (or “CAT scan”) or computerized axial tomography, this procedure makes a series of detailed pictures of areas inside your body from different angles. A computer linked to an X-ray machine makes the pictures. An iodine-based dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. Pictures may be taken of the chest, abdomen, and pelvis to see if the melanoma has spread. 
  • Chest X-ray. A chest X-ray is an X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through your body and onto film, making a picture of certain areas inside your body.
  • Position emission tomography (PET). A PET scan uses glucose (a form of sugar) containing a radioactive atom. A small amount is injected into your arm. While lying in a PET machine, a special camera detects the radioactivity in any part of your body. Cancer cells generally absorb large amounts of the radioactive sugar and look brighter, so the doctor reading the PET scan can identify them. 
  • Magnetic resonance imaging (MRI). MRI scans use radio waves and strong magnets instead of X-rays. Energy from the radio waves is absorbed by your body and then released in a pattern formed by the type of tissue and by certain diseases, such as melanoma. A computer translates this pattern into a very detailed image of designated parts of your body. 
  • Bone scan. A bone scan looks for abnormalities in your bones. It can focus on a particular joint or bone, but in cancer diagnosis it is more typical to scan the whole body. A small amount of a radioactive substance called a radionuclide is injected into your blood stream. Aside from the injection, the procedure is painless. The scan uses a gamma camera that picks up radioactivity where it collects in your bones, identifying “hot spots” which can indicate bone cancer or other conditions like arthritis. 
  • Laboratory tests. Your doctor may order some medical procedures to test samples of your tissue, blood, urine, or other substances in your body. These tests help diagnose diseases, plan and monitor your treatment, and follow your disease over time.

The next step

Once your tests are completed, your team will have an educated view of your illness and its stage, including whether or not it has spread, and where it has spread. At this point you can begin to consider and discuss treatment options with your SCCA team of specialists.
Ask someone you trust to go with you to doctors' appointments and tests. This person can provide emotional support, help by taking notes at visits, and do research on your disease and treatment options.
Keep all your information, ideas, and questions organized, perhaps in a notebook. Keep a list of questions and concerns to discuss with your team.  

Tips for talking with your doctors

Good communication is the centerpiece of your cancer care. And you can help make it work. One way is to be prepared for appointments with your providers. Here are some ideas to make the most of your visits:

  • Bring a written list of your concerns and questions. Your doctor may not have time to talk about everything on your list, so prioritize items, putting the most important at the top. 
  • Read your list to your doctor and write down her or his answers. Some people bring a tape recorder so they can listen to the conversation at home when they are more relaxed and can take in more information. 
  • Consider bringing a trusted friend or relative to take notes for you to read later. 
  • Tell your doctor and nurse how you are feeling about things. Your SCCA skin cancer team is a group of sympathetic listeners who care about their patients. If your doctor cannot deal with an issue directly, she or he knows who can. 
  • Before you leave your doctor’s office or a treatment appointment, make sure you totally understand all the next steps. At SCCA we work hard to be very clear with our patients. If you don’t understand something, please ask.