Malignant Melanoma Diagnosis
Malignant melanoma has the best chance of recovery if it is detected at an early stage. Therefore, it is important to examine the skin regularly for changes and show conspicuous nevi (birthmarks) to a doctor or to observe. This is especially true for high-risk patients . This self-control can be done well using the ABCDE criteria and can be done together with the partner.
The suspicion of a malignant lesion may arise in addition to the self-examination in the context of a routine examination or a professional skin cancer screening . First step of the further diagnostics is then the confirmation of the clinical suspicion finding.
In the first step, a tissue sample is taken from the suspicious area of the skin. This procedure is called “biopsy” and can be done in two different ways:
Excisional biopsy is the preferred biopsy for suspected melanoma. It includes the complete removal of the suspicious lesions, including a safety distance of 1 to 3 millimeters from the surrounding tissue. Usually excisional biopsy can be performed under local anesthetic (local anesthesia).
In an incisional biopsy, only a portion of the suspicious lesion is initially removed. It is used for very large findings or those that are located on body parts such as the face, palms or soles. At such cosmetically or functionally important sites, the diagnosis should be confirmed before the entire skin area is removed.
The biopsy sample is subsequently examined in a laboratory by a pathologist.
The histologic examination of the extracted tissue in the laboratory currently provides the safest method of distinguishing between a benign and a malignant lesion. If the suspected diagnosis of “malignant melanoma” is confirmed, this laboratory diagnosis, also known as “microstaging”, will be followed by further investigations that are decisive for the type of treatment .
In the case of microstaging, the following factors in particular are examined and assessed:
Type of melanoma tumor thickness Invasiveness (How deep is the melanoma already embedded in the lower layers of the skin?) Ulceration (Has the tumor already breached the uppermost layer of skin? This change is partially invisible to the naked eye.)
The results of this study are the basis for an initial assessment of the stage in which the malignant melanoma is located. In the early stages, healing through the complete surgical removal of the tumor is often possible. However, if melanoma is discovered later, it is often impossible to cure it.
Depending on the findings, additional diagnostic steps are performed in addition to the microstaging, for example a repeated, very thorough examination of the skin on the entire body (including the head and genitals) or an examination of the lymphatic or lymph nodes. Special X-ray and blood tests are performed to find any metastases in the body. On the basis of these and other criteria, initial statements on the metastasis risk and the prognosis (assessment of the course of the disease) can be made.
If the melanoma has penetrated more than a millimeter deep into the skin, a biopsy of the so-called sentinel lymph node is also recommended.
For the choice of therapy then the so-called staging of the tumor is crucial.
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