At Penn Medicine, our skilled melanoma and skin cancer specialists have experience recognizing the signs of melanoma in its early stages so you can begin treatment right away.
Diagnosing melanoma: The Penn Medicine advantage
Penn Medicine is nationally known for exceptional care. Our program offers:
- Team of melanoma experts: Our highly trained doctors have years of experience in oncology (cancer care), dermatology, pathology (disease diagnosis), surgery, and other fields. We bring together our expertise in weekly team meetings, where we review complex cases from all perspectives.
- Sophisticated testing: We use a variety of biopsy techniques, tumor mutation testing, and other methods as appropriate.
- Individualized treatment: With an accurate diagnosis, we work closely with you to plan effective, customized care. We offer the latest melanoma treatment options, including Mohs surgery, immunotherapy, and targeted therapy, many of which can provide a cure.
Initial melanoma evaluation
Whether you come to us with potential symptoms or a confirmed diagnosis, we evaluate your situation thoroughly. We tailor the plan to you, but our cancer specialists begin by:
- Discussing your symptoms and possible risk factors
- Reviewing your personal and family medical history
- Ordering tests to confirm a diagnosis
Diagnosing melanoma of the skin
To diagnose melanoma of the skin, we do a physical exam and a complete skin exam to check for moles or suspicious skin growths. To closely examine your skin, our doctors use a dermatoscope, which has a special magnifying lens and light.
If we see a suspicious-looking growth, we order tests to help us confirm a diagnosis. A skin biopsy is our main tool for confirming a diagnosis of melanoma skin cancer.
During a biopsy, we take a small tissue sample of the suspicious area. Our dermatopathologists (specialists in diagnosing skin diseases) examine the sample under a microscope for signs of melanoma.
We do several types of skin biopsy, including:
- Shave biopsy: The doctor removes the top few layers of skin in a growth.
- Punch biopsy: Using a tool with a tiny circular blade, we take a deeper tissue sample of all the layers of skin.
- Excisional biopsy: In this procedure, the doctor removes the whole growth and a small margin (border) of skin around it.
If a skin biopsy confirms melanoma, we do further tests to see if the cancer has spread. When melanoma spreads, it usually travels to nearby lymph nodes. Lymph nodes are part of the lymphatic system, which helps filter waste, infections, and other substances from the body.
Tests to check for cancer spread include:
- Fine needle aspiration biopsy: We use a syringe with a thin needle to take small samples of tissue. This test examines tissue from nearby lymph nodes.
- Sentinel lymph node biopsy: Near the tumor, we inject a dye that travels to nearby lymph nodes. The closest lymph node or nodes (sentinel nodes) pick up the dye. We remove those nodes and check them for cancer cells.
These tests help guide your treatment planning:
- Tumor mutation testing: We recommend genetic testing of the melanoma tumor in anyone with advanced melanoma, which is stage III or higher. Advanced melanoma has spread from its original site to nearby tissue and distant areas of the body. Genetic testing can show if the tumor or melanoma has specific gene mutations (changes) that targeted therapy can treat.
- Imaging: We may use imaging to see if melanoma has spread to other areas of the body. Our advanced imaging technologies include CT scans, MRI scans, PET/CT scans, and ultrasound.
Diagnosing mucosal melanoma
If we suspect mucosal melanoma in your initial evaluation, we take a biopsy to confirm a diagnosis. If the biopsy finds cancer cells, we may request MRI or CT scans to see whether the cancer has spread.
Diagnosing eye (ocular) melanoma
Ocular melanoma may not show symptoms early on. Your ophthalmologist may discover it during a routine eye exam. Additional tests that you might need include:
- Eye ultrasound: A handheld scanner uses high-frequency sound waves to produce images inside the eye to help diagnose ocular melanoma.
- Biopsy: Your ophthalmologist removes a small sample of tissue from the surface of the eye. Our pathologists examine the sample for signs of melanoma.
- Fluorescein angiography: We first inject dye into your arm. The dye travels to blood vessels in the eye. A specialized camera takes pictures of the retina (back of the eye) to check for any problems.
Second opinions for melanoma
An accurate diagnosis is critical so that you can get the right treatment as soon as possible. At Penn Medicine, our Melanoma and Skin Cancer Care specialists work together to confirm a diagnosis and recommend treatments.
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.