what tests will I have?

If you think that you may have melanoma, you will need to see your GP. Your GP will ask you questions about your symptoms and examine the area of skin troubling you. She or he may ask about your lifestyle and family history.

If your GP decides the condition is suspicious, she or he may then send you to see a specialist doctor at the hospital. There are cancer referral guidelines to help GPs decide who needs to see a specialist, and how quickly.

Suspected Melanoma

You should see your GP if you have a mole on any part of your body that has any of the following symptoms:

• it is changing shape, particularly if the edge is getting irregular
  
  
• it is getting bigger
  
  
• it is changing colour – getting darker or becoming patchy or multi-shaded
  
  
• it is painful, itchy, bleeding, ulcerated or inflamed

If your GP thinks it is possible that you have melanoma, you will be referred to a dermatologist (a doctor who specialises in skin problems). At the clinic you are likely to have a full skin examination. Photographs may be taken of some areas of your skin for future reference.

Biopsy
There is only one test to diagnose melanoma, and that is biopsy. This means that a piece of body tissue is taken for examination under a microscope to look for signs that cells have turned cancerous.

Excisional biopsy is the standard treatment. In a few cases an incision biopsy may be undertaken. The biopsy is usually undertaken at a day surgery unit, and a local anaesthetic is used to numb the skin:

• excision biopsy
  In this procedure the area around the spot is swabbed with antiseptic and injected with a local anaesthetic. An oval cut is made with a scalpel and the whole of the abnormal area, plus a margin of healthy cells around it, are removed. The wound is stitched up. It takes about 10-15 minutes to do. The stitches will have to be taken out in about a week, or later, depending on where the excision has taken place.
  
  
• incision biopsy
  In this procedure a small portion of the suspect area is cut out for examination. The usual reason for this type of biopsy is that the affected area is large and there is significant uncertainty about the diagnosis. Your doctor will choose this method to avoid cutting out a larger piece of skin unnecessarily.

Biopsy results
You should have the results given to you in person, usually at the hospital. Your doctor will discuss them with you.

A suspected melanoma may turn out to be a harmless growth. If pre-cancerous cells or melanoma is found, you will be fully examined for other suspicious skin growths.

Other tests
Sometimes the biopsy will completely remove the cancer, and no further treatment will be needed. The likelihood of a melanoma spreading depends on how thick it is. This is measured in the laboratory on the skin sample that was taken at biopsy.

The thickness influences whether you will need to have more surgery to remove a wider area of skin. This is done to make sure that all the cancer cells are removed. The operation is called a wide local excision. There is more information about this procedure on the page about ‘surgery’.

The thickness of the melanoma also influences whether there is a need for further investigations. In many patients with thin melanomas, no further tests will be required (other than routine clinical follow-up).

For some patients, further tests may be necessary to check the size, thickness and possible spread of the melanoma. This is called staging. The following tests can be used:

• blood tests
• chest x-ray
• computerised tomography (CT or CAT) scan
• biopsy of lymph node or other tissues
• ultrasound scan
• magnetic resonance imaging (MRI) scan
• whole-body PET

Your consent
Before any doctor, nurse or therapist examines or treats you, they must get your consent.

Blood Tests
There is no blood test to detect melanoma in the blood stream, although tests are being developed. Blood tests may be carried out to check your general health and to see whether there are any indications that further tests may be needed.

Chest X-ray
A chest X-ray may be undertaken if further surgery is needed, or because of your past medical history. It may be undertaken if you have the type or tumour that is more likely to spread.

Computerised Tomography (CT or CAT) scan
This is a type of X-ray that creates a picture of a cross section, or slices, of the inside of the body. It gives a clear picture of soft tissue such as the liver, lymph glands, blood vessels, as well as bone. CT scanning can help tell whether the disease has spread to other parts of the body.

See our tests section, on having a CT scan for more infomation.

Biopsy of lymph node or other tissue
If melanoma has spread, the most likely site for this is local draining glands known as lymph nodes (for example, in the armpit for a melanoma on the arm). If your doctor can feel an enlarged lymph node, a sample of cells may be taken for further examination under a microscope (biopsy). The sample is taken through a syringe (fine needle aspiration cytology or FNAC). The needle may need to be inserted several times. An anaesthetic is not usually needed. Occasionally a little local anaesthetic is injected and a sample is taken by cutting out the node or a sample from it (open biopsy).

Sentinel lymph node biopsy
In some cases, usually with patients with higher risk melanomas, a dye may be injected at the time of surgery (wide local exicision) and a lymph gland removed at the time. This is a procedure called sentinel lymph node biopsy. It is a test to check whether the cancer has spread to the lymph glands (nodes). If it is performed, then it is usually at the time of a wider excision procedure, and in patients who do not have enlarged lymph nodes.

For more information about a sentinel lymph node biopsy, please speak to your doctor.

Ultrasound scan
You may have an ultrasound scan of your lymph glands or liver. See our 'tests' section, on having an ultrasound scan for more information.

Bone scan
If your symptoms point to possible bone disease, a bone scan may be done. A small amount of radioactive substance is injected into a vein. It travels through the blood stream and collects temporarily in the bones. An instrument called a scanner picks up a picture from the radiation and creates images of the bones on a computer or onto film. This can show whether cancer has spread to the bones.

For more information on having a bone scan, see our 'tests' section.

Magnetic Resonance Imaging (MRI) scan
This test uses powerful magnetic waves to make a picture of the soft tissue, organs and bones of your body. It does not use X-rays. It can give greater detail than a CT scan.

See our 'tests' section on having an MRI for more information.

Positron Emision Tomography (PET) scan
PET is not used routinely. In some rare cases PET scanners may be more sensitive than CT scanners for detecting whether the melanoma has spread.

For more information on this test, please talk to your doctor.

For more information about these tests and others, go to our cancer tests section.