Seeing a specialist
You'll be referred to a dermatology clinic for further testing if melanoma is suspected. You should see a specialist within 2 weeks of seeing your GP.
A dermatologist (skin specialist) or plastic surgeon will examine the mole and the rest of your skin. They may remove the mole and send it for testing (biopsy) to check whether it's cancerous. A biopsy is usually carried out under local anaesthetic, which means the area around the mole will be numbed and you won't feel any pain.
If cancer is confirmed, you'll usually need another operation, most often carried out by a plastic surgeon, to remove a wider area of skin. This is to make absolutely sure that no cancerous cells are left behind in the skin.
You'll have further tests if there's a concern the cancer has spread into other organs, bones or your bloodstream.
Sentinel lymph node biopsy
If melanoma spreads, it will usually begin spreading through channels in the skin (lymphatics) to the nearest group of glands (lymph nodes). Lymph nodes are part of the body's immune system. They help remove unwanted bacteria and particles from the body and play a role in activating the immune system.
Sentinel lymph node biopsy is a test to determine whether microscopic amounts of melanoma (less than would show up on any X-ray or scan) might have spread to the lymph nodes. It's usually carried out by a specialist plastic surgeon, while you're under general anaesthetic.
A combination of blue dye and a weak radioactive chemical is injected around your scar. This is usually done just before the wider area of skin is removed. The solution follows the same channels in the skin as any melanoma.
The first lymph node the dye and chemical reaches is known as the "sentinel" lymph node. The surgeon can locate and remove the sentinel node, leaving the others intact. The node is then examined for microscopic specks of melanoma (this process can take several weeks).
If the sentinel lymph node is clear of melanoma, it's extremely unlikely that any other lymph nodes are affected. This can be reassuring because if melanoma reaches the lymph nodes, it's more likely to spread elsewhere.
If the sentinel lymph node contains melanoma, there's a risk that other lymph nodes in the same group will also contain melanoma.
Your surgeon should discuss the pros and cons of having a sentinel lymph node biopsy before you agree to having it. The National Institute for Health and Care Excellence (NICE) has developed an interactive decision aid called Melanoma: sentinel biopsy – yes or no? to help make the decision easier.
Lymph node dissection or completion lymphadectomy
An operation to remove the remaining lymph nodes in the group is known as a completion lymph node dissection or completion lymphadenectomy. NICE have also developed an interactive decision aid called Melanoma: completion lymphadenectomy – yes or no? which outlines the pros and cons of the procedure.
Other tests you may have include:
- a computerised tomography (CT) scan
- a magnetic resonance imaging (MRI) scan
- a positron emission tomography (PET) scan
- blood tests
Healthcare professionals use a staging system called the AJCC system to describe how far melanoma has grown into the skin (the thickness) and whether it has spread. The type of treatment you receive will depend on what stage the melanoma has reached.
The melanoma stages can be described as:
- Stage 0 – the melanoma is on the surface of the skin
- Stage 1A – the melanoma is less than 1mm thick
- Stage 1B – the melanoma is 1-2mm thick, or less than 1mm thick and the surface of the skin is broken (ulcerated) or its cells are dividing faster than usual
- Stage 2A – the melanoma is 2-4mm thick, or it's 1-2mm thick and ulcerated
- Stage 2B – the melanoma is thicker than 4mm, or it's 2-4mm thick and ulcerated
- Stage 2C – the melanoma is thicker than 4mm and ulcerated
- Stage 3A – the melanoma has spread into 1 to 3 nearby lymph nodes, but they're not enlarged; the melanoma isn't ulcerated and hasn't spread further
- Stage 3B – the melanoma is ulcerated and has spread into 1 to 3 nearby lymph nodes but they're not enlarged, or the melanoma isn't ulcerated and has spread into 1 to 3 nearby lymph nodes and they are enlarged, or the melanoma has spread to small areas of skin or lymphatic channels, but not to nearby lymph nodes
- Stage 3C – the melanoma is ulcerated and has spread into 1 to 3 nearby lymph nodes and they're enlarged, or it's spread into 4 or more lymph nodes nearby
- Stage 4 – the melanoma cells have spread to other parts of the body, such as the lungs, brain or other areas of the skin
Cancer Research UK has more information about the stages of melanoma.