Melanoma – Online Resources

This resource was originally published by Melanoma International here.

Online Resources

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Caregiver ResourcesClinical TrialsPrescription Drug AssistanceSupportHospiceHotlines and ForumsInsurance/Financial AssistanceLodgingLymphedemaOther Types of MelanomaPain ManagementRadiationSuggested ReadingSurvivorshipTransportation


Caregiver Resources

Caregiver Action Network

1130 Connecticut Ave, NW
Suite 300
Washington, DC 20036

Phone: (202) 454-3970
www.caregiveraction.org

Caregiver Action Network works to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age. CAN (the National Family Caregivers Association) is a non-profit organization providing education, peer support, and resources to family caregivers across the country free of charge.

Family Caregiver Alliance

785 Market Street
Suite 750
San Francisco, CA 94103

(415) 434-3388
(800) 445-8106
www.caregiver.org

FCA seeks to improve the quality of life for caregivers through education, services, research, and advocacy. FCA’s National Center on Caregiving offers information on current social, public policy and caregiving issues, and provides assistance in the development of public and private programs for caregivers.

The Caregiver Relief Fund

900 South Wabash Avenue
Suite 603
Chicago, IL 60605

https://caregiverrelieffund.wordpress.com/

A social venture committed to caring for caregivers. Provides resources, assistance and a voice to over 50 million Americans who are currently caregivers to the chronically ill, aged and disabled.

4th Angel

9500 Euclid Avenue R36
Cleveland, OH 44195

(866) 520-3197
www.4thangel.org

The 4th Angel Program is part of the Scott Hamilton CARES Initiative. This is a free, national service which provides a one-to-one supportive relationship (phone or email based) to cancer patients and their caregivers. The program has over 400 patient and caregiver mentors who are at least 6 months post treatment, and continues to train more mentors.

Caregivers4Cancer

P.O.Box 153448
Irving, Texas 75015

(800) 787-2840
(972) 513-0668
Caregivers4cancer.com

Organization strives to educate and assure caregivers and oncology teams there are ways to ease the journey’s relentless demands. Goal is to help caregivers emerge on the other end with less stress, more energy and a feeling of accomplishment that they did all they could for their loved ones.

Caregiver.com

3350 Griffin Road
Fort Lauderdale, FL 33312

954-893-0550
1-800-829-2734
www.caregiver.com

A leading provider of information, support and guidance for family and professional caregivers. Founded in 1995as a producer of Today’s Caregiver magazine, the first national magazine dedicated to caregivers. Caregiver Media Group and all of its products are developed for caregivers, about caregivers and by caregivers.


Clinical Trials

ClinicalTrials.Gov

The National Cancer Institute at the National institute of Health
Bethesda, Maryland

1-800-4-Cancer
www.clinicaltrials.gov

A registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and phone numbers for more details.

Oncolink

The Perelman Center for Advanced Medicine
3400 Civic Center Blvd
Suite 2338
Philadelphia, PA 19104

215-349-8895
www.oncolink.org

Comprehensive information about specific types of cancer, updates on cancer treatments and news about research advances. Information is updated every day and provided at various levels, from introductory to in-depth.

Dermatology & Early Detection

Center for Disease Control (CDC) Centers for Disease Control and Prevention
4770 Buford Hwy NE
MS K-64
Atlanta, GA 30341

800-232-4636
cdcinfo@cdc.gov
www.cdc.gov

Federal agency that provides information on cancer prevention and control.

American Academy of Dermatology

930 E. Woodfield Road
Schaumburg, IL 60173

1445 New York Avenue, NW, Suite 800
Washington, DC 20005

(866) 503-SKIN (7546)
International: (847) 240-1280
www.aad.org

Founded in 1938. With a membership of more than 17,000, it represents virtually all practicing dermatologists in the United States, as well as a growing number of international dermatologists. Find free screening locations as well as information on research, diagnosis and treatment.

DermWeb

The Department of Dermatology and Skin Science
University of British Columbia
835 West 10th Avenue
Vancouver, B.C.
Canada V5Z 4E8

604-875-4747
www.DermWeb.com

DermWeb is a premier destination for dermatology links and resources on the Web. There are several areas of interest for practicing dermatologists, for dermatology students, and for the general public.

The Skin Cancer Foundation

149 Madison Av.
Suite 901
New York, NY 10016

212-725-5176
1-800-754-6490 (1-800-SKIN-490)
www.skincancer.org

Educates about skin cancer and its prevention by means of sun protection; as well as the need for early detection, and prompt, effective treatment. It is the only international organization devoted solely to combating the world’s most common cancer, now occurring at epidemic levels.

National Cancer Institute

6116 Executive Boulevard, Suite 300
Bethesda, MD 20892

1-800-422-6237 (1-800-4-CANCER)
TYY: 1-800-332-8615
www.cancer.gov

The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.


Prescription Drug Assistance

Needy Meds, Inc.

P.O. Box 219
Gloucester, MA 01931

(800) 503-6897
www.needymeds.org

This service provides information on drugs and offers applications (if available) for financial assistance, coupons for drugs, discount drug cards, free/low cost clinics and government program information.

Together Rx Access Card

One Outlet Lane
Bald Eagle Court
Lock HavenPA 17745

(800) 444-4106
http://www.togetherrxacces.com

Free prescription savings program for qualified enrollees, which provides savings on more than 300 FDA-approved prescription drugs.

Partnership for Prescription Assistance

1-888-4PPA-NOW (1-888-477-2669)
www.pparx.org

This program helps uninsured and financially struggling patients get access to nearly 500 healthcare and prescription assistance programs that offer medicines for free or nearly free.

National Conference of State Legislatures

State Pharmaceutical Assistance Programs
http://www.ncsl.org

More than 30 states have programs that will give discounts on prescription drugs, often for free. Visit web site to learn more about the various programs state legislatures have developed.

RxAssist

111 Brewster Street
Pawtucket, RI 02860

401-729-3284
www.rxassist.org

Patient assistance programs run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles.

RxHope

P.O. Box 42886
Cincinnati, OH 45242

1-877-267-0517
www.RxHope.com

Advocate in making the patient assistance program journey easier and faster by supplying vital information and help.


Support

The Cancer Support Community

1050 17th Street, NW
Suite 500
Washington DC 20036

202-659-9709
cancersupportcommunity.org
help@cancersupportcommunity.org

An international non-profit dedicated to providing support to people affected by cancer. Services are available through a network of professionally led community-based centers, hospitals, community oncology practices and other non-profits, as well as online.

CanCare

Fighting Cancer with Hope
9575 Katy Freeway, Suite 428
Houston, Texas 77024

713-461-0028
1-888-461-0028
www.cancare.org

Cancer survivors of more than 50 different types of cancer volunteer for CanCare to provide emotional support to those currently facing a battle with cancer. Family members of survivors provide emotional support to family members of cancer patients.

Caring Bridge

1715 Yankee Doodle Road
Suite 301
Eagan, MN 55121

651-452-7940
651-681-7115
www.caringbridge.org

Free, personal and private websites that connect people experiencing a significant health challenge to family and friends, making each health journey easier.

MyLifeLine.org Cancer Foundation

55 Madison St., Ste. 750
Denver, CO 80206

303-549-0405
www.mylifeline.org
support@mylifeline.org

A 501(c)(3) nonprofit organization that encourages cancer patients and caregivers to create free, customized websites. Our mission is to empower patients to build an online support community of family and friends to foster connection, inspiration, and healing.

CancerCare

275 Seventh Ave. Floor 22
New York, NY 10001

1-800-813-HOPE (4673)
info@cancercare.org
www.Cancercare.org

National Office serves people with cancer and their loved ones throughout the entire 50 states, Puerto Rico, and the U.S. Virgin Islands.

US Dept of Health & Human Services

P.O. Box 1133
Washington, DC 20013-1133

healthfinder.gov
healthfinder@nhic.org

Write to healthfinder.gov at Health and Human Services Department for easy entry point to trustworthy health information.

National Cancer Institute (NCI)

1-800-4-cancer
www.cancer.gov

Very comprehensive information from the US Government agency wing of the National Institute of Health (NIH).

Web MD

A medical education site from a company that helps both consumers and healthcare providers navigate the healthcare community.


Hospice

HFA Hospice Foundation of America

1710 Rhode Island Ave, NW
Suite 400
Washington, DC 20036

National Hospice Foundation

1731 King Street, Suite 200
Alexandria, Virginia 22314

Caring Connections

800-658-8898
Multilingual Line: 877-658-8896


Hotlines and Forums

Melanoma International Foundation

Toll free Patient and Family Helpline: 1-866-463-6663
Forum: Melanoma Forum

Dana Farber Cancer Institute

Family Studies Cancer Risk Line
Voice: 1-800-828-6622
www.dana-farber.org

Information regarding familial cancers

Patient Advocate Foundation

1-800-532-5274 (Mon.-Thurs., 8am-8pm; Fri., 8:30am-7pm EST)
www.patientadvocate.org

Provides education and legal counseling to cancer patients (relative to a diagnosis) concerning managed care, discrimination, insurance and financial issues.

Hereditary Cancer Center

Creighton University School of Medicine
2500 California Plaza
Omaha, NE 68178

1-800-648-8133 (Mon.-Fri., 8am-5pm CST)
http://medschool.creighton.edu/centers/hcc/

Studies family-linked cancer. Counseling, information on clinical trials, cancer and hereditary factors.

Cancer Information Service

Sponsored by National Cancer Institute.
1-800-422-6237
www.cancer.gov

Provides information about cancer and cancer-related resources to patients, the public and health professionals. Offers one-on-one smoking cessation counseling and literature. Free publications.

Skin Cancer Foundation

1-800-754-6490 (Mon.-Fri., 9am-5pm EST)
www.skincancer.org

Provides educational materials and information on skin cancer and treatment.

Cancer Research Institute

1-800-992-2623 (Mon.-Fri., 9am-5pm EST)
www.cancerresearch.org

Provides general cancer resource information. Supports leading-edge research aimed at developing immunologic methods of preventing, treating and curing cancer.

Cancer Information and Counseling Line

1-800-525-3777
(Mon.-Fri., 8:30am-5pm MST)

Provides current medical information and counseling for cancer issues.

Cancer Hope Network

1-877-467-3638 (Mon.-Fri., 9am-5:30pm EST)
www.cancerhopenetwork.org

One-on-one support offered to cancer patients and their families undergoing cancer treatment from trained volunteers who have survived cancer themselves.

BLOCH Cancer Hotline

1-800-433-0464

Networks persons with cancer and home volunteers with same type of cancer. Free books about cancer.


Insurance/Financial Assistance

Good Days

6900 N Dallas Pkwy,
Suite 200
Plano, TX 75024

(877) 968-7233
(972) 608-7141
http://www.mygooddays.org/

Good Days exists to improve the health and quality of life of patients battling chronic disease, cancer or other life-altering conditions who cannot afford the medications they so desperately need.

HealthWell Foundation

P.O. Box 4133
Gaithersburg, MD 20878

800-675-8416
www.healthwellfoundation.org

The HealthWell Foundation® provides full or partial financial assistance to eligible individuals who cannot afford their insurance co-payments, premiums, deductibles for certain treatments, and other out-of-pocket health care expenses.

Medicare & Medicaid

7500 Security Blvd
Baltimore, MD 21244-1850

800-318-2596
www.healthcare.gov/medicaid-chip/

800-MEDICARE
www.medicare.gov

Medicare is a federal system of health insurance for people over 65 years of age, and Medicaid assists low-income individuals and certain younger people with disabilities.

National Patient Advocate Foundation (NPAF)

725 15th St, NW, 10th Floor
Washington, DC 20005

202-347-8009
www.npaf.org

NPAF provides professional case management services to individuals facing barriers to healthcare access for chronic and disabling disease, medical debt crisis and employment-related issues at no cost.


Lodging

Joe’s House

505 E 79th Street
New York, NY 10075

877-563-7468
www.joeshouse.org

Joe’s House website lists thousands of places to stay across the country near hospitals and treatments centers that offer a discount for traveling patients and their loved ones.

Healthcare Hospitality Network, Inc.

P.O. Box 1439
Gresham, OR 97030

(800) 542-9730
http://www.hhnetwork.org/

The Healthcare Hospitality Network, Inc. (HHN) is a nationwide professional association of nearly 200 unique, nonprofit organizations that provide lodging and support services to patients, families and their loved ones who are receiving medical treatment far from their home communities. The mission of HHN is to support homes that help and heal to be more effective in their service to patients and families.

Hope Lodge –American Cancer Society

(800) 227-2345
WEBSITE

Hope Lodge offers cancer patients and their caregivers a free, temporary place to stay when their best hope for effective treatment may be in another city. Currently, there are 31 Hope Lodge locations throughout the United States. Accommodations and eligibility requirements may vary by location.


Lymphedema

National Lymphedema Network

116 New Montgomery Street, Suite 235
San Francisco, CA 94105

1-800-541-3259
415-908-3681
www.lymphnet.org

A non-profit organization founded in 1988 to provide education and guidance to lymphedema patients, health care professionals and the general public by disseminating information on the prevention and management of primary and secondary lymphedema.


Other Types of Melanoma

Mucosal Melanoma

Oral Cancer Foundation
3419 Via Lido #205
Newport Beach, CA 92663

949-723-4400
www.oralcancerfoundation.org

The Oral Cancer Foundation is a non-profit 501 (c) (3) public service charity that provides information, patient support, sponsorship of research and advocacy related to this disease. At the forefront of our agenda is to promote solid awareness in the minds of the American public about the need to undergo an annual oral cancer screening and an outreach to the dental community to provide this service as a matter of routine practice.

Ocular Melanoma Foundation

P.O. Box 29261
Richmond, VA 23242-0261

www.ocularmelanoma.org

OMF aspires to be the top destination for up-to-date OM-related educational information, a meeting place, and advocacy resource. For doctors and researchers, OMF strives to be the connective tissue, facilitating interdisciplinary cancer research.


Pain Management

American Academy of Pain Management

The largest pain management organization in the nation and the only one that embraces an integrative model of care, which is patient-centered, focuses on the “whole” person, is informed by evidence, and brings together, all appropriate therapeutic approaches to reduce pain and achieve optimal health and healing. The Academy offers continuing education, publications, and advocacy.

American Chronic Pain Association

PO Box 850
Rocklin, CA 95677

1-800-533-3231
https://theacpa.org

Since 1980, the ACPA has offered peer support and education in pain management skills to people with pain, family and friends, and health care professionals. The information and tools on our site can help you to better understand your pain and work more effectively with your health care team toward a higher quality of life.


Radiation

RT Answers

American Society of Radiation Oncology
8280 Willow Oaks Corporate Drive, Suite 500
Fairfax, VA

703-502-1550 or 1-800-962-7876
www.rtanswers.org

Web site explains to patients, their families and the public how doctors called radiation oncologists use radiation therapy to treat cancer safely and effectively.

Radiation Therapy Fact Sheet

National Cancer Institute
www.cancer.gov

A fact sheet that defines the different types of radiation therapy and discusses scientific advances that improve the effectiveness of this treatment.

Melanoma: Learning to Live With It

This video was originally published by American Cancer Society on May 15, 2015, here.

Tom Crawford’s battle with melanoma has been a long one. He shares some of the wisdom he’s learned along the way.

 

Managing Out of Pocket Expenses for Melanoma

This video was originally published by Cancer Support Community on August 24, 2015, here.

 

Pathology

This video was originally published by Aim At Melanoma on Nov 4, 2014, here.

 

 

 

Skin samples taken by a biopsy or surgical excision are typically sent to a pathologist/pathology laboratory for microscopic examination and diagnosis. A pathology report is issued by the pathologist or dermatopathologist. The pathology report states the diagnosis and further describes many aspects of the appearance of the melanoma, including the type, depth of invasion, tissue level of invasion, presence or absence of a lymphatic response, presence or absence of ulceration, mitotic count, presence or absence of regression, presence or absence of satellite lesions, and presence or absence of blood vessel/lymphatic vessel/nerve invasion.

Additionally, the pathology report will describe whether the excised lesion is a primary melanoma, in which case it would be described using the terms above, or a metastatic melanoma deposit. A metastatic melanoma deposit is one in which the melanoma started somewhere else on the skin and some of the melanoma cells broke off and spread within the skin tissue to the current biopsy/specimen site.

Some Terms You May See on Your Pathology Report

Type of Melanoma (Histologic Subtype):

  • Superficial spreading melanoma
  • Nodular melanoma
  • Acral lentiginous melanoma
  • Lentigo melanoma
  • Desmoplastic melanoma
  • Other: mucosal melanoma
  • Other: uveal melanoma

Breslow Depth: Measurement in millimeters of how thick the primary tumor is, regardless of its Clark Level. It is measured from the top layer of the skin to its deepest point.

Clark Level: Clark Level was replaced in the revised melanoma staging system in 2010 by more reliably predictive features (mitotic count and ulceration). It is now only used to stage thin melanomas (< 1mm).

Radial Growth Phase (RGP): The melanoma lesion is described as either having RGP present or absent. If present, RGP is an indication that the melanoma is growing horizontally, or radially, within a single plane in the upper/superficial skin layers (mainly in the epidermis).

Vertical Growth Phase (VGP): The melanoma is described as either having VGP present or absent. If present, VGP is an indication that the melanoma is growing vertically, or deeper, into the tissues.

Tumor-Infiltrating Lymphocytes (TILs)TILs describe the patient’s immune response to the melanoma. When the pathologist examines the melanoma under the microscope, he/she looks to see whether or not there are lymphocytes within the melanoma. The amount of lymphocyte invasion/response to the melanoma is described as brisk (a lot of lymphocytes), nonbrisk (some), sparse (few) or absent (none), although occasionally it can be described as mild or moderate. TILs appear to indicate that your immune system has recognized the melanoma cells as abnormal and is trying to move into the melanoma to attack it. Some studies suggest that the presence of increasing number of TILs may be associated with a better prognosis.

Ulceration: Ulceration is described as being present or absent. It is the breakdown or loss of the top layer of cells in a melanoma and often occurs in the center of a tumor. The presence of ulceration increases the stage classification of a melanoma. Ulceration is thought to reflect rapid tumor growth, leading to the death of cells in the center of the melanoma and thus is associated with a worse prognosis. The pathologist can determine whether ulceration is present or absent when they review the biopsy under the microscope.

Regression: Regression is described as an area of the tumor without active melanoma cell growth and is described as present or absent. If it is present, the extent of regression is estimated… When regression is present, the measured thickness of the melanoma may not be the greatest/true thickness.

Mitotic Count (Mitotic Rate): Mitosis is the process by which one mature cell divides into two identical cells. When pathologists study melanoma, they will count the number of actively dividing cells that they see. Averaging this number gives the mitotic count and it is reported as the number of mitoses per square millimeter (mm2), (example ≤1 mitoses/mm2). A high mitotic count means more tumor cells are dividing at a given time and is associated with a worse prognosis.

Satellites: Satellite lesions are small nodules of tumor/melanoma located more than 0.05mm from the primary lesion, but less than 2cm. Satellites are described as being present or absent. Some satellite lesions (macroscopic) can be seen with the naked eye. Others, which are smaller (microscopic) can be found only by the pathologists. Both macroscopic and microscopic lesions are reported in the pathology report.

Blood Vessel/Lymphatic Invasion: Blood vessel invasion, also called angioinvasion, or lymphatic vessel invasion, is described as being present or absent. If present, it means that the melanoma has invaded the blood or lymph system and is associated with more aggressively growing melanomas.

Early Detection of Melanoma

This video was originally published by Aim At Melanoma on  November 4, 2014, here.

 

 

Tips to reduce your risk of developing melanoma:

Wear Sunscreen.

Make sunscreen a daily habit. UV radiation can still damage skin even in the winter and on cloudy days.

Use a broad-spectrum sunscreen (protects against UVA and UVB rays) with SPF of at least 30.

Wear Protective Clothing.

Protect your body with sun-protective clothing, hat, and sunglasses.

Avoid Peak Rays. Seek shade during the mid-day sun, when the sun’s rays are most intense.

Don’t Use Tanning Beds. Indoor tanning has been shown to increase the risk of melanoma by up to 75%. Melanoma is one of the top three cancers diagnosed in young adults (ages 25-29), and scientists attribute this trend to the use of tanning beds among this age group, particularly young women.

Protect Your Children. Just one bad sunburn in childhood or adolescence doubles your child’s chances of developing melanoma later in life.

Melanoma Risk Factors: People with the following traits are at higher risk for developing melanoma and other skin cancers:

Fair skin, red or blonde hair light eyes, more than 50 moles, history of sunburn or UV exposure, family history of skin cancer, and personal history of skin cancer.

The ABCDE Melanoma Check

This video was originally published by The Mayo Clinic on Aug 7, 2017, here.

Melanoma develops in the cells that produce your skin’s pigment and is the most serious type of skin cancer. However, when it’s detected early, melanoma can be effectively treated. The ABCDE melanoma test can help you identify the warning signs of cancer.

Tests for Melanoma Skin Cancer

This resource was originally published by the American Cancer Society here.

Most melanomas are brought to a doctor’s attention because of signs or symptoms a person is having.

If you have an abnormal area on your skin that might be cancer, your doctor will examine it and might do tests to find out if it is melanoma, another type of skin cancer, or some other skin condition. If melanoma is found, other tests may be done to find out if it has spread to other areas of the body.

Medical history and physical exam

Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.

During the physical exam, your doctor will note the size, shape, color, and texture of the area(s) in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer (or other skin conditions).

The doctor may also feel the lymph nodes (small, bean-sized collections of immune cells) under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.

If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.

Along with a standard physical exam, many dermatologists use a technique called dermoscopy (also known as dermatoscopy, epiluminescence microscopy [ELM], or surface microscopy) to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.

Skin biopsy

If the doctor thinks a spot might be a melanoma, the suspicious area will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy.

There are many ways to do a skin biopsy. The doctor will choose one based on the size of the affected area, where it is on your body, and other factors. Any biopsy is likely to leave at least a small scar. Different methods can result in different types of scars, so ask your doctor about scarring before the biopsy. No matter which type of biopsy is done, it should remove as much of the suspected area as possible so that an accurate diagnosis can be made.

Skin biopsies are done using a local anesthetic (numbing medicine), which is injected into the area with a very small needle. You will likely feel a small prick and a little stinging as the medicine is injected, but you should not feel any pain during the biopsy.

Shave (tangential) biopsy

For this type of biopsy, the doctor shaves off the top layers of the skin with a small surgical blade. Bleeding from the biopsy site is stopped by applying an ointment, a chemical that stops bleeding, or a small electrical current to cauterize the wound.

A shave biopsy is useful in diagnosing many types of skin diseases and in sampling moles when the risk of melanoma is very low. This type of biopsy is not generally used if a melanoma is strongly suspected unless the biopsy blade will go deep enough to get below the suspicious area. Otherwise, if it is a melanoma, the biopsy sample may not be thick enough to measure how deeply the cancer has invaded the skin.

Punch biopsy

For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper sample of skin. The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed and the edges of the biopsy site are often stitched together.

Excisional and incisional biopsies

To examine a tumor that might have grown into deeper layers of the skin, the doctor may use an excisional (or less often, an incisional) biopsy.

  • An excisional biopsy removes the entire tumor (along with a small margin of normal skin around it). This is usually the preferred method of biopsy for suspected melanomas if it can be done, although this isn’t always possible.
  • An incisional biopsy removes only a portion of the tumor.

For these types of biopsies, a surgical knife is used to cut through the full thickness of skin. A wedge or sliver of skin is removed for examination, and the edges of the cut are usually stitched together.

“Optical” biopsies

Some newer types of biopsies, such as reflectance confocal microscopy (RCM), can be done without needing to remove samples of skin. To learn more, see What’s New in Melanoma Skin Cancer Research?

Biopsies of melanoma that may have spread

Biopsies of areas other than the skin may be needed in some cases. For example, if melanoma has already been diagnosed on the skin, nearby lymph nodes may be biopsied to see if the cancer has spread to them.

Rarely, biopsies may be needed to figure out what type of cancer someone has. For example, some melanomas can spread so quickly that they reach the lymph nodes, lungs, brain, or other areas while the original skin melanoma is still very small. Sometimes these tumors are found with imaging tests (such as CT scans) or other exams even before the melanoma on the skin is discovered. In other cases, they may be found long after a skin melanoma has been removed, so it’s not clear if it’s the same cancer.

In still other cases, melanoma may be found somewhere in the body without ever finding a spot on the skin. This may be because some skin lesions go away on their own (without any treatment) after some of their cells have spread to other parts of the body. Melanoma can also start in internal organs, but this is very rare, and if melanoma has spread widely throughout the body, it may not be possible to tell exactly where it started.

When melanoma has spread to other organs, it can sometimes be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a primary lung cancer (cancer that starts in the lung).

Special lab tests can be done on the biopsy samples that can tell whether it is a melanoma or some other kind of cancer. This is important because different types of cancer are treated differently.

Biopsies of suspicious areas inside the body often are more involved than those used to sample the skin.

Fine needle aspiration (FNA) biopsy

FNA biopsy is not used on suspicious moles. But it may be used, for example, to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.

For this type of biopsy, the doctor uses a syringe with a thin, hollow needle to remove very small pieces of a lymph node or tumor. The needle is smaller than the needle used for a blood test. A local anesthetic is sometimes used to numb the area first. This test rarely causes much discomfort and does not leave a scar.

If the lymph node is just under the skin, the doctor can often feel it well enough to guide the needle into it. For a suspicious lymph node deeper in the body or a tumor in an organ such as the lung or liver, an imaging test such as ultrasound or a CT scan is often used to help guide the needle into place.

FNA biopsies are not as invasive as some other types of biopsies, but they may not always collect enough of a sample to tell if a suspicious area is melanoma. In these cases, a more invasive type of biopsy may be needed.

Surgical (excisional) lymph node biopsy

This procedure can be used to remove an enlarged lymph node through a small incision (cut) in the skin. A local anesthetic (numbing medicine) is generally used if the lymph node is just under the skin, but the person may need to be sedated or even asleep (using general anesthesia) if the lymph node is deeper in the body.

This type of biopsy is often done if a lymph node’s size suggests the melanoma has spread there but an FNA biopsy of the node wasn’t done or didn’t find any melanoma cells.

Sentinel lymph node biopsy

If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy (SLNB) is often done to see if the cancer has spread to nearby lymph nodes, which in turn might affect treatment options. This test can be used to find the lymph nodes that are likely to be the first place the melanoma would go if it has spread. These lymph nodes are called sentinel nodes (they stand sentinel, or watch, over the tumor, so to speak).

To find the sentinel lymph node (or nodes), a doctor injects a small amount of a radioactive substance into the area of the melanoma. After giving the substance time to travel to the lymph node areas near the tumor, a special camera is used to see if it collects in one or more sentinel lymph nodes. Once the radioactive area has been marked, the patient is taken for surgery, and a blue dye is injected in the same place the radioactive substance was injected. A small incision is then made in the marked area, and the lymph nodes are then checked to find which one(s) became radioactive and turned blue. These sentinel nodes are removed and looked at under a microscope.

If there are no melanoma cells in the sentinel nodes, no more lymph node surgery is needed because it is very unlikely the melanoma would have spread beyond this point. If melanoma cells are found in the sentinel node, the remaining lymph nodes in this area are typically removed and looked at as well. This is known as a lymph node dissection (see Surgery for Melanoma Skin Cancer).

If a lymph node near a melanoma is abnormally large, a sentinel node biopsy probably won’t be needed. The enlarged node is simply biopsied.

Lab tests of biopsy samples

Samples from any biopsies will be sent to a lab, where a doctor called a pathologist will look at them under a microscope for melanoma cells. Often, skin samples are sent to a dermatopathologist, a doctor who has special training in looking at skin samples.

If the doctor can’t tell for sure if melanoma cells are in the sample just by looking at it, special lab tests will be done on the cells to try to confirm the diagnosis. These might include:

  • Immunohistochemistry (IHC)
  • Fluorescence in situ hybridization (FISH)
  • Comparative genomic hybridization (CGH)
  • Gene expression profiling (GEP)

If melanoma is found in the samples, the pathologist will look at certain important features such as the tumor thickness and mitotic rate (the portion of cells that are actively dividing). These features help determine the stage of the melanoma (see Melanoma Skin Cancer Stages), which in turn can affect treatment options and prognosis (outlook).

Testing for gene changes

For some people with melanoma, biopsy samples may be tested to see if the cells have mutations (changes) in certain genes, such as the BRAF gene. About half of melanomas have BRAF mutations. Some drugs used to treat advanced melanomas are only likely to work if the cells have BRAF mutations (see Targeted Therapy for Melanoma Skin Cancer), so this test is important in helping to determine treatment options. Tests for changes in other genes, such as C-KIT, might be done as well.

A newer lab test known as DecisionDx-Melanoma looks at certain gene expression patterns in melanoma cells to help show if early-stage melanomas are likely to spread. This might be used to help determine treatment options. To learn more, see What’s New in Melanoma Skin Cancer Research?

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body. They are used mainly to look for the possible spread of melanoma to lymph nodes or other organs. These tests are not needed for most people with very early-stage melanoma, which is very unlikely to have spread.

Imaging tests can also be done to help determine how well treatment is working or to look for possible signs of cancer coming back (recurring) after treatment.

Chest x-ray

This test might be done to help determine if melanoma has spread to the lungs, although a CT scan of the chest (see below) is often done instead.

Ultrasound

Ultrasound uses sound waves to create images of the inside of your body on a computer screen. This test might be used to look at the lymph nodes near the tumor, especially if it’s not clear if they’re enlarged based on a physical exam. Ultrasound is typically fairly quick and easy to do, and it doesn’t expose you to radiation.

Ultrasound-guided needle biopsy: Ultrasound can also be used to help guide a biopsy needle into a suspicious lymph node.

Computed tomography (CT) scan

The CT scan uses x-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). This test can show if any lymph nodes are enlarged or if organs such as the lungs or liver have suspicious spots, which might be from the spread of melanoma.

CT-guided needle biopsy: CT scans can also be used to help guide a biopsy needle into a suspicious area within the body.

Magnetic resonance imaging (MRI) scan

MRI scans use radio waves and strong magnets instead of x-rays to create detailed images of parts of your body. MRI scans can be very helpful in looking at the brain and spinal cord.

Positron emission tomography (PET) scan

PET scan can help show if the cancer has spread to lymph nodes or other parts of the body. It is most useful in people with more advanced stages of melanoma.

For this test, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.

PET/CT scan: Many centers have special machines that do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.

Blood tests

Blood tests aren’t used to diagnose melanoma, but some tests may be done before or during treatment, especially for more advanced melanomas.

Doctors often test blood for levels of a substance called lactate dehydrogenase (LDH) before treatment. If the melanoma has spread to distant parts of the body, a high LDH level is a sign that the cancer may be harder to treat. This can affect the stage of the cancer (see Melanoma Skin Cancer Stages).

Other tests of blood cell counts and blood chemistry levels may be done in a person who has advanced melanoma to see how well the bone marrow (where new blood cells are made), liver, and kidneys are working before and during treatment.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: August 14, 2019 Last Revised: August 14, 2019

 

Lung Cancer: Coping With Unexpected Challenges

This video was originally published by Cancer Support Community on August 13, 2015, here.

Lung Cancer New Therapies

This podcast was originally published by City Of Hope Radio here.

 

Ravi Salgia, MD – Speaker Bio
  • Topic Info:


    There is extensive collaboration between lung cancer clinicians and researchers to develop and evaluate new therapies designed to improve survival and quality of life outcomes

    Listen in as Ravi Salgia, M.D., Ph.D. explains all of the new therapies available if you or a loved one has been diagnosed with lung cancer.

Radiotherapy for Lung Cancer

This podcast was originally published by City of Radio Hope here.

Helen Chen, MD – Speaker Bio
  • Topic Info: Stereotactic radiotherapy is used to treat tumors in the lung without having to make an opening in the skin. The treatment machine directs beams of high-dose radiation directly to the area in the lung that needs to be treated. The radiation beams are silent and invisible.

    Radiotherapy can play a pivotal role in the treatment of lung cancer in all stages and can result in long-term curative outcomes for patients.

    Listen in as Helen Chen, MD explains how Stereotactic radiotherapy is used to help treat lung cancer.

Lung Cancer Latest in Research and Therapy

This podcast was originally published by Cornell Weill Cancer Cast on April 4, 2019, here.

Brendon Stiles, MD – Speaker Bio
  • Hot topics in lung cancer, including screening, immunotherapy, vaping, and more.Guest: Brendon Stiles, MD, thoracic surgeon at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

    Host: John Leonard, MD, world-renowned hematologist and medical oncologist at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

Updates In Lung Cancer

This video was originally published by National Comprehensive Cancer Network here.

Lung Cancer experts provide information and answer questions on types of lung cancer, new research, biomarker (molecular) testing, and quality of life.

Click the play button above to view the Updates in Lung Cancer videos playlist or select an individual video within the playlist menu in the top left corner of the video window or from the list below. You may also view on YouTube.

The Know What Your Doctors Know: Updates in Lung Cancer webinars occurred in February 2019. This informational program was created in conjunction with the recently updated NCCN Guidelines for Patients® for Early Stage and Locally Advanced Lung Cancer and NCCN Guidelines for Patients for Metastatic Lung Cancer.

The NCCN Guidelines for Patients and NCCN Quick Guide™ sheets are available to read and download for free online and via the NCCN Patient Guides for Cancer mobile app. Printed editions can be ordered from Amazon.com for a small fee.

NCCN Guidelines for Patients and NCCN Quick Guide™ sheets DO NOT replace the expertise and clinical judgment of the clinician.

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This activity is supported through the NCCN Foundation, by a contribution from our industry supporters AstraZeneca and Pfizer, Inc. NCCN independently develops and distributes the NCCN Guidelines for Patients. Our industry supporters do not participate in the development of the NCCN Guidelines for Patients and are not responsible for the content and recommendations contained therein.

The NCCN Guidelines for Patients: Lung Cancer are endorsed by:

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Lung Procedures, Tests & Treatments

This resource was originally published by the American Lung Association here.

Depending on your symptoms and diagnosis, your doctor might recommend a lung test or procedure. Use the glossary or search field below to learn more about various procedures.

B

Bronchoscopy
Bronchoscopy is a technique used to look at your air passages with a small camera that is located at the end of a flexible tube.

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C

Chest Tube Procedure
A chest tube is a plastic tube that is used to drain fluid or air from the chest.

CT Scan
Cat scan or CT scan, is a diagnostic test that uses a series of computerized views taken from different angles to create detailed internal pictures of your body.

CT Scan-Guided Lung Biopsy
Radiologists use a CT scan-guided lung biopsy to guide a needle through the chest wall and into the lung nodule to obtain and examine tissue.

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E

Endobronchial Ultrasound (EBUS)
EBUS (endobronchial ultrasound) bronchoscopy is a procedure used to diagnose different types of lung disorders, including inflammation, infections or cancer.

Exhaled Nitric Oxide Test
An exhaled nitric oxide level test can help diagnose and manage asthma.

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L

Lobectomy
A lobectomy is a surgical procedure where an entire lobe of your lung is removed for a variety of reasons that may include a lung cancer diagnosis, infection, COPD or benign tumors.

Lung Function Tests
Lung function tests (or pulmonary function tests) include a variety of tests that check how well the lungs work.

Lung Transplant
Lung transplantation is a treatment option for some lung disease patients. A lung transplant is a very serious procedure and it is important to learn as much as you can about the process if you think it might be right for you.

Lung Volume Reduction Surgery
Lung volume reduction surgery (LVRS) is a procedure designed to help you breathe easier when your lungs have been damaged by severe COPD.

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M

Methacholine Challenge Test
Methacholine challenge test (also known as bronchoprovocation test) is performed to evaluate how “reactive” or “responsive” your lungs are to things in the environment.

Minimally Invasive Thoracic Surgery
Minimally invasive thoracic surgery is a way of performing surgery in the chest through small incisions, without making large cuts or incisions in the body, and does not require spreading apart of the ribs.

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O

Getting Started with Oxygen
Oxygen therapy may be an important part of your treatment if you have lung disease. Learn how to get started using oxygen therapy.

How Can Oxygen Help Me?
Oxygen therapy can help people with lung disease feel better and be more active. Learn about the ways oxygen therapy can help improve your quality of life.

Oxygen Delivery Devices and Accessories
Learn about the different types of home oxygen and the accessories you use for each.

Oxygen Therapy
Oxygen therapy is a treatment that provides you with supplemental oxygen.

Supporting Someone on Oxygen
It can be a big adjustment for someone to start using oxygen therapy. The support of a friend or loved one can make the transition much easier. Read what real patients and caregivers have to say about supporting someone on oxygen.

Traveling with Oxygen
It may take more planning, but many people successfully travel while using oxygen therapy. Learn some key points to consider before you travel with oxygen.

Using Oxygen at Home
It is easy to get started using oxygen therapy at home. Make sure you read the instructions from your oxygen company and then follow these steps to get started.

Using Oxygen Safely
Oxygen therapy can be an important part of treatment for people living with lung disease. It is important to learn how to use oxygen therapy safely so you can protect yourself and those around you from harm.

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P

Pulse Oximetry
The pulse oximeter, or Pulse Ox, is an electronic device that measures the saturation of oxygen carried in your red blood cells.

The Basics of Pulmonary Rehabilitation
Pulmonary rehabilitation (PR/Rehab) can help people with chronic lung disease improve lung function, reduce symptoms and improve quality of life through exercise and education.

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S

Six-Minute Walk Test
The six-minute walk test is used as a simple measure of aerobic exercise capacity.

Spirometry
Spirometry is the most common type of pulmonary function or breathing test that measures how much air you can breathe in and out of your lungs.

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T

Thoracotomy
A thoracotomy is a surgical procedure in which a cut is made between the ribs to see and reach the lungs or other organs in the chest or thorax.