Melanoma tests

If you have a mole that you think may be a melanoma, you will need to go to your GP. Your doctor will look at the mole and ask you what you have noticed about it. If there is any reason to think the mole may be becoming cancerous, you will need to have tests.

Only one test can accurately diagnose melanoma. The whole of the suspicious mole needs to be removed and looked at under a microscope. This is called an excision biopsy. Usually you can have a mole biopsied under local anaesthetic. But this will depend on where in the body your mole is.

Your doctor may suggest removing the mole at your local surgery. But if it could be a melanoma, the NICE referral guidelines say you should be referred to a specialist clinic or hospital to have it removed. You should see the specialist within 2 weeks of seeing your GP. Having the mole removed in hospital means there is less risk of leaving any cancerous tissue behind if it does turn out to be a melanoma. If your mole has no suspicious signs, it is reasonable for your GP to remove it if you want it taken off for cosmetic reasons. But your GP should only remove the mole if their practice has specialist facilities to do minor surgery.

If your GP refers you to a specialist, the specialist will be a member of either the local hospital skin cancer multidisciplinary team or the specialist skin multidisciplinary team.

You might see a specialist in hospital at a dermatology outpatient clinic (dermatology means specialising in diseases of the skin). Or your GP might send you to a pigmented lesion clinic if there is one in your area. A pigmented lesion clinic is a dermatology clinic and it specialises in picking up suspicious moles and diagnosing melanoma.

You may need to have two appointments. At the first appointment the specialist will look at your mole. If the mole needs to be removed you will have a second appointment.

If you are referred to a multidisciplinary team because of suspected melanoma, you may have a test called dermatoscopy to help make the initial diagnosis. This is not an essential test, and it may not be offered by your doctors. It is a painless test in which the doctor uses an instrument called a dermatoscope to closely examine the suspicious area on your skin. The doctor puts some oil on to your skin and then holds the dermatoscope in his hand, a bit like a magnifying glass. This can magnify the area by up to 10 times.

When you go to have your mole removed, the nurse or doctor will ask you to lie down on a couch in the treatment room. First you have an injection of local anaesthetic into the area close to the mole. The doctor then cuts out the mole and sends it off to the laboratory for close examination under a microscope by a tissue specialist (histopathologist). You then have a few stitches put in to sew up the area where the mole was cut out. The stitches will stay in for about a week.

When you go back to have your stitches taken out, you will get your biopsy results. This may be at the hospital or at your GP surgery. If the mole contained any cancerous cells you may have to have more tests. If not, you will not need any more treatment.

If your mole was found to contain cancerous or pre-cancerous cells, the biopsy will be looked at very closely in the laboratory to make sure that there is a border of healthy skin tissue all around it. This is to make sure that all abnormal cells have been removed. If any are left behind, they could go on to develop into a melanoma or spread somewhere else in the body.

If your cancerous mole was not completely removed, you will be asked to go into hospital for an operation called a wide local excision. This means having a bit more skin tissue cut away, with a border of healthy tissue removed as well. This is to make sure no abnormal cells have been left behind.

This operation is often called a wide local excision. You usually have this operation under local anaesthetic but in some circumstances your doctor may suggest a general anaesthetic. The operation is much the same as having your mole removed. But the surgeon will take more tissue away. How much they take will depend on

• How much of the mole was left behind in the surrounding skin
• How deeply the melanoma has grown into the tissue beneath the skin

Generally, this is a small operation. The doctor will put in stitches to close up the area where the tissue has been removed. This will feel a little tight at first. But as it heals, the surrounding skin will stretch and the tightness should ease.

Occasionally, a large area of skin has to be removed. If this is the case, you may need to have a skin graft to repair it. This means taking a thin sheet of skin from somewhere else on your body (the donor site) and placing it over the area that has been removed. The donor skin is usually taken from somewhere where it will not be too obvious, such as your inner thigh. At first it looks like a large graze. The skin will grow back quite quickly - over a couple of weeks.

The skin graft will be very delicate while it heals. It is vital that the graft is not damaged during this time. You must be very careful not to knock it. And your doctor and nurses will be very careful that your wound does not become infected. You may have antibiotics to take, to help prevent this. Most people having a wide local excision do not need a skin graft. The area heals up perfectly well without one.