Tests and Procedures That May be used in the Staging Process of Melanoma
The Skin Cancer Program uses sentinel
lymph node (SLN) biopsy to detect
microscopic spread of melanoma in
regional lymph nodes with novel
imaging modalities to improve
accuracy
The following tests and procedures may be used in the staging process:
- Wide local excision
A surgical procedure to remove a clinical margin of the normal tissue surrounding the melanoma site, to check for cancer cells, ensure complete removal of the melanoma, and prevent local recurrence. Standard margins are used depending on the thickness of the skin melanoma. - Lymph node mapping and sentinel lymph node biopsy
Procedures in which a radioactive substance (generally a sulfur colloid) and/or blue dye is injected around the skin melanoma or biopsy scar. The substance or dye travels through the skin lymph channels (lymphatics) to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only the nodes with that emit a certain degree of radioactivity and/or demonstrate the colored dye. A dermatopathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it is not necessary to remove additional regional lymph nodes. - Chest x-ray
An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Imaging studies are not generally ordered at the time of diagnosis of cutaneous melanoma, unless there are suspicious findings for disease spread to other organs at the outset. Follow-up (surveillance) chest x-rays may be ordered depending on the depth and stage of the melanoma. - CT scan (CAT scan)
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the chest, abdomen, and pelvis. - MRI (magnetic resonance imaging)
A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). - PET scan (positron emission tomography scan)
A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Stanford also offers state-of-art technology for whole-body scanning for melanoma with a combined PET/CT scanner. The PET/CT scanner creates a fusion of the diagnostic capabilities of CT and PET scanning to deliver the most accurate and sensitive detection of melanoma within the body possible. - Laboratory tests
Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests may help to diagnose disease, plan and check treatment, or monitor the disease over time. - Blood chemistry studies
A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For advanced (stage IV) melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). Laboratory tests are generally not necessary for baseline assessment and follow-up of patients with cutaneous melanoma.
The results of these tests are viewed together with the results of the tumor biopsy to determine the melanoma stage.
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