This information is currently under review
This information has been reviewed by:
Professor John Kelly, Dermatologist
Doctors and other health professionals you may see
The first sign of a melanoma is usually the appearance of a new spot or a change in an existing freckle or mole. The change may be in size, shape and/or colour and the change is normally noticed over several weeks or months rather than days.
A normal freckle or mole is usually small and has an even colour and a smooth edge. A melanoma often has an irregular edge or surface. It may be spotted with brown, black, blue, red, white and/or light grey. A freckle or mole that itches or bleeds is sometimes (but not always) a melanoma. A freckle or mole that becomes larger or irregular in shape may be a melanoma.
It is quite normal for new moles to appear and change during childhood and pregnancy. However, in adults a new mole is less common and could be a melanoma.
Melanoma can occur anywhere on the body.
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options.
You may be cared for by a team of health professionals from the relevant major fields (see list on page 10). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with melanoma include:
Melanoma is diagnosed by physical examination and biopsy. Your doctor will first examine the suspicious spot or mole and other spots and moles and ask about your own and your family's history of melanoma. Your doctor may use a magnifying instrument, called a dermoscope, to examine the spot and improve the chances of making a correct diagnosis. The doctor may also feel the lymph nodes near the suspicious spot or mole.
If your doctor suspects that you have melanoma, they will suggest that you have a biopsy.
This is a quick and simple procedure. It may be done by your family doctor, or you may be referred to a dermatologist or surgeon. The doctor will give you a local anaesthetic and then use a scalpel to remove the spot and some surrounding tissue. You will have a stitch or stitches to help the wound to heal.
The tissue that is cut out will be sent to a laboratory to be examined under a microscope. It will probably take around a week for the results of your tests to be ready, and a follow-up appointment may be arranged for you. This waiting period can be an anxious time and it may help to talk things over with a close friend or relative.
If the cells are found to be cancerous, the doctor will stage the melanoma and may conduct some other tests to see if the cancer cells have spread, including taking more tissue if needed.
If the biopsied tissue is found to have cancer cells in it, the depth to which the cancer cells go will be measured. This is called ‘staging' the disease. The deeper the cancer cells have penetrated the skin, the more likely it is that the cancer could have spread. If the cells have not penetrated very far, it is likely that the removal of the melanoma is all that will be needed, and you will not require any further treatment.
Melanoma is staged in the following way:
Your doctor will provide more information on the stage of your melanoma when discussing treatment.
You might hear the term ‘level' or ‘Clark level'. This refers to an assessment of the layers of skin involved. It is not the same as the depth or the stage of the melanoma.
If you have melanoma, your doctor may recommend other tests. This is generally if surgery is being planned or if there is evidence that the melanoma may have spread to other parts of the body. The tests include:
Melanoma centres are based in some public hospitals. At these centres, specialists in melanoma form a panel which can assess patients' cases and recommend the best treatment.
The biopsy of your melanoma will be reviewed by an expert pathologist to ensure that no error has been made and that there is no conflict of opinion about your diagnosis. You will be given the opportunity to talk to an expert medical specialist, who will answer any difficult questions that you may have about your illness. Advice will be provided to you and your doctor about your treatment.
As well as providing treatment advice, melanoma centres are involved in research studies and may invite you to become involved. They may also collect information about you and your melanoma for use in research. People who are at high risk of melanoma are sometimes invited to take part in research studies, even if they have not been diagnosed with melanoma.
You will probably be given the opportunity to speak to a counsellor or psychologist with expertise in melanoma to help you cope with any challenges and difficulties you face.
If you wish to attend a melanoma centre, ask your doctor about a referral.
