If the initial biopsy shows melanoma, you may need further tests. Understanding the extent of the melanoma can help your doctor decide the best treatment option for you. There are several types of tests that can be used, though you might only need one or two of these.32

Lymph node biopsy
If the skin biopsy confirms you have a melanoma, a further biopsy might be needed to check if the melanoma has spread to your lymph nodes. There are two types of test that can help determine this:

  • Lymph node ultrasound and biopsy: Ultrasound scans use high frequency sound waves to create a picture of the area where the melanoma was. If the lymph nodes look abnormal, doctors (radiologists) use the ultrasound to help guide them as they take a biopsy.33
  • Sentinel lymph node biopsy: This is a test to find the first lymph node that a melanoma may spread to and check it for cancer cells.34 It involves injecting a dye into the lymph vessels next to where the melanoma was. The dye will flow along the lymph vessel and identify the nearest lymph node, so it can be removed.

The lymph node biopsy is sent for analysis to check if any melanoma cells have spread there.

Blood tests: Blood samples may be taken to check your general health, including how well your liver and kidneys are working, as well as check numbers of blood cells.35

CT scan: CT stands for computerised tomography. CT scans take X-ray pictures to find out whether the melanoma has spread to other parts of the body.36

PET-CT scan: A PET-CT scan combines a CT scan and a positron emission tomography (PET) scan. The CT scan takes a series of x-rays from all around your body. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active. Cancer cells are more active than normal cells, therefore, showing if the melanoma has spread.37

MRI scan: MRI stands for magnetic resonance imaging. It produces pictures from angles all around the body and shows up soft tissues very clearly. It can show if the melanoma has spread to other parts of the body.38 If the results of your test/scans show the melanoma has spread to the lymph nodes or other parts of the body, your biopsy will need a BRAF test. 

BRAF testing 38,39

Your doctor should test to see if your melanoma cells have certain genetic changes (mutations), such as the BRAF gene. Understanding if your melanoma cells have mutations may help your doctor decide which treatment is best for you.

BRAF acts as a ‘switch’ in normal cells to help regulate cell division and growth. If BRAF is mutated, the ‘switch’ is ‘on’ all the time, and ultimately contributes to uncontrolled cell growth.

If you have changes in the BRAF gene, doctors describe your melanoma as BRAF-positive. If you don’t have changes, then your melanoma is BRAF-negative or BRAF-wild type.

Approximately 50% of melanomas have a mutation in the BRAF gene. Amongst these, approximately 90% of mutations are in a specific part of the gene, called BRAF V600. 

Multi-Disciplinary Team Review

If the analysis of your biopsy confirms that you have a melanoma and there is any suggestion of spread, your case will be discussed by a multi-disciplinary team (MDT) which consists of two or more specialists. They can include:

  • Skin specialists (dermatologists)
  • Skin cancer nurse specialists
  • Surgeons
  • Oncologists (doctors who specialise in treating cancer)
  • Histopathologists (doctors who specialise in diagnosing illness from tissue specimens)40

The MDT may consider many factors when considering the most suitable treatment for you, including your general health and lifestyle factors, the stage of the melanoma, mutation test results and its location on your body.41 Following the MDT meeting, your doctor will discuss the treatment options with you.

You may want to ask your doctor these questions about tests for melanoma:

  • What tests do you suggest for me?
  • Where will the tests take place? Do I need to go to the hospital?
  • How long do the tests take?
  • Do I need to bring a list of my medications?
  • How long does it take to recover? Do I need any medication after the tests?
  • When will I know the results? Who will explain them to me?
  • If I have cancer, who will talk with me about the next steps? When?

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