Diagnosis and Prognosis

Melanoma is a serious cancer of the cells of the skin that normally make the skin’s dark pigment. No one expects to be diagnosed with melanoma, but the diagnosis is actually surprisingly common. About 60,000 Americans will be diagnosed with melanoma every year. The lifetime probability of developing melanoma is about 1 in 49 for men, and 1 in 73 for women. Anyone can develop melanoma, though it is more common in those who are fair-haired and fair-complexioned, and in those who have experienced prior severe sunburns. It may sometimes run in families, and those with many moles, or many large unusual looking moles have a higher risk. Most of the time, we don’t know why any one individual develops the disease.

Some people are diagnosed when their family physician or dermatologist notice an abnormal spot on the skin that looks suspicious. Other times, patients themselves, or family or friends notice that a spot on the skin doesn’t “look right.” An indicator that a spot on the skin (usually dark) may be suspicious is if it fits the “ABCDE” criteria: A = Asymmetry of the spot; B = Border that is ragged, blotchy or blurry; C = Color that is not uniform throughout the spot; D = Diameter that is great than 6 millimeters (about the size of a pencil eraser tip); E= Evolving or changing in size, shape, or appearance.

A biopsy is always needed to make a definite diagnosis of melanoma (please visit our FAQ page for more information). Usually a skin biopsy will be performed by your family physician or dermatologist. The small piece of skin will be sent to a pathologist, who will look at the tissue under a microscope, and decide if the spot is melanoma. Certain features of a melanoma are important to note:

• Depth -- from the skin surface to the deepest point the melanoma extends to (thinner is better)
• Clark’s level – a higher level reflects a deeper layer of skin involved (lower number is better)
• Ulceration – whether the surface looks ragged (it’s better to look smooth)

A medical oncologist will be able to assess your situation to help determine prognosis – the chance that you will be cured with treatment. The oncologist puts together the features noted by the pathologist, along with individual characteristics that may affect prognosis (such as your age, general health, site of the melanoma on the skin, and others).

The North Bay Melanoma Program physicians have expertise in assessing melanoma diagnosis and prognosis.