Diagnostics establishes the causes of health problems. This process may seem long and exhausting, but it is important for the doctor to rule out other possible violations before the cancer diagnosis. Tests for the diagnosis of melanoma is usually appointed in the following cases:
- Revealed symptoms of malignancy, such as the appearance of the affected tumors on the skin or change of a mole, freckle, birthmark, as well as their color painting.
- The doctor suspected melanoma appear after history-taking and physical examination.
Many of the tests used for the initial diagnosis of cancer, are used to determine the stage of the disease. In melanoma than 1 mm thick are assigned more extensive tests, studying the propagation or metastasis. It is also possible to assign the analysis , checking the overall health of the treatment program planning. Of melanoma of Diagnosis in Assuta hospital A may the include the the following tests.
- History and physical examination.
- A biopsy.
- Biopsy of a lymph node.
- Chest X-ray.
- Computed tomography.
- Blood chemistry.
History and physical examination
Medical history is the collection and recording of existing symptoms, risk factors and all the medical events and problems that have been a person in the past. Family history also can help in the diagnosis andtreatment of melanoma in Israel .
The doctor may ask questions:
- on the patient's personal history;
- of melanoma or other skin cancers;
- on the effects of the sun and UV radiation, the presence of sunburn in the past;
- on the use of tanning;
- on immunosuppression (immunosuppressed);
- of congenital nevi of considerable size;
- the large number of moles and freckles;
- of abnormal moles;
- sensitivity to the sun, or the inability to tan;
- of some genetic features;
- the presence of cancer, this type of skin cancer or any other in the history of the family;
- about the symptoms of the disease.
skin examination in the diagnosis of melanoma allows the doctor to look for signs of malignancy. During the procedure, a doctor at the clinic Assuta can:
- pay attention to the size, shape, color and surface texture of a mole, freckle, birthmark or wart;
- ask how long the tumor is present, have occurred if changing the size and appearance;
- to ask questions about any symptoms caused by the formation, such as pain, itching or bleeding;
- check nearby lymph nodes;
- examine all moles, freckles, birthmarks on the body.
In the diagnosis of melanoma in addition to the physical examination of the skin Dermoscopy doctor may use a method (also known as epiluminescence microscopy or surface microscopy). This method is used to study changes in pigmented or non-pigmented skin lesions that are not visible to the naked eye.
Before examining the tumor is coated with mineral oil to reduce the reflection of light from the skin, improving the appearance of the lesion. After that, the doctor examines the tumor under magnification with a manual microscope, dermatoscope or computerized digital images.
During a biopsy tissue or cells are removed from the body for further examination in the laboratory. pathologist report confirm or negate the presence of cancer cells in the sample.
Various approaches can be used for skin biopsies. Select the type of surgical biopsy depends on the location and size of the affected area.
Excisional biopsy is the preferred method for the diagnosis of melanoma. It involves removal of the entire lesion, plus a small amount of healthy tissue around the hearth (1-2 mm).
Incisional biopsy involves resection of the neoplasm, and is used when the above-mentioned type of survey is not feasible because of the size or location of the lesion.
A biopsy of the lymph nodes
First of all melanoma metastasizes to the lymph nodes located near. This type of biopsy is surgically removes the lymph nodes, then they were examined under a microscope for the presence of malignant cells.
During the medical examination in the diagnosis of melanoma doctor examines the lymph nodes. If they increased in size and hard to the touch, fine-needle aspiration biopsy may be performed to find out whether there are metastases. When the lymph nodes are not palpable, and melanoma thickness greater than 1 mm is likely to recommend sentinel lymph node biopsy.
Fine-needle aspiration biopsy
In the diagnosis of melanoma this type of biopsy is used to remove fluid from an enlarged lymph node and check for the presence of cancer cells. If present, is an operation to remove all the lymph nodes in the area.
Surgical or excisional biopsy
It involves surgery in which resecting enlarged lymph node, and then assayed for the presence of malignant its segments.
Biopsy signal (watchdog) lymph node
"Watchdog" node - this is the first lymph node in a chain or cluster nodes that receive from lymph areas around the tumor. Cancer cells tend to first apply to the organ. This type of biopsy in the diagnosis of melanoma involves removing one or more nodes according to route them around the drain neoplasms and further study samples.
Sentinel node biopsy is an intermediate procedure which can provide prognostic information. In most cases, it is assigned to patients who melanoma thickness greater than 1 mm, and no clinical evidence of cancer spread to lymph nodes. If tumor thickness less than 1 mm, there is no information that this type of diagnosis of melanoma can help to determine the prognosis and increased survival.
Sentinel lymph node biopsy is indicated for patients who have:
- melanoma in situ;
- 1A stage of the disease;
- enlarged lymph nodes, which are palpated during physical examination;
- previously carried out operation to the lymph nodes;
- local melanoma that has spread to the lymph nodes;
- metastatic melanoma.
Preferably, this type of biopsy in the diagnosis of melanoma was performed before surgery to remove a tumor, since it provides a more accurate determination of the stage of disease and the prognosis for the information to plan a more adequate treatment.
If the results are negative (no cancer cells), it is unlikely that the other lymph nodes are overwhelmed, as a result of eliminating the need for additional surgery. For positive - made the removal of all the lymph nodes in the area.
Lymphadenectomy for melanoma
This operation involves the removal of all the lymph nodes within the anatomical region around the tumor (in the armpit, groin or in the head and neck). Lymphadenectomy is performed if:
- Fine-needle aspiration biopsy, or biopsy of the sentinel node showed that melanoma has metastasized to the lymph nodes.
- CT of the head, chest and pelvis did not show overt metastases.
Ultrasound uses high-frequency sound waves to create images of internal structures in the human body. This kind of diagnosis of melanoma is used to control and check the status of the lymph nodes.
This method uses small doses of radiation to form images. It is recommended to check the spread of melanoma to the lung area.
Computed tomography (CT)
CT uses special x-ray equipment to create a three-dimensional and cross-sectional images of organs, tissues, bones and blood vessels within the body. The computer converts them into detailed pictures. This kind of diagnosis in melanoma is assigned to check the spread of metastases in the lymph nodes, thorax, lungs, liver or brain.
Biochemical blood tests
These assays measure the level of certain chemical substances in the blood. They show how well certain organs are functioning, as well as carry out in order to detect anomalies. With this type of melanoma diagnostics determine the stage of disease. The increase of lactate dehydrogenase (LDH) indicates a poor prognosis, on the occurrence of metastases in distant organs.
Magnetic resonance imaging (MRI)
MRI uses a powerful magnetic fields and radio waves to create cross-sectional images of organs, tissues, bones, and blood vessels. Then, using the computer converts them to three-dimensional. MRI for the diagnosis of melanoma is assigned if there is a suspicion on the occurrence of secondary lesions in the brain and spinal cord.
Positron emission tomography (PET)
PET uses radioactive material to detect changes in metabolic activity of body tissues. The computer analyzes the radioactive structure and creates a three-dimensional color images. This kind of diagnosis for melanoma are used to detect metastases in the lymph nodes and other organs.