Melanoma Diagnosis

Dermatologist Michael Marchetti performs a dermoscopy

Dermatologist Michael Marchetti performs a dermoscopy, a screening technique that allows for the noninvasive diagnosis of melanoma.

No one knows your skin better than you do, so it makes sense that you would notice any changes before anyone else. Most melanomas are first noticed by patients or their family members.

In order to determine whether you have melanoma, your doctor will take a complete medical history, which includes details about:

  • your past exposure to the sun
  • any exposure to other known causes of melanoma
  • whether you have any personal or family history of melanoma
  • when you first noticed the mark
  • if the mark has changed at all, in size or appearance

Your doctor will also do a skin examination and check for enlarged lymph nodes.

If your doctor thinks that a particular patch of skin may be melanoma, you’ll have a biopsy, in which a small piece of tissue is removed. A pathologist will examine the tissue under a microscope to determine whether melanoma cells are present.

The distinction between an atypical but ultimately benign (noncancerous) mole and a true malignant melanoma is often not obvious, and a diagnosis can sometimes be challenging to make. Memorial Sloan Kettering is one of the few hospitals in the United States with access to advanced diagnostic techniques that can help accurately evaluate your tumor.

If you come to us with metastatic melanoma, meaning it has spread to other parts of the body and can’t be treated with surgery alone, we’ll perform extensive analysis of the genes involved in your tumor and apply cutting-edge tools to help us determine the most effective treatment approach for you.

Most melanomas are driven by specific mutations, or genetic changes, that cause a tumor to develop. In about half of melanomas, there is a mutation in the BRAF gene. Drugs that block this mutated gene (called RAF inhibitors) can lead to dramatic shrinkage of tumors.

At MSK today, we test all metastatic melanomas for BRAF mutations. In fact, we test most melanomas for mutations in more than 400 genes, which helps us learn more about your specific melanomas and can tell us if you might benefit from participation in new clinical trials.

To confirm a diagnosis of eye melanoma, we perform a complete ophthalmic exam and review and may order our own diagnostic imaging tests. These may include:

Digital Imaging

This approach enables us to visualize the tissues of the eye, as well as the circulation of blood within the eye. We use advanced methods, such as autofluorescent photography and fluorescein angiography, to enhance image details.

Ultrasound Imaging

Also called high-frequency one- and two-dimensional ultrasound imaging, or A and B scan ultrasonography, this approach provides another way of examining areas of the eye that contain possible tumors.

Optical Coherence Tomography

This approach enables us to map eye tissues using reflected light, visualizing tumors in yet another manner.