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Melanoma

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How does the Orlando Dermatology Center diagnose Melanoma?

To diagnose melanoma, a dermatologist begins by looking at the patient’s skin. A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.

The dermatologist also may feel the patient’s lymph nodes. Many people call these lymph glands.

If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Melanoma cannot be diagnosed without a biopsy.

This biopsy is quick, safe, and easy for a dermatologist to perform. This type of biopsy should not cause anxiety. The discomfort and risks are minimal.

If the biopsy report says that the patient has melanoma, the report also may tell the stage of the melanoma. Stage tells the doctor how deeply the cancer has grown into the skin.

How do dermatologists treat melanoma?

The first step in treatment is the removal of the melanoma, and the standard method of doing this is by surgical excision (cutting it out). Surgery has made great advances in the past decade, and much less tissue is removed than was customary in the past. Patients do just as well after the lesser surgery, which is easier to tolerate and produces a smaller scar.

Surgical excision is also called resection, and the borders of the entire area excised are known as the margins.

In most cases, the surgery for thin melanomas can be done in the doctor’s office or as an outpatient procedure under local anesthesia. Stitches (sutures) remain in place for one to two weeks, and most patients are advised to avoid heavy exercise during this time. Scars are usually small and improve over time.

Discolorations and areas that are depressed or raised following the surgery can be concealed with cosmetics specially formulated to provide camouflage. If the melanoma is larger and requires more extensive surgery, a better cosmetic appearance can be obtained with flaps made from skin near the tumor, or with grafts of skin taken from another part of the body. For grafting, the skin is removed from areas that are normally or easily covered with clothing.

There is now a trend towards performing sentinel node biopsy and tumor removal surgery at the same time, provided the tumor is 1 mm or more thick. When the procedures are combined in this way, the patient is spared an extra visit.

Surgical excision is also called resection, and the borders of the entire area excised are known as the margins. Surgical excision is used to treat all types of skin cancer.  At its best – given an experienced surgeon and a small, well-placed tumor – it offers results that are both medically and cosmetically excellent.

The physician begins by outlining the tumor with a marking pen.  A “safety margin” of healthy-looking tissue will be included, because it is not possible to determine with the naked eye how far microscopic strands of tumor may have extended.  The extended line of excision is drawn, so the skin may be sewn back together.

The physician will administer a local anesthetic, and then cut along the lines that were drawn.  The entire procedure takes about thirty minutes for smaller lesions.

Wounds heal rapidly, usually in a week or two.  Scarring depends on many factors, including  the placement of the tumor and the patient’s care of the wound after the procedure.

The tissue sample will be sent to a lab, to see if any of the “safety margin” has been invaded by skin cancer.  If this is the case, it is assumed that the cancer is still present, and additional surgery is required.  Sometimes,  Mohs micrographic surgery is a good option at this point.

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