With so many possible skin conditions diagnoses, a visual examination is usually not adequate for making a skin cancer diagnosis. A mole, growth or lesion may look like a “classic case” of skin cancer. However, it could also be benign. Conversely, a mole that looks quite normal could be a dangerous melanoma.
Many doctors from many varied specialties are knowledgeable in diagnosing and treating skin cancers. Generally dermatologists and dermatological surgeons are trained to diagnose skin cancer. However, the following health professionals can also help you diagnose skin cancer:
Initially, your family doctor or dermatologist will first ask you for a medical history. Inquiries will be made about sun exposure, use of sunscreens and family history of skin cancer. You doctor may also ask you questions about markings or lesions on the skin, such as when you first noticed it, as well as if and how it has changed in size or appearance.
Following the medical history, doctors conduct a thorough examination of the skin. Doctors note the size, shape and condition of lesions and whether they have changed over time. In addition, your doctor will examine other parts of the body with particular attention to skin that is exposed to the sun. If abnormal markings are found, the doctor will perform additional tests such as biopsy. In fact, the only way to accurately diagnose skin cancer is using a biopsy. However, other possible diagnostic tests include:
Biopsy – During a biopsy, doctors remove a small skin sample for examination under a microscope. Often, the biopsy is sent to a pathologist who has special expertise in diagnosing skin samples. Because it is sometimes difficult to tell if a skin growth is benign (not cancer) or malignant (cancer), you may want to have the biopsy sample checked by a second pathologist. Types of skin biopsies doctors order include:
Excisional / incisional biopsy - The doctor uses a scalpel to remove either part of or the entire skin growth and some tissue around it. An excisional biopsy generally involves obtaining tissue specimens from the deepest layer of skin, called the subcutaneous tissue.
Fine needle aspiration (FNA) biopsy – The doctor uses a thin needle to remove very small tissue fragments from a tumor to biopsy large lymph nodes near a melanoma to see if the melanoma has metastasized (spread).
Punch biopsy - The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area. A punch biopsy generally involves obtaining tissue specimens from the epidermis. However, in some cases, a punch biopsy involves the dermis and subcutaneous tissue.
Shave biopsy - The doctor uses a thin, sharp blade to shave off the abnormal growth. A shave biopsy generally involves obtaining tissue specimens from the thin outer layer of skin, called the epidermis.
Skin biopsy – The doctor removes a sample of skin for examination under the microscope to determine if skin cancer is present. The biopsy is performed under local anesthesia.
If skin cancer is found, more tests will be performed to find out if the cancer cells have spread to other parts of the body. This process is called staging, and is necessary before treatment for the cancer can begin. Read on for more information about skin cancer stages here.