Clinical Appearance

Clinical appearance

Clinical appearance is the first step in diagnosis. What the spot looks like to your doctor will dictate the treatment. If it is thought to be a skin cancer, then a biopsy will be done. The biopsy results will then dictate the follow-up treatment.

Patients are the ones who most often discover an atypical spot. Thus, underscoring the importance of monthly self-exams and full knowledge of the ABCDEF’s of spot appearance as crucial to patient education. A study from the Pigmented Lesion Clinic showed that the majority of abnormal spots (54%) are primarily found by the patient. Once an abnormal spot is found it should be examined by a physician, preferably a skin specialist (dermatologist).

Diagnosing melanoma can be tricky since it can mimic other skin lesions and it has been shown that the clinical diagnosis of melanoma is accurate in only about 65% of cases (Townsend, 2001). This underscores the need for having a dermatologist examine the spot and determine the appropriate type of biopsy. If there is any question as to whether or not the lesion is melanoma, a full-thickness excision with appropriate margins should be done.

Before excision is performed, the need for sentinel lymph node biopsy (SLNB) should be decided as this procedure is done before lesion removal. The AJCC and the WHO both recommend SLNB for tumors greater than 1 mm thick. If the tumor is less than 1 mm thick but is ulcerated or has evidence of vascular/lymphatic invasion, SLNB should be done.

For help in locating a dermatologist, go to the American Academy of Dermatologists: http://www.aad.org/public/searchderm.htm