Diagnosing Skin Cancer

Support Throughout the Diagnostic Process

Our physicians, nurses and support staff are here to advise you, listen to you and calm your fears. Your physicians will explain your diagnosis and compassionately offer suggestions for treatment and care. Their job is to help you.

Also available for counsel, support and guidance are nurse coordinators, oncology social workers and a pastoral team. They’ll help you navigate through the system and provide additional assistance, including:

  • Social support
  • Spiritual guidance
  • Emotional support
  • Practical advice
  • Tips on coping

Call on them. They’re here for you.

Diagnostic Excellence and Precision

The Scott & White Skin Cancer Team is renowned for its expertise and skill. For your convenience, in one location are:

  • Board-certified dermatologists with specialized training in identifying and treating all types of skin cancers
  • Board-certified dermatologic surgeons with specialized training in surgery of the skin
  • Fellowship-trained Mohs surgeons with extensive experience in the microscopic removal of all types of skin cancers
  • Fellowship-trained dermatopathologists with extensive experience in classifying all types of skin cancers

Basal cell carcinoma rarely spreads; squamous cell carcinoma is controllable when caught early. They both have a high cure rate. With the prompt attention and exactness of our skin specialists, you can expect an excellent recovery for your nonmelanoma skin cancer.

Melanoma has a high cure rate when found early. For tumors less than 1 mm thick, the cure rate at Scott & White exceeds 98 percent. But if the lesion gets thicker, the risk of your melanoma spreading increases considerably. With melanoma, detection is the better part of cure.

Skin Cancer Diagnostic Services

At Scott & White Healthcare, our board-certified dermatologists use state-of-the-art diagnostic equipment to help identify your skin lesions with clarity and precision.

If your physician suspects you may have skin cancer, he or she may recommend one or more of the following tests.

Physical Exams & Laboratory Tests

  • Physical exam and history. Your physician will begin with a thorough physical exam and medical history. Your physician will examine growths on your skin for:
    • Irregular shape
    • Irregular border
    • Different colors with them
    • Moles that have changed over time
  • Dermoscopy. In this procedure, your dermatologist, using a hand-held scope device, may examine your abnormal mole or lesion with intensified light and magnification. In some cases, your dermatologist may use polarized light that allows him or her to see more specific abnormalities. Dermoscopy in some cases can confirm that a mole is benign or that a biopsy does not need to be performed.
  • Blood tests and tumor marker tests. If your physician suspects you may have melanoma, there are a number of blood tests and tumor marker tests your physician may order to help determine treatment options. A tumor marker is a substance that may be found in a tumor or released from a tumor into your blood or other body fluids. A high level of a tumor marker may note the presence of cancer.

    • Complete blood count
    • Blood chemistry panel
    • Lactate dehydrogenase (LDH) test—Elevated levels may indicate advanced disease.

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Biopsy

A biopsy is the best way to rule out or confirm the presence of melanoma (the most dangerous form of skin cancer). In all forms of biopsy, tissue samples will be sent to our board-certified dermatopathologist for assessment. Results will be sent to your physician.

In most cases, your dermatologist will recommend a punch or incisional biopsy if your lesion is large or in a location that is cosmetically important.

Tumors that are 1 to 4 millimeters in size may require a sentinel node biopsy to determine whether your melanoma has spread to your lymph nodes. (Sentinel lymph nodes are those lymph nodes closest to the original cancer site.)

  • Shave biopsy. In this procedure, your physician will shave off the top layer of skin with a thin, surgical blade, or scalpel. It’s the least invasive of all biopsy procedures. Shave biopsy is generally used for nonmelanomas.
  • Excisional biopsy. An excisional biopsy is done to remove the entire lesion. A numbing medicine is injected into the area. Then the entire lump, spot, or sore is removed, going as deep as needed to get the whole area. The area is closed with stitches. If a large area is biopsied, a skin graft or flap of normal skin may be used to replace the skin that was removed.
  • Incisional biopsy. An incisional biopsy takes a piece of a larger growth for examination. The area is injected with a numbing medicine. A piece of the growth is cut and sent to the lab for examination. You may have stitches, if needed. The rest of the growth can be treated after the diagnosis is made.
  • Punch biopsy. Punch biopsies are most often used for deeper skin spots or sores. Your doctor will remove a small round piece of skin (usually the size of a pencil eraser) using a sharp, hollow instrument, similar to a cookie cutter. If a large sample is taken, the area may be closed with stitches.
    • Punch biopsy is used in most cases to diagnose melanoma but may be used in some cases to diagnose nonmelanomas.
  • Fine needle aspiration biopsy. With a fine needle aspiration (FNA) biopsy, your physician will insert a thin, hollow needle into the affected area to remove a small sample of tissue.
  • Surgical lymph node biopsy. Your physician may order this test to determine whether your melanoma has spread. In this procedure, your surgeon will make a small incision and remove an enlarged lymph node.
  • Sentinel node biopsy. Your physician may order this test to determine whether your melanoma has spread to your lymph nodes. In this procedure, your surgical oncologist will remove a lymph node near the tumor to determine the presence of cancer in the lymph. The nodes are checked with a blue dye to determine the presence of cancerous cells.

For melanoma patients, a sentinel node biopsy is the most important independent predictor of survival. A sentinel node biopsy followed by selective node dissection results in a 71 percent survival versus 55 percent if the node dissection is delayed.

Your dermatologists will work closely with plastic surgery and surgical oncology so that you receive the best possible care for your melanoma.

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