Diagnosing Stage 4 Melanoma

Health Writer

The diagnosis of any type of skin cancer, including melanoma, begins the same way: with a skin examination by a dermatologist. If you have spots or lesions that are concerning, you should point these out to your doctor, especially if the spots or lesions have changed in color, shape or size. If your doctor thinks any of the spots or lesions could be skin cancer, he may use a dermascope, a medical device that shines light and magnifies the lesion allowing the doctor to see the pigment and structure. During the examination, your doctor will also examine lymph nodes in your neck, armpit and groin to see if they are enlarged.

What happens during a biopsy?

If your doctor suspects that any of your lesions are melanoma, he will remove a part, or all, of the lesion and have it sent to a laboratory for a biopsy. If the biopsy confirms that you do have melanoma, the pathologist will look for further information which can help "stage" your cancer. He will pay attention to how fast the cells are dividing and how many of the cells are actively dividing. He will also look at whether melanoma is found in the entire tissue sample or only within the lesion. The pathologist might also look to see if you have certain genes, including the BRAF gene, which will help your medical team decide which treatment is best.

Melanoma stages

If you do have melanoma, it is important to determine the stage of your cancer, which tells whether your cancer has spread to other areas of your body.

Stage 0 - The cancer is confined to the epidermis

Stage 1 - The cancer is still only in the skin but is thicker

Stage 2 - The cancer has grown in thickness and the lesion might be ulcerated

Stage 3 - The cancer has spread to either other parts of your nearby skin or to your lymph nodes

Stage 4 - The cancer has spread to further lymph nodes, organs or to skin further away from the original lesion

Your treatment will be tailored around the stage of your cancer, the higher the stage, the more aggressive the treatment.

Tests to determine if you have stage 4 melanoma

To help your doctor better understand how your cancer has spread, you might be asked to undergo further testing. The following tests are sometimes used although not everyone goes through all of these tests:

  • Ultrasound
  • Computed tomography (CT) scan
  • Lymph node biopsy
  • CT guided needle biopsy
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan

While there is no blood test to diagnose melanoma, your doctor might request blood tests to find out if your levels of an enzyme called lactate dehydrogenase is high, which can be a sign that the cancer has spread to other parts of your body.

Once your doctor has completed a physical examination, a biopsy and any further testing, he can determine the stage of your cancer.

See more helpful articles:

What to Expect When You Are Diagnosed with Melanoma

What Happens After a Stage 4 Melanoma Diagnosis?

Questions to Ask Your Doctor When Diagnosed with Stage 4 Melanoma

Living with Metastatic Melanoma

Treatment Options for Metastatic Melanoma


"How is Melanoma Skin Cancer Diagnosed?" Reviewed 2015, March 20, Staff Writer, American Cancer Society

"Melanoma: Diagnosis, Treatment and Outcome," Date Unknown, Staff Writer, American Academy of Dermatology

"Stages of Melanoma Diagnosis," Date Unknown, Staff Writer, Melanoma Research Foundation