Tests after diagnosis

Tests for everyone with melanoma

Your vitamin D level should be measured. If it's thought that the level is low, you should be given information and advice about taking vitamin D supplements. See other NICE guidance for details of our guidance on vitamin D.

Questions you might like to ask your care team

  • Should I take vitamin D supplements and why?

  • Could taking vitamin D supplements do me any harm?

Tests for stage 1B or stage 2 melanoma

If your melanoma is stage 1B or stage 2, you may be offered an operation called a sentinel lymph node biopsy. In this procedure 1 or 2 of your lymph nodes are removed (see the box below for more information about lymph nodes). The lymph nodes that have been removed are sent to the laboratory to check whether there is melanoma in them.

Lymph nodes

Lymph nodes are small, bean‑shaped structures that are part of the body's immune system. They are found in many parts of the body, including the armpits, neck and groin. If a melanoma has started to travel or spread through the body's immune system, it may have reached the nearby lymph nodes. For this reason doctors sometimes check these lymph nodes to work out whether the melanoma has spread.

Your care team should explain sentinel lymph node biopsy and discuss it with you. There are both possible advantages and possible disadvantages to having this operation. These are shown in the table below.

Possible advantages of having sentinel lymph node biopsy

Possible disadvantages of having sentinel lymph node biopsy

It can help to find out whether the melanoma has spread to any nearby lymph nodes, so that those lymph nodes can be removed. Sentinel lymph node biopsy is better than ultrasound scans at finding very small cancers.

It doesn't cure your melanoma, and there is no good evidence that people who have the operation live longer than those who don't.

It can help to predict what might happen in the future, based on what has happened to other people. For example, in people with melanoma who've had a sentinel lymph node biopsy:

  • about 7 out of 10 live for at least another 10 years if melanoma is found in their lymph nodes

  • about 9 out of 10 live for at least another 10 years if melanoma isn't found in their lymph nodes.

It doesn't always predict what might happen in the future. For example, about 3 out of 100 people who have no melanoma in their lymph nodes at the time of their sentinel lymph node biopsy develop cancer in their lymph nodes later on.

It can allow you to take part in clinical trials of new treatments for melanoma. These trials often can't accept people who haven't had a sentinel lymph node biopsy.

You would need to have a general anaesthetic for this operation.

The operation has caused other health problems, such as swelling under the incision (the cut made to perform the operation), for between 4 and 10 out of every 100 people who have had it.

NICE has also produced a decision aid (called an 'option grid') to help you discuss with your healthcare professional whether to have sentinel lymph node biopsy.

If melanoma is found in the lymph nodes, your melanoma stage will be changed to stage 3. You should be told if your melanoma stage is changed and offered scans to check whether the melanoma has spread to other parts of your body (see tests for stage 3 melanoma below). You should also be offered treatment, which is explained in treatment for stage 3 melanoma.

Tests for stage 3 melanoma

CT or whole‑body MRI scan

If your melanoma is stage 3, you should be offered a CT scan to check other areas of your body. A CT (short for computed tomography) scan makes a picture of part of the body using a series of X‑rays. If the cancer might have spread beyond the lymph nodes, you should also have a CT scan of your brain.

If you're aged 24 or under, you may be offered a whole‑body MRI scan instead of a CT scan. A whole‑body MRI (short for magnetic resonance imaging) scan makes a picture of the whole body using magnetic fields and radio waves. There is less radiation from an MRI scan than from a CT scan.

Genetic testing for stage 2C or stage 3 melanoma

If your melanoma is stage 2C or stage 3, you may be offered genetic testing of the melanoma. This is to find out whether a type of drug treatment called targeted systemic therapy might be suitable for you later on if the melanoma spreads further. For more information see genetic testing and targeted systemic therapy.

Questions you might like to ask your care team

Tests for stage 0 or stage 1A melanoma

  • Do I need any more tests if my melanoma is stage 0 or stage 1A?

Sentinel lymph node biopsy

  • Why have you decided to offer me a sentinel lymph node biopsy?

  • What does this operation involve? Where can I have it done?

  • Can you give me more detailed information about sentinel lymph node biopsy? Is there any written information, like a leaflet, that I could have?

  • What's likely to happen if I have the sentinel lymph node biopsy? What's likely to happen if I don't have it?

  • If I decide not to have it now, can I change my mind later?

  • What are the side effects? Are they permanent?

  • How long will I have to wait to have a sentinel lymph node biopsy? Will I have any treatment for my melanoma while I'm waiting?

  • How long does it take to get the results? What will they tell you?

Scans

  • Why are you offering me a CT scan if there is less radiation from an MRI scan?

  • How long will I have to wait to have a scan?

  • How long does it take to get the results of a scan? What will they tell you?

Genetic testing for stage 2C or stage 3 melanoma

  • Will I be able to have genetic testing of my melanoma?

  • How is the genetic testing done? When will you know the result?

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