What does a dermatologist do when finding a suspicious mole that might be melanoma?

When a dermatologist suspects melanoma (the most serious type of skin cancer) based on an evaluation of a mole, the essential step is to confirm the diagnosis through precise procedures. The doctor begins with a comprehensive skin examination to assess any abnormal changes in the size, shape, or color of the mole, often relying on the ABCDE rule, which helps determine risk [1].

A skin biopsy is the definitive and necessary procedure for diagnosing melanoma; visual examination alone cannot confirm the presence of the disease [2]. The biopsy aims to remove a portion of the tissue or the entire mole for microscopic examination by a pathologist, which clarifies the nature of the cells present and whether they are cancerous [2].

Types of skin biopsies for diagnosing suspicious moles

The doctor determines the appropriate type of biopsy based on the location of the mole, its size, and its expected depth. Common methods include the following [2]:

• Shave Biopsy: A sterile blade is used to remove the surface layer of the skin growth.
• Punch Biopsy: A special circular tool is used to extract a tissue sample that includes deeper layers, including the subcutaneous fat tissue.
• Excisional Biopsy: Often the preferred procedure when there is a strong suspicion of melanoma, where the entire mole is surgically removed with a scalpel.
• Incisional Biopsy: Involves removing only a part of a large growth or one located in sensitive areas.

In many cases, patients are advised to seek a second opinion on the tissue sample from another pathologist to ensure diagnostic accuracy, given the significant similarity between pigmented moles and early-stage melanoma [2].

Staging and treatment planning

If the biopsy confirms the presence of melanoma, the doctor performs "staging" to assess the extent of the disease's spread. This helps determine the optimal treatment plan suited to the patient's condition, which may include wide surgical excision or additional interventions [2]. For more information on how to examine your skin and prevention, you can view our specialized article on Mole Examination Using the ABCDE Rule (Arabic).

Post-diagnosis procedures

After determining the stage of the disease, the doctor may request additional tests to ensure that there is no spread elsewhere. These tests include procedures such as sentinel lymph node biopsy, CT scans, MRIs, or even blood tests for specific enzymes such as LDH [2]. The final treatment choice depends on several factors, including the thickness of the tumor, its location on the body, and the patient's general health status [2].

Always remember that any mole that begins to bleed, ulcerate, itch, or change rapidly in shape requires an immediate medical consultation. Regular follow-ups with a dermatologist remain the best guarantee for early detection and proper management of any suspicious skin developments [1].

Medical references

• Melanoma
• Melanoma Treatment (PDQ®)–Patient Version