A diagnosis moves through a set sequence: an exam, a biopsy, a pathology report, and then staging. Knowing the sequence makes the waiting easier to bear.
A dermatologist looks at the spot and at the rest of your skin, usually with a dermatoscope, a handheld magnifier with polarized light. The exam decides whether a biopsy is needed.
The doctor numbs the skin and removes the spot, ideally all of it, in a few minutes. No scan or blood test can replace this step.1
A pathologist, often a dermatopathologist, examines the tissue under a microscope and writes the diagnosis. For melanoma the report lists Breslow thickness, ulceration, mitotic rate, and margins.2
Thickness and ulceration set the tumor category. For melanomas thicker than about 1 millimeter, and for some thinner ones, doctors discuss a sentinel lymph node biopsy to check the nearest lymph node.3 Scans are reserved for higher stages or for symptoms.
Your team combines the findings into a stage from 0 to IV, and the stage guides treatment.
A positive sentinel node used to mean a second, larger operation to remove the remaining nodes. The MSLT-II trial followed 1,934 patients and found that careful observation with ultrasound gave the same melanoma-specific survival as immediate surgery, with far less lymphedema.4 Most patients now avoid the larger operation.
Some pigmented lesions are hard to classify, even for experts. In a study of 187 pathologists reading 240 cases, agreement was high for clearly benign and clearly invasive lesions and much lower for the categories in between.5 Asking for a second dermatopathologist to review the slides is a reasonable request, and laboratories handle it routinely.
Shave, punch, and excisional biopsies, step by step.
A line-by-line guide to a melanoma pathology report.
Who is offered it and what the result changes.
The 3 microscope findings that matter most.
How to request a slide review.
Special stains and gene tests on difficult lesions.
Reviewed against these sources in September 2026. Figures change every year, and this page is updated when new estimates are released.
