According to the American Cancer Society, over 100,000 people in the United States will be diagnosed with melanoma in 2024. Melanoma is the least common type of skin cancer but also the most dangerous. Getting an early diagnosis offers the best chance of successful treatment. Melanoma diagnosis relies on a procedure called a biopsy.

During a biopsy, a surgeon removes cells from the body and sends them to a lab for a closer look. Sometimes, these cells are taken from a pigmented spot or skin lesion. Other times, they’re removed from the lymph nodes.

You should never put an important biopsy on hold, especially if there is a risk of melanoma. Always discuss options with your doctor. Here’s an overview of the five types of biopsy that are commonly used to diagnose melanoma.

1. Skin Biopsy

Skin biopsies are usually the first course of action if you or your dermatologist finds a mark that seems like it could be cancerous. During this in-office procedure, the dermatologist numbs the area and cuts off as much of the mole as possible. Then, the sample is sent to the lab for further examination. Skin biopsies shouldn’t hurt, but they can leave you feeling a bit sore, and they can leave a permanent scar. If you’re concerned about scarring, ask your doctor whether you should expect a scar and if they have any tips to help with the healing process.

2. Shave Biopsy

The technical term for a shave biopsy is “tangential biopsy.” During this procedure, the dermatologist uses a small blade to shave off the top layer of the skin. If you have a low risk of melanoma, your doctor may recommend a shave biopsy since it doesn’t cut as deep as a skin biopsy.

A deeper shave biopsy is called saucerization. Rather than just taking off a superficial skin layer, this biopsy goes further into the skin. Your doctor uses a surgical blade to scoop far enough for an accurate analysis. Like other skin biopsies, this procedure is done at the doctor’s office under local anesthesia. You shouldn’t feel pain once the area is properly numbed, but you may feel some pressure.

Some people experience bleeding from a shave biopsy and may need to apply ointment while the biopsy site heals. Your dermatologist can also stop bleeding with an electrical current. This is known as cauterizing the wound.

3. Punch Biopsy

A punch biopsy is an incisional biopsy. That means only a portion of the suspicious mole gets removed. Punch biopsies can be a good option if the suspicious area on your body is big or if its removal would have a significant impact on your appearance — for instance, if it’s on your face or another conspicuous area. In a punch biopsy, a smaller skin sample is analyzed to see if further action is needed before a larger area is removed.

Punch biopsies use a “cookie cutter” type device that’s rotated on the skin to slice through each layer. Unlike in shave biopsies, the surgeon repairs the skin with stitches. Some stitches dissolve on their own with time. Others need to be removed during a follow-up office visit. Ask your surgeon how to care for your wound and whether you need to come back in to have the stitches removed.

4. Optical Biopsy

As technology has improved, so have the accessibility and accuracy of noninvasive screening tools. An optical biopsy doesn’t involve any cutting, pain, or scarring. Instead, health care professionals use three-dimensional images to examine the area of skin. This technology is called confocal microscopy.

Biopsies that involve cutting out tissue for inspection are generally the preferred way to diagnose melanoma. However, these procedures can be difficult in sensitive areas. They’re also not always the best for people with other health conditions or people who are very hesitant to have an invasive test.

5. Lymph Node Biopsies

Sometimes, looking at cells on the skin isn’t enough to get a full picture of melanoma. Lymph node biopsies tell your doctor whether the cancer has spread to other parts of the body. Spreading to the lymph nodes would mean that the melanoma has progressed to a more advanced stage. The lymph nodes are part of the immune system, and they’re one of the first places where melanoma typically spreads.

To decide if you need a lymph node biopsy, your doctor will feel specific areas where the lymph nodes are found, such as:

• Groin
• Head and neck
• Underarms

This helps them determine if your lymph nodes are enlarged and should be biopsied. There are a few different ways to biopsy the lymph nodes, explained below. Your health care provider can help guide you on the procedure they recommend.

Fine Needle Aspiration

During a fine needle aspiration (FNA) biopsy, a small syringe pulls off samples from the lymph nodes or tumor. The process may be guided by imaging to make sure the syringe reaches the target area.

Surgical (Excisional) Biopsy

If your doctor suspects that melanoma has metastasized (spread), they may suggest moving straight to a surgical or excisional biopsy of the lymph nodes. Surgical biopsies may be recommended if you didn’t have an FNA or if the results of an FNA didn’t find cancer.

During this procedure, the enlarged lymph node is completely removed. Surgeons make a small incision, cutting through the skin to reach the lymph node.

Sentinel Biopsy

Sentinel lymph node biopsies are performed on the lymph node that’s closest to the area of skin found to have melanoma. If the cancer cells on the skin have aggressive characteristics, doctors may not want to wait for signs of an enlarged lymph node to check if it’s spreading.

Instead, they’ll inject a radioactive chemical and blue dye into the nearby lymph nodes where the melanoma was found initially. If this tracer fluid collects in one of the lymph nodes, they’ll remove the lymph node tissue and send it to the lab to look for melanoma cells. Sentinel biopsies are recommended for people with a melanoma tumor that’s 1 millimeter thick or bigger.

It may be several days before you receive your results. Some people have swelling or pain as the incision heals. Your doctor can provide pain medications, and they may also give you a device known as a drain to help with swelling. Fortunately, additional lymph node biopsies are usually unnecessary if a sentinel biopsy finds no cancer cells.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with melanoma skin cancer.

What type of biopsy did you have before getting a diagnosis of melanoma? How did the results of your biopsy help inform your melanoma treatment plan? Share your experience in the comments below, or start a conversation by posting on your Activities page.