The diagnosis phase of skin cancer can be difficult and overwhelming. During this phase, further testing will be necessary to obtain a diagnosis and determine the best course of treatment.
If a suspicious growth is noticed on the neck or facial skin, patients should seek care from a dermatologist: a doctor who specializes in diseases of the skin. Patients can expect their doctor to have a discussion with them about the risks, benefits, and alternatives to each of the following approaches.
When there is a suspicious growth on the skin, a biopsy will need to be performed to make a definitive diagnosis. This can usually be done in the office with very little risk. Biopsies of the skin are more straightforward than in other sites, mainly because they are easier to get to. Typically, patients will get a tiny injection of numbing medicine before the procedure.
The doctor may perform an incisional biopsy (also known as a punch biopsy), excisional biopsy, or shave biopsy. Learn more about these and other types of biopsies.
The biopsy results will reveal whether there is any cancer present and determine what the next steps should be. Learn more about the different types of skin cancer.
In some cases, the doctor may want to assess lymph nodes located in the neck. This can be done by fine needle aspiration, core biopsy, open biopsy (rarely) or by sentinel lymph node biopsy in the operating room. Sentinel lymph node biopsies for skin cancers are used mainly for melanoma and Merkel cell cancers, and sometimes squamous cell carcinomas. Learn more about different kinds of lymph node biopsies.
Imaging refers to radiologic studies, or scans, that create pictures of the structures inside the body. In general, imaging might not be necessary for small skin tumors easily evaluated by physical examination. CT and MRI are the most common types of imaging scans.
For skin cancer, imaging is most commonly used to look for enlarged lymph nodes in the neck. These scans may also be important to see how deep a growth has progressed, and to assess for invasion into surrounding structures such as the facial skeleton. Occasionally, a more advanced imaging study called a PET/CT will be needed to look for spread of cancer to other parts of the body.
More aggressive skin cancers, such as melanoma, are more likely to require an imaging test than are other types of skin cancers. For cancers more severe than melanoma in situ (which is an extremely thin melanoma that has not invaded into the deeper layers of the skin), patients will likely be advised to have a chest X-ray and blood work.