I think I have melanoma – what's next? The path from suspicion

Content author: MD. Piotr Rak, surgeon · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Piotr Rak · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of educational nature and is not intended for self-assessment of skin lesions. The diagnosis of melanoma is not made based on photos, descriptions or applications - it requires a medical examination with dermatoscopic evaluation, and ultimately a histopathological examination of the excised lesion. A lesion that bleeds, ulcerates, grows rapidly or does not heal requires urgent consultation.

The most important information at a glance

• Most lesions that patients present with suspected melanoma turn out to be benign.
• Suspected melanoma isn't a medical emergency — but it's not next quarter's issue, either.
• A reasonable framework is to consult within the next few days, not weeks or months.
• The phone photo and the application do not replace dermatoscopy or medical examination.
• A suspicious lesion is not incised or biopsied - it is removed entirely.
• The diagnosis is made by a pathologist based on a microscopic examination, not a doctor in the office.
• The histopathological result usually takes from several days to several weeks.
• The key parameter in the result is the thickness of the infiltration, described as the Breslow thickness.
• If the diagnosis is confirmed, a second procedure is performed to widen the margin and, in selected cases, assessment of the sentinel node.
• Time matters: the earlier melanoma is diagnosed, the smaller the scope of treatment and the better the prognosis.

Find out more about the specialist

Doctor. Piotr Rak is a surgeon at the Island of Friendly Medicine in Gdańsk. He deals with surgical procedures, including the assessment and removal of skin lesions. When melanoma is suspected, the doctor's task is to make one decision: whether to observe the lesion or remove it entirely and send it for histopathological examination. Everything else is decided only under a microscope.

Schedule a consultation

How much time do I really have?

This question is asked by everyone who has just noticed something disturbing about themselves - and rarely finds a specific answer. There are either reassurances without substance or messages that sound like alarms. Let's try to be precise.

This is not an emergency or night duty situation. Melanoma does not develop in hours. There is no reason to go to the emergency room because of a birthmark that has changed your appearance.

This is also not something that can be postponed to a slower month. Melanoma in the phase of horizontal growth, i.e. spreading within the epidermis, may remain harmless for a long time. However, when it enters the phase of vertical growth and begins to infiltrate deep into the skin, the situation changes significantly - and the moment of this transition is unpredictable.

A reasonable framework is consultation within the next few days. Not on the same afternoon, but also not "when an appointment becomes available in three months." If the lesion bleeds, ulcerates, grows quickly or does not heal - do not wait for the standard date, tell us about it during registration.

There is one more argument that is rarely talked about. A few weeks of delay may not change the course of the disease - but it will almost certainly change how you feel. Most people don't stop thinking about it during this time.

The path from suspicion to diagnosis

The greatest anxiety comes from not knowing what is actually going to happen. Below is the whole route, stage by stage.

It is worth paying attention to the third stage. The decision is made during the visit and is always the same: observe or cut out. There is no third option of "let's wait and see if it grows" when it comes to a change that raises suspicion. If the image is inconclusive, cutting out is safer than waiting.

Why is the entire lesion excised and not a part of it?

This question is asked often and deserves explanation because it concerns the essence of the diagnosis.

When melanoma is suspected, the standard procedure is excision of the entire lesion with a small margin of healthy skin. The reason is simple: the pathologist must evaluate the lesion as a whole to measure how deep the infiltration reaches. This depth is the most important parameter deciding on further proceedings. It cannot be reliably determined from the fragment - the deepest place could remain in the skin.

For the same reason, suspicious lesions are not removed by laser, electrocoagulation or freezing. These methods destroy the tissue, so there is no material left for testing. If it was an early change, the diagnosis is irretrievably lost and the patient leaves convinced that the problem has been solved.

The margin on the first treatment is intentionally small. It's not about removing as much as possible at once - it's about making a diagnosis. If it turns out to be melanoma, a second procedure is performed to widen the margin, and its scope depends on the thickness of the infiltration. The two-step approach is not an oversight, but a well-thought-out approach.

Waiting for the result - the most difficult stage

Several days between the procedure and the result are the worst part of the entire journey for most patients. It's worth knowing a few things that make it easier.

Why is it taking so long. The material must be fixed, properly prepared, cut into very thin sections, stained and evaluated under a microscope - sometimes with additional staining to resolve doubts. Each of these stages takes time. A longer wait does not mean that "something is wrong" - quite the contrary, because difficult cases are consulted with a second pathologist.

Not having a phone is not a bad sign. The results are discussed at the scheduled appointment, regardless of the content. Silence in the meantime means nothing.

Searching on the Internet at this time is harmful. You will find statistics on advanced stages, descriptions of the most severe cases and forums where mainly people with a difficult course write. None of this information applies to you yet because you don't have a diagnosis.

It's worth telling someone. Waiting alone is much more difficult, and someone close to you can go with you to discuss the result - this really helps you remember what was said.

And one thing that's worth repeating to yourself: you don't have a diagnosis of melanoma at this point. You have a lesion that was cut out to check it out. These are two completely different situations.

What will be the result - dictionary

The histopathological result may be written in a language that is illegible to the patient. Below are the most important terms so you know what your doctor is looking at.

Breslow thickness is crucial here and it is worth understanding why. The skin has layers, and the deeper the infiltration reaches, the greater the chance of contact with blood and lymphatic vessels. Therefore, the depth is measured, not the diameter of the lesion visible on the surface - a large, flat mole may be less advanced than a small but infiltrating one.

We consciously do not provide survival percentages assigned to specific values ​​here. Such numbers refer to large groups of patients, not a single person, and when read in isolation from the rest of the picture, they are misleading. The result is always discussed by the doctor in the context of the whole.

What to do next if the diagnosis is confirmed

The first thing you should know: a diagnosis of melanoma does not automatically mean severe treatment. The procedure depends primarily on the depth of the infiltration.

Margin widening. The standard is the second treatment, which involves cutting out an additional margin of healthy skin around the scar after the first treatment. The range depends on the thickness of the infiltrate. In the earliest cases, this may be the only treatment needed.

Sentinel node biopsy. Considered for thicker infiltrates. It involves finding and examining the lymph node to which the lymph from the lesion area first flows. It is used to assess the progress and helps plan further proceedings.

Further oncological care. If the disease is advanced and requires systemic treatment, the patient is referred to an oncology center. It is worth knowing that the treatment options for melanoma have changed significantly in recent years - information from a decade ago does not correspond to today's realities.

Controls. After treatment, regular supervision is required: scar inspection, inspection of the entire skin and examination of lymph nodes, at intervals determined individually.

What if it's not melanoma?

This is the most likely scenario and is worth mentioning separately, because it is usually omitted in texts about melanoma.

The changes that cause concern for the patient are most often benign: ordinary melanocytic nevi, seborrheic warts, hemangiomas, lentigines, dysplastic nevi. Some of them look scary precisely because they are unusual - not because they are malicious.

If the result is mild, the matter usually ends there. However, it is worth using this moment to do two things: determine with your doctor how often to check your skin, and - if you have not done so yet - examine the entire skin, not just this one lesion. Many melanomas are discovered by accident while evaluating something completely different.

And one note: an unnecessarily removed mole is not a failure. A scar after a minor procedure costs incomparably less than an overlooked early melanoma. A doctor who excises when in doubt is doing the right thing.

What not to do

• Do not remove the lesion yourself - do not tie it with thread, do not scrape it, do not burn it with preparations.
• Do not go for laser removal or freezing if the change is suspicious - there will be no material left for examination.
• Don't pick off scabs or irritate the lesion "to see if it hurts."
• Do not rely on applications that assess moles from a photo - they do not replace dermatoscopy or examination.
• Don't compare yourself with photos from the Internet - melanoma can be atypical, and benign changes can be disturbing in appearance.
• Don't wait until the change growsto "be sure". Earlier diagnosis means less treatment.
• Do not postpone your visit because of holidays or work - the procedure is minor and does not take away from your life.
• Don't read the survival statisticsbefore you have the diagnosis and full results.

Most common myths

• "Melanoma is always black." No. It can be brown, pink, red, or even dye-free.
• "If it doesn't hurt, it's not melanoma." No. Early changes usually don't hurt; the pain appears late.
• "It has to be big to be dangerous." No. What matters is the depth of the infiltration, not the diameter on the surface.
• "Removing the mole spreads the cancer." No. This is a persistent myth; correct diagnostic excision is the treatment of choice.
• "Better to wait and watch." Not for a suspicious change. The observation concerns changes that do not raise any doubts.
• "The photo is enough for the assessment." No. Dermatoscopy is needed, and histopathological examination is decisive.
• "Melanoma only affects people who have sunbathed." No. It also occurs in places not exposed to the sun.
• "A diagnosis of melanoma is a death sentence." No. The prognosis depends primarily on the stage, and melanoma detected early is treated surgically.

Instead of looking for answers on the Internet - arrange an examination

Dermatoscopic assessment takes a few minutes and is painless. In most cases, it ends with information that the change is benign. And if not, earlier diagnosis means less treatment.

Assessment and removal of skin lesions at the Island of Friendly Medicine in Gdańsk

At the Island of Friendly Medicine doctor. Piotr Rak consults patients with skin lesions that cause concern. The visit includes an interview, dermatoscopic assessment and a decision: observation with follow-up or complete removal of the lesion with histopathological examination.

We remove pigmented lesions only surgically, with histopathological examination - no exceptions. If the diagnosis is confirmed and requires oncological treatment, the patient is referred to the appropriate center. The current scope of treatments, availability of dates and prices should be confirmed during registration.

Make an appointment Dermatoscopy

What to ask the doctor?

• Does this change make you suspicious in dermatoscopy?
• Observation or excision - and why?
• If observation, for how much and what should I pay attention to?
• How large will the procedure be and where will the incision be made?
• When will I know the result and how will it be communicated to me?
• What will the result mean if it is incorrect?
• Will I need a second treatment?
• Do I have other changes that are worth seeing or photographing?
• How often should I check my skin?
• Do I have risk factors that require more frequent monitoring?
• How to care for a scar and protect it from the sun?
• What should I worry about before my next visit?

FAQ - suspected melanoma

Is suspected melanoma an emergency?

Not in the emergency sense - melanoma doesn't develop in hours. However, you should not postpone your visit for weeks or months. A reasonable framework is to consult within the next few days.

Is a photo or application sufficient for evaluation?

No. An examination with dermatoscopic evaluation is needed, which shows structures invisible to the naked eye. The histopathological examination of the excised lesion remains decisive.

Why is the entire lesion removed?

Because the pathologist must assess the depth of infiltration, and this cannot be reliably measured in the fragment. For the same reason, no laser or freezing is used - no material is left for examination.

Can removing a mole spread the cancer?

No. This is a persistent myth that can lead to dangerous delays. Proper diagnostic excision is the standard procedure when melanoma is suspected.

How long does it take to get the histopathological result?

Usually from several days to several weeks, depending on the studio. A longer wait does not mean a worse result - sometimes it results from additional staining or consultation of a second pathologist.

What does Breslow thickness mean?

This is the depth of infiltration measured in millimeters - the most important prognostic parameter and determining the scope of further treatment. What matters is the depth, not the diameter of the lesion visible on the surface.

What is melanoma in situ?

This is the earliest form of melanoma, limited to the epidermis, without infiltrating into the skin. Treatment then involves surgical excision with an appropriate margin.

Is a second treatment always necessary?

In case of confirmed melanoma, the standard procedure is to widen the margin, the scope of which depends on the thickness of the infiltration. In case of mild lesions, a second treatment is not necessary.

What is a sentinel node biopsy?

This is an examination of the lymph node to which the lymph from the lesion area first drains. They are considered in case of thicker infiltrations, in order to assess the advancement and plan further treatment.

Is it a mistake to remove a mole unnecessarily?

No. A scar after a minor procedure costs incomparably less than an overlooked early melanoma. When in doubt, excision is the appropriate course of action.

What to do while waiting for the result?

Avoid reading survival statistics because they concern diagnoses you don't yet have. It is worth telling a loved one about the situation and asking them to accompany you to the visit to discuss the results.

Who assesses skin lesions in WMP?

On the WMP website, MD. Piotr Rak is described as a surgeon who performs surgical procedures, including the evaluation and removal of skin lesions. The scope of treatments and availability of dates are confirmed by registration.

Sources

• DermNet, Melanoma: https://dermnetnz.org/topics/melanoma
• DermNet, Melanoma in situ: https://dermnetnz.org/topics/melanoma-in-situ
• DermNet, Dermatoscopy: https://dermnetnz.org/topics/dermatoscopy
• DermNet, Atypical naevus: https://dermnetnz.org/topics/atypical-naevus
• NHS, Melanoma skin cancer: https://www.nhs.uk/conditions/melanoma-skin-cancer/
• NHS, Moles: https://www.nhs.uk/conditions/moles/
• NHS, Sunscreen and sun safety: https://www.nhs.uk/live-well/seasonal-health/sunscreen-and-sun-safety/
• NICE, Melanoma: assessment and management (NG14): https://www.nice.org.uk/guidance/ng14
• NICE, Suspected cancer: recognition and referral (NG12): https://www.nice.org.uk/guidance/ng12
• British Association of Dermatologists, information for patients: https://www.bad.org.uk/patient-information-leaflets/