How are patients with melanoma evaluated after the initial diagnosis?

Baseline evaluations then should be performed to determine if there are any detectable secondary primary tumors, local extension of the first primary, or if metastatic disease is present. These evaluations should include a complete physical examination—a complete skin evaluation and lymph node exam; a chest x-ray; and may include baseline laboratory tests such as a complete blood count, blood chemistry studies, liver function tests, and possibly serum lactate dehydrogenase. It should be stressed that there is significant evidence to suggest that routine imaging studies and blood work have limited, if any, value in the initial evaluation of asymptomatic patients with a primary cutaneous melanoma 4 mm or less in thickness. The American Academy of Dermatology recommends that these tests should be optional and directed based on a thorough medical history and physical examination. Exceptions for asymptomatic patients include those with a primary tumor >4 mm and in the setting of clinical trials. Any abnormality detected with these exams should be more fully investigated with the proper diagnostic procedure (e.g., a fine-needle aspirate to assess an enlarged lymph node or computerized tomography of the abdomen for abnormal liver chemistry).