Melanoma: Practical Tips for Early Detection & Evaluation
A UVA Health surgical oncologist whose practice focuses on melanoma, Russell Witt, MD, routinely sees patients after they have been referred for specialty care. He sees firsthand how decisions made earlier in the care continuum can shape the evaluation and treatment that follow.
“Early steps matter — especially with biopsy planning, surgical planning, and sequencing of treatment,” Witt stresses. “Referring providers are on the front lines and know their patients really well. I value our partnership and working together to ensure patients get the right care at the right time.”
Drawing on his melanoma-focused practice, Witt shares several ways providers can support early melanoma detection and treatment.
Encourage Patients to Speak Up About Skin Changes
Patients may be the first to notice that a mole or other skin lesion looks or behaves differently. Witt recommends encouraging them to mention those changes, even if they are uncertain whether they are significant.
“Early detection starts with listening to patients when they notice a changing or concerning skin lesion, performing a skin exam when appropriate, and having a low threshold for biopsy or dermatology referral,” he says.
Risk factors that may warrant added attention include:
- Numerous or atypical moles
- Fair skin
- Significant sun exposure or a history of blistering sunburns
- Tanning bed use
- Immunosuppression
Examine, Measure, & Document What You See
When a patient raises a concern, a few simple observations can provide useful information after referral.
“Take a moment to examine, measure, and document them,” Witt says. “A simple measurement, photograph, or note about whether a lesion is changing over time can be extremely helpful.”
This documentation can provide a useful baseline for subsequent evaluation and help clinicians understand how a lesion has evolved.
Seek Additional Evaluation When a Lesion Is Concerning
When a lesion raises concern, Witt recommends early biopsy or dermatology referral.
Providers also do not need to be certain that specialty evaluation is necessary before reaching out.
We welcome questions from referring providers, even if the question is simply whether a patient should be seen by us.
For patients already diagnosed with melanoma, specialty evaluation may be particularly helpful when disease is invasive, thick, ulcerated, recurrent, or may require sentinel lymph node biopsy or multidisciplinary care.
Coordinated Care From the Beginning
Melanoma treatment can require input from multiple specialties, and the appropriate approach depends on many factors, including:
- Characteristics of the primary tumor
- Lymph node risk
- Disease extent
- Patient goals
- The role of systemic therapy
At UVA Health, patients can access coordinated care involving specialized surgery, medical oncology, radiation oncology, dermatology, pathology, radiology, reconstructive surgery, clinical trials, and supportive services.
“For a complex disease like melanoma, that coordination can make the experience less fragmented and help ensure that treatment decisions are made thoughtfully from the beginning,” Witt says.
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