Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Soft Tissue Masses — Mole Diagnosis
Suspicion, biopsy, Breslow thickness, and the sentinel node
In Istanbul, a suspicious mole is not diagnosed by looking alone. A site-matched biopsy comes first, and Breslow thickness then sets the plan. A sentinel node is not routine for every melanoma.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
- The block shows epidermis, dermis, and an example pigmented lesion.
- The dashed line is Breslow thickness: vertical distance to the deepest tumor cell.
- The drawing does not mean every melanoma is this deep.
Related educational figures
Tap a figure to enlarge.
The sentinel node is the first draining node. A positive result does not mean every other node is removed. Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
The sentinel node is the first draining node. A positive result does not mean every other node is removed.
Key points
- Key note inside
How suspicion starts
Change, bleeding, a new spot, or an atypical dermoscopic pattern creates suspicion. Fair skin, a history of blistering sunburn, many atypical moles, and a family history of melanoma raise risk. None of them is a diagnosis.
Biopsy technique depends on the site
When the site allows it, a narrow complete excisional biopsy is preferred. The goal is to remove the whole lesion so Breslow thickness can be measured. Wide oncologic margins are not placed at this step, because lymphatic mapping may still be ahead. On the face, a digit, the palm, the sole, or a very large lesion, a punch or partial biopsy is acceptable. A superficial shave can undercut the thickness measurement.
- A narrow complete excision is usually the cleanest diagnostic sample
- A partial biopsy can be reasonable where tissue is scarce
- A superficial shave can leave Breslow incomplete
What Breslow thickness is
Breslow thickness is the vertical distance from the top of the epidermis — or from the base of an ulcer, if one is present — to the deepest melanoma cell. It guides stage, the margin range discussed for wide excision, and whether a sentinel-node biopsy is even on the table. The arrow in the figure is an example. The millimeter belongs to the pathology report, not to a website formula.
What a sentinel node shows
The sentinel node is the first node lymph reaches from the primary site. The biopsy asks whether that node holds microscopic disease. It is not removal of the whole nodal basin. A positive sentinel node does not automatically mean completion lymph-node dissection. After MSLT-II, current practice reads ultrasound, systemic therapy, and a multidisciplinary plan together.
Related pages
Moles and ABCDE →
Ordinary mole, suspicious nevus, and melanoma concern.
Melanoma surgery →
Wide excision, the sentinel decision, and advanced disease.
Surgical oncology →
How oncologic surgery is approached in this practice.
Tumor board →
Dermatology, surgery, pathology, and medical oncology plan together.
International patients →
How to share records for a remote review.
Contact and appointments →
Write for an exam or a second opinion.
Frequently asked questions
Why does biopsy technique change with the site?
On the trunk or a limb, a narrow complete excision is often enough. On the face, a finger, the palm, or the sole, tissue is limited and a partial biopsy can be appropriate. A superficial shave can spoil the thickness measurement.
Why does Breslow thickness matter?
Vertical thickness guides stage and the next surgical conversation. One millimeter does not prescribe the same operation for everyone. Anatomy and the pathology report are read together.
What does a sentinel-node biopsy show?
Whether the first draining node holds microscopic disease. It is not routine for every melanoma. A positive result does not automatically mean the rest of the nodes are removed.
More chapters in this hub
Lipoma
Benign fatty masses — when to observe or excise
Skin Cysts
Epidermoid and pilar cysts — inflammation, infection, and excision
General Diagnosis
Lipoma and skin cysts — exam, ultrasound, MRI
General Treatment
Lipoma and skin cysts — observation and excision
Moles and Melanoma
Ordinary moles, common myths, and why change matters
Melanoma Surgery
Wide excision, sentinel decision, and advanced disease
Liposarcoma
Deep fatty malignancy — not a lipoma
Liposarcoma Diagnosis
MRI, biopsy, and tumor board
Liposarcoma Treatment
Wide excision, radiotherapy, and surveillance
Retroperitoneal Masses
Deep abdominal tumors — imaging and resection
Appointment / info
Evidence
Scientific sources
Show sources · 3NCCN, ESMO, and AAD framing for diagnostic biopsy, Breslow thickness, wide-excision margin ranges, and sentinel-node decisions in cutaneous melanoma. Ranges are adapted to the person and the site. A positive sentinel node is not automatic completion dissection.
Evidence
Scientific sources
- 1. NCCN Clinical Practice Guidelines in Oncology: Cutaneous MelanomaNational Comprehensive Cancer Network (NCCN) · Current versionOpen source →
- 2. Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-upEuropean Society for Medical Oncology (ESMO) · 2024 · DOI: 10.1016/j.annonc.2024.11.006Open source →
- 3. AAD — melanoma: signs, diagnosis, and treatment (patient education)American Academy of Dermatology (AAD) · Patient resource libraryOpen source →
Last reviewed: 21 August 2026. Links go to publisher pages.
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.