From the Guidelines
For a cutaneous growth on the leg suspicious for cancer, I recommend ordering a complete skin examination, skin biopsy, complete blood count (CBC), comprehensive metabolic panel (CMP), and imaging studies including ultrasound of the regional lymph nodes and, depending on suspicion level, CT scans of the chest, abdomen, and pelvis. The skin biopsy is the most essential diagnostic test and should be performed promptly, ideally as an excisional biopsy if possible, or as an incisional or punch biopsy for larger lesions, as recommended by the revised U.K. guidelines for the management of cutaneous melanoma 2010 1. This provides tissue for histopathological examination to determine the type of cancer, depth of invasion, and other prognostic factors. Blood tests, such as CBC and CMP, help assess overall health status and potential systemic effects of the cancer, as suggested by the guidelines for non-Hodgkin's lymphomas 1. Ultrasound of regional lymph nodes can detect metastatic spread, while advanced imaging with CT scans may be necessary if there is concern for distant metastasis, as indicated by the guidelines of care for the management of primary cutaneous melanoma 1. For melanoma specifically, sentinel lymph node biopsy may be indicated based on the depth and characteristics of the primary lesion. These diagnostic steps are crucial for accurate staging, which directly influences treatment planning and prognosis determination. Key points to consider include:
- Complete skin examination to assess the lesion and surrounding skin
- Skin biopsy, preferably excisional, to determine the type and extent of cancer
- Blood tests, including CBC and CMP, to evaluate overall health and potential systemic effects
- Imaging studies, such as ultrasound and CT scans, to detect metastatic spread and assess distant metastasis
- Sentinel lymph node biopsy for melanoma, based on lesion characteristics and depth.
From the Research
Diagnostic Approach for Cutaneous Growth on Leg Suspicious for Cancer
- For a cutaneous growth on the leg suspicious for cancer, a biopsy is essential for diagnosis 2.
- The choice of biopsy technique depends on the type of lesion, with options including superficial shave biopsy, saucerization excision, punch biopsy, and elliptical excision 2.
Laboratory Tests and Imaging
- There is limited evidence to support the routine use of laboratory tests such as complete blood count (CBC) and liver function tests (LFTs) in the evaluation of cutaneous growths suspicious for cancer 3, 4.
- Chest X-rays are also not recommended as a routine screening test for occult metastasis in patients with early-stage cancer 3, 4.
- However, CBC components such as white blood cell count, neutrophil-to-lymphocyte ratio, and platelet count may be useful markers for predicting cardiovascular and metabolic diseases 5.
- Liver blood tests, including LFTs, can be useful in diagnosing and managing hepatobiliary disease, but their role in evaluating cutaneous growths is limited 6.