I’ve Been Diagnosed With Melanomawhat Happens Next
Doctors use the TNM system developed by the American Joint Committee on Cancer to begin the staging process. Its a classification based on three key factors:
T stands for the extent of the original tumor, its thickness or how deep it has grown and whether it has ulcerated.
What Is Breslow depth?
Breslow depth is a measurement from the surface of the skin to the deepest component of the melanoma.
Tumor thickness: Known as Breslow thickness or Breslow depth, this is a significant factor in predicting how far a melanoma has advanced. In general, a thinner Breslow depth indicates a smaller chance that the tumor has spread and a better outlook for treatment success. The thicker the melanoma measures, the greater its chance of spreading.
Tumor ulceration: Ulceration is a breakdown of the skin on top of the melanoma. Melanomas with ulceration are more serious because they have a greater risk of spreading, so they are staged higher than tumors without ulceration.
N indicates whether or not the cancer has already spread to nearby lymph nodes. The N category also includes in-transit tumors that have spread beyond the primary tumor toward the local lymph nodes but have not yet reached the lymph nodes.
M represents spread or metastasis to distant lymph nodes or skin sites and organs such as the lungs or brain.
After TNM categories are identified, the overall stage number is assigned. A lower stage number means less progression of the disease.
How Often Should You Follow Up With Your Doctor
After your treatment, your doctor will recommend a regular follow-up schedule to monitor your cancer. Theyll be checking to make sure the cancer hasnt come back or new cancerous lesions havent appeared. The types of follow-up include:
A yearly skin check: Skin checks are an important aspect of detecting melanoma in its earliest, most treatable stages. You should also conduct a skin check on yourself once per month. Look everywhere from the bottoms of your feet to behind your neck.
Imaging tests every three months to a year: Imaging studies, such as an X-ray, CT scan, or brain MRI, look for cancer recurrence.
Physical exam as needed: A physical exam to assess your overall health is important when you have had melanoma. For the first two years, youll want to get an exam every three to six months. Then for the next three years, the appointments can be every three months to a year. After the fifth year, the exams can be as needed. Do a monthly self-examination of your lymph nodes to check your progress.
Your doctor may recommend a different schedule based on your overall health.
What Else Should I Know About Treatment For Advanced Melanoma
Thanks to research breakthroughs, more patients diagnosed with advanced melanoma are living longer some for years.
Because these breakthrough are relatively recent, its important to:
Work with a team of melanoma specialists.
Ask your melanoma specialists if any of the newer treatments are appropriate for you.
Realize that no one treatment works for everyone, so you may need to try different treatments or combine treatments.
Researchers continue to study advanced melanoma, and next-generation treatments are now being studied in clinical trials. If you want to know whether you are a match for a trial, you can find out if there are any relevant trials at, Clinical Trial Finder.
Related AAD resources
ReferencesChukwueke U, Batchelor T, et al. Management of brain metastases in patients with melanoma. J Oncol Pract. 2016 12:536-42.
Emory Medical Center. A year in the life: Jimmy Carter shares his cancer experience. Posted July 11, 2016. Last accessed March 26, 2018.
Podlipnik S, Carrera C, et al. Performance of diagnostic tests in an intensive follow-up protocol for patients with American Joint Committee on Cancer stage IIB, IIC, and III localized primary melanoma: A prospective cohort study. J Am Acad Dermatol. 2016 75:516-24.
Nordmann N, Hubbard M, et al. Effect of gamma knife radiosurgery and programmed cell death 1 receptor antagonists on metastatic melanoma. Cureus. 2017 9: e1943.
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Stage 1 Melanoma Fingernail
With information about melanoma stages, prognosis is then possible. To find out the stage of your cancer you might need one. Stage 4 is the most advanced phase of melanoma. Melanoma is a skin cancer usually caused by ultraviolet rays from the sun or tanning beds. This type of cancer forms in the cells that give color to your skin, called melanocytes. No one is ever prepared to hear they have any type of cancer, particularly not melanoma, the most dangerous form of skin cancer. Not only does the stage tell you how serious the disease is, but it can help you and. This is called the stage.
To find out the stage of your cancer you might need one. Transferring treatment from wi to mn need some suggestions on clinics to finish chemo. See what the symptoms of melanoma looks like and learn about your treatment options. A cancer diagnosis can leave you unable to comprehend anything else your doctor says, but it’s important to pay attention to what stage of cancer you have. Stage 4 is the most advanced phase of melanoma, a serious. Use the menu to see other pages.staging is a way of describing where the cancer is located, if or where it has spread, and whethe. It’s usually caused by ultraviolet rays from the sun or tanning beds. Knowing the stage helps your doctor decide which treatment you need.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for melanoma skin cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread beyond the skin where it started.
- Regional: The cancer has spread beyond the skin where it started to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body, such as the lungs, liver, or skin on other parts of the body.
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Treating Stage 1 To 2 Melanoma
Treating stage 1 melanoma involves surgery to remove the melanoma and a small area of skin around it. This is known as surgical excision.
Surgical excision is usually done using local anaesthetic, which means you’ll be awake, but the area around the melanoma will be numbed, so you will not feel pain. In some cases, general anaesthetic is used, which means you’ll be unconscious during the procedure.
If a surgical excision is likely to leave a significant scar, it may be done in combination with a skin graft. However, skin flaps are now more commonly used because the scars are usually less noticeable than those resulting from a skin graft.
Read more about flap surgery.
In most cases, once the melanoma has been removed there’s little possibility of it returning and no further treatment should be needed. Most people are monitored for 1 to 5 years and are then discharged with no further problems.
How Is Melanoma Staged
Melanoma stages are assigned using the TNM system.
The stage of the disease indicates how much the cancer has progressed by taking into account the size of the tumor, whether its spread to lymph nodes, and whether its spread to other parts of the body.
A doctor can identify a possible melanoma during a physical exam and confirm the diagnosis with a biopsy, where the tissue is removed to determine if its cancerous.
There are five stages of melanoma. The first stage is called stage 0, or melanoma in situ. The last stage is called stage 4. Survival rates decrease with later stages of melanoma.
Its important to note that survival rates for each stage are just estimates. Each person with melanoma is different, and your outlook can vary based on a number of different factors.
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Final Thoughts On The Patient Journey
Based on the stage, cancer type, and other characteristics, every patient with melanoma is different. Even patients with stage III melanoma cannot be considered identical because of differences in their individual cancers .
Despite these differences, treatments are available for almost all patients. These include new postsurgical adjuvant treatment options that have become available over the past several years and have changed the outlook for many patients with stage III melanoma. Because these options differ with respect to how they work and their potential side effects, it is important for patients to discuss with their healthcare team all of the available treatment options. As part of this discussion, patients should consider asking their healthcare team about additional biomarker testing, which is required to determine if targeted treatments are appropriate. When targeted therapies are appropriate, both patients and their caregivers have a role to play in ensuring that the medications are taken at the correct dose and at the correct time.
Regardless of which type of therapy they receive for their melanoma, all patients should discuss the development of any adverse effects with their healthcare team. Oftentimes, side effects can be effectively managed before they become serious and impact a patients ability to continue his or her treatment.
Support And Advice Services
If you have any concerns or worries please contact our Helpline, which is manned by skin cancer nurses from 1pm 2pm and 7pm 9pm Monday to Friday and 7pm 9pm Sunday.
There are lots of sources of support and advice for people with melanoma and other types of cancer. If you speak to your professional about your needs whether they be emotional, social, financial or practical they can refer you to an appropriate key worker who can help you to find the support you need. For example, if you are struggling with household chores because you have been affected by your melanoma , social services might pay for someone to visit to help you out.
The biggest cancer charities in the UK are Cancer Research UK and Macmillan Cancer Support. Both have lots of information on their websites about coping with cancer, along with online communities where you can discuss your treatment with other people. Macmillan also has a phone line and provides face-to-face and financial support to people with cancer and their families.
Melanoma Focus is a national charity dedicated to providing a comprehensive source of information for the public and professionals, as well as lobbying, supporting education and funding research about melanoma. Melanoma Focus also has a helpline, manned by skin cancer nurses, which can be found here.
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Stop Tumors In Their Tracks
Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. Its impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.
To be sure youre spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total-body skin-exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.
Trust your instincts and dont take no for an answer, Leland says. Insist that a doctor biopsy anything you believe is suspicious.
Braf & Mek Kinase Inhibitors
The BRAF and MEK genes are known to play a role in cell growth, and mutations of these genes are common in several types of cancer. Approximately half of all melanomas carry a specific BRAF mutation known as V600E. This mutation produces an abnormal version of the BRAF kinase that stimulates cancer growth. Some melanomas carry another mutation known as V600K. BRAF and MEK inhibitors block the activity of the V600E and V600K mutations respectively.
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Changes To Melanoma Staging
Melanoma staging is based on the American Joint Committee on Cancer staging system, which uses 3 key pieces of information to stage a cancer:the extent of the Tumor thickness , whether the melanoma hasspread to local lymph Nodes , and whether the cancer has spread to distantlymph nodes or other organs, or Metastasized . Combining these 3 metrics, theTNM system is then used to classify the stage of a cancer.
In 2017, with the release of the new 8th Edition staging system, the AJCC adjustedmelanoma staging to incorporate additional factors that may affect a patientsresponse to treatment.17 This change from the previous AJCC 7th Edition meansthat many melanomas have been upstaged or downstaged since the 8th Edition staging system wasfully implemented in 2018.17 These changes also affect how clinical trials should beinterpreted: For example, the studies presented below enrolled patients using theolder AJCC 7th Edition staging system, prior to the release of the 8th Edition.
We understand that this change may be confusing for many patients and recommendthat they discuss any questions about the staging of their cancer withtheir treatment team.
The only targeted therapy that is currently available in the United States for the adjuvant treatment of melanoma is dabrafenib in combination with trametinib .7 Using a BRAF inhibitor combined with a MEK inhibitor is more effective than a BRAF inhibitor alone and may prevent melanoma cells from becoming resistant to the BRAF inhibitor .
Treatments For Stage Iii Melanoma
Stage III melanoma has multiple treatment options and can include surgery , neo-adjuvant therapy, adjuvant therapy, radiation therapy, and clinical trials. You will likely see a surgical oncologist for the surgery-related treatments and a medical oncologist for the drug-related treatments. If you have any radiation treatments, you will see a radiation oncologist.
It is important to know whether all of your Stage III melanoma has been completely removed with surgery , or if it was not possible to remove all of the melanoma . These two types of Stage III melanoma are treated very differently. Unresectable Stage III patients are treated similarly to Stage IV melanoma patients. Read about Stage IV melanoma.
Order of Treatment
Patients with melanoma often receive more than one type of treatment, and certain terms are used to describe the order of treatments given. Neo-adjuvant treatment is what is given before primary treatmentin melanoma, primary treatment is generally surgeryto shrink tumors. For Stage III patients, neo-adjuvant treatment is mostly given in clinical trials. Primary treatment is the main treatment to remove cancer. Adjuvant treatment is given after primary treatment to kill any remaining cancer cells. FDA-approved adjuvant therapies for Stage III are noted below.
The standard treatment for all primary melanoma is a surgery called wide local excision. The purpose of the surgery is to remove any cancer remaining after the biopsy of the primary tumor.
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Stages Iiia Iiib And Iiic
In order to better describe these variable factors, stage III melanoma is further divided into the following three categories:
- Stage III A: This stage includes microscopic levels of melanoma present in lymph nodes.
- Stage III B: This stage includes an ulcerated primary tumor, microscopic levels of melanoma in the skin near the primary tumor, microscopic levels of melanoma in lymph nodes, and melanoma in the draining nodes.
- Stage III C: This stage includes an ulcerated primary tumor and melanoma big enough to be felt in the draining nodes.
How Can You Manage Stage 3 Melanoma
Managing stage 3 melanoma can be challenging. With technological and medical advances, this diagnosis may not be as severe as it once was.
After your surgery or if youre unable to undergo surgery, you may need adjuvant treatment to prevent the cancer from coming back. There is adjuvant radiation therapy and adjuvant immunotherapy. These therapies help reduce the risk of melanoma returning, but they dont increase your survival rate.
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Putting The Results Of These Clinical Trials Into Context
The clinical studies described above have shown that both immunotherapies and targeted therapies are adjuvant treatment options following surgery, which are intended to delay or prevent the recurrence of melanoma in patients with high-risk stage III disease. Although both types of therapy provide good options for individuals with late-stage melanoma, patients should be aware of the clear differences in the side effect profiles of immunotherapies and targeted therapies.39
About 1 in 4 patients who received the checkpoint inhibitor nivolumab and about 1 in 3 patients who received the checkpoint inhibitor pembrolizumab in the clinical trials described above have reported experiencing severe side effects.31,36 Immune-related severe side effects that were observed in the clinical trials, such as the onset of type 1 diabetes or disorders of the thyroid and pituitary gland, have been confirmed in the treatment of real-world patients .
Because they work differently, targeted therapies do not carry the risk of triggering immune-related adverse effects. Nevertheless, about 2 of every 5 patients who received dabrafenib plus trametinib in the COMBI-AD study reported experiencing severe side effects.33 The proportion of patients treated with dabrafenib plus trametinib who withdrew from the study early because of side effects was 26%.33
Tnm Categories And Subcategories For Stage Iii Melanoma
T means Tumor. This category is related to your primary melanoma tumor.
T0 means no evidence of a primary tumor.
The T1 category includes tumors that are less than 1.0 mm thick. T1 subcategories:
- T1a tumors are less than 0.8 mm thick and are not ulcerated.
- T1b tumors are less than 0.8 mm thick and are ulcerated or are 0.8 to 1.0 mm thick and can be ulcerated or not.
The T2 category includes tumors that are greater than 1.0 mm and up to 2.0 mm thick. T2 subcategories:
- T2a tumors are greater than 1.0 mm and up to 2.0 mm thick and do not have ulceration.
- T2b tumors are greater than 1.0 mm and up to 2.0 mm thick and are ulcerated.
The T3 category includes tumors that are 2.0 to 4.0 mm thick. T3 subcategories:
- T3a tumors are 2.0 to 4.0 mm thick and are not ulcerated.
- T3b tumors are 2.0 to 4.0 mm thick and are ulcerated.
The T4 category includes tumors that are greater than 4.0 mm thick. T4 subcategories:
- T4a tumors are greater than 4.0 mm thick and are not ulcerated.
- T4b tumors are greater than 4.0 mm thick and are ulcerated.
N means Node. This category is related to the regional spread of your melanoma, beyond the primary tumor.
The N1 category comprises spread to only one lymph node OR there is in-transit, satellite, or microsatellite metastasis. N1 subcategories:
The N2 category comprises spread to two or three lymph nodes OR that there is in-transit, satellite, or microsatellite metastases AND one positive lymph node. N2 subcategories: