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.
But more sophisticated technology, such as PET scans and sentinel lymph node biopsies, are necessary to determine the cancers stage or how far its progressed.
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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Treating Stage 0 Melanoma
Stage 0 melanoma has not grown deeper than the top layer of the skin . It is usually treated by surgery to remove the melanoma and a small margin of normal skin around it. The removed sample is then sent to a lab to be looked at with a microscope. If cancer cells are seen at the edges of the sample, a second, wider excision of the area may be done.
Some doctors may consider the use of imiquimod cream or radiation therapy instead of surgery, although not all doctors agree with this.
For melanomas in sensitive areas on the face, some doctors may use Mohs surgery or even imiquimod cream if surgery might be disfiguring, although not all doctors agree with these uses.
Characteristics Of Stage I Melanoma
Stage I melanomas are defined by two primary characteristics: tumor thickness and ulceration.
Tumor thickness : how deeply the tumor has penetrated the skin. Thickness is measured in millimeters . These comparisons will give you an idea of size:
- 1 mm = .04 inch, or less than 1/16 inchabout equal to the edge of a penny
- 2 mm = between 1/16 and 1/8 inchabout equal to the edge of a nickel
Ulceration: when the epidermis that covers a portion of the primary melanoma is not intact. Ulceration can only be seen under a microscope, not by the naked eye.
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Stage : Melanoma In Situ
The earliest stage of melanoma is stage 0, also known as melanoma in situ or carcinoma in situ. In situ is a Latin phrase that means in position, and this diagnosis means that the cancer cells are present only in the epidermisthe bodys most superficial layer of skinand nowhere else.
This diagnosis has a very good prognosis, Noelani González, MD, an instructor of dermatology at the Mount Sinai Icahn School of Medicine in New York City, tells Health. People with localized melanomas who are treated quickly have a 5-year survival rate of 97%meaning they are, on average, about 97% as likely to still be alive in five years as people who dont have these cancers.
Treatment for this stage cancer involves a wide excision surgery, where the affected skin is cut away and the wound is stitched and bandaged. The skin will be removed with margins, explains Dr. González. That means that some normal skin will also be removed around the edges to make sure there arent any cancer cells left over.
The removed skin is then looked at under a microscope to ensure that all of the cancer was removed with clean margins, says Dr. González. Because stage 0 cancer has not spread to any other tissues or organs, no further treatment is required.
What Does A Cancerous Lump Look Like
Bumps that are cancerous are typically large, hard, painless to the touch and appear spontaneously. The mass will grow in size steadily over the weeks and months. Cancerous lumps that can be felt from the outside of your body can appear in the breast, testicle, or neck, but also in the arms and legs.
What can be mistaken for melanoma? To better illustrate the appearance of mimics, well present six photographs of common skin conditions that have been mistaken for melanoma.
- Solar Lentigo. These are more commonly known as age or liver spots.
- Seborrheic Keratosis.
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Recurrence In Other Parts Of The Body
Melanoma can also come back in distant parts of the body. Almost any organ can be affected. Most often, the melanoma will come back in the lungs, bones, liver, or brain. Treatment for these recurrences is generally the same as for stage IV melanoma . Melanomas that recur on an arm or leg may be treated with isolated limb perfusion/infusion chemotherapy.
Melanoma that comes back in the brain can be hard to treat. Single tumors can sometimes be removed by surgery. Radiation therapy to the brain may help as well. Systemic treatments might also be tried.
As with other stages of melanoma, people with recurrent melanoma may want to think about taking part in a clinical trial.
The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options.
When Should I Call My Doctor
You should have a skin examination by a doctor if you have any of the following:
- A personal history of skin cancer or atypical moles .
- A family history of skin cancer.
- A history of intense sun exposure as a young person and painful or blistering sunburns.
- New or numerous large moles.
- A mole that changes in size, color or shape.
- Any mole that itches, bleeds or is tender.
A note from Cleveland Clinic
Receiving a diagnosis of melanoma can be scary. Watch your skin and moles for any changes and seeing your doctor regularly for skin examinations, especially if youre fair-skinned, will give you the best chances for catching melanoma early when its most treatable.
Last reviewed by a Cleveland Clinic medical professional on 06/21/2021.
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Is Stage 1 Melanoma Serious
All stages of melanoma are serious, but stage 1 melanoma is one of the mildly-serious stages of the cancer. When detected early in stage 1, the cancerous mole or growth has spread from the epidermis to the dermis . However, its not yet spread to other parts of the body. Generally, surgical removal of the growth and some surrounding tissue will get rid of the melanoma and generally has a five-year survival rate of 89percent to 95percent, which means that about 90 percent of people with this surgery will still be alive five years later. However, once the disease has spread from the skin to other parts of the body, it may become fatal. That being said, its very important to see a doctor if you notice any changes in existing moles or any new skin growths, since the chance for a full recovery is better the earlier you treat it.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
What Causes Moles To Suddenly Appear
Its thought to be an interaction of genetic factors and sun damage in most cases. Moles usually emerge in childhood and adolescence, and change in size and color as you grow. New moles commonly appear at times when your hormone levels change, such as during pregnancy.
What does redness around a mole mean? An inflamed mole can become more red in appearance and begin to swell, making it look like it has grown. This tends to occur from irritation when healthy moles are rubbed or injured, such as with habits like shaving.
What does a cancerous mole feel like?
Also, when melanoma develops in an existing mole, the texture of the mole may change and become hard or lumpy. The skin lesion may feel different and may itch, ooze, or bleed, but a melanoma skin lesion usually does not cause pain.
What color are cancerous moles? Malignant melanoma, which starts out as a mole, is the most dangerous form of skin cancer, killing almost 10,000 people each year. The majority of melanomas are black or brown, but they can be almost any color skin-colored, pink, red, purple, blue or white. Melanomas are caused mainly by intense UV exposure.
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What To Ask Your Doctor About Stage I Melanoma
When your doctor tells you that you have Stage I melanoma, it can be overwhelming. But it is important to use the time with your doctor to learn as much about your cancer as you can. S/he will provide you important information about your diagnosis.
The following questions are those you may want to ask your doctor. Remember, it is ALWAYS okay to ask your doctor to repeat or clarify something s/he said so that you can better understand it. You may find it helpful to print out these questions and bring them with you to your next appointment.
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.
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Stages Of Melanoma Skin Cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the skin have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome .
The most common staging system for melanoma skin cancer is the TNM system. For melanoma skin cancer there are 5 stages stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
When describing the stage, doctors often use the words early stage, locoregional or metastatic.
Early stage means that the cancer is only in where it started and has not spread to other parts of the body. It includes stage 0, stage 1A, stage 1B, stage 2A, stage 2B and stage 2C melanoma skin cancers.
Locoregional means the cancer has spread to nearby lymph nodes, or it has spread to nearby areas of skin or lymph vessels. It includes stage 3 melanoma skin cancer.
Metastatic means that the cancer is in a part of the body farther from where it started. It includes stage 4 melanoma skin cancer.
Find out more about .
Sentinel Lymph Node Biopsy
The purpose of SLNB is to determine whether any cancer cells have spread to the sentinel nodethe first lymph node to receive drainage from the primary tumor, and the site where melanoma commonly spreads to first.
Sentinel lymph node biopsy is most accurate when the lymph channels around the primary melanoma have not been disturbed by a prior wide local excision. Therefore, in most cases, if you are having an SLNB, your SLNB and wide local excision are performed in succession, with the SLNB performed first.
SLNB is recommended for patients with
- tumors greater than 1.0 mm thick
- tumors between 0.8 and 1.0 mm thick with additional adverse prognostic markers
- ulcerated tumors of any thickness
- positive biopsy margins
- lymphovascular invasion
Further treatment will depend on whether the lymph node biopsy is positive.
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Treating Stage 4 Melanoma
If melanoma comes back or spreads to other organs its called stage 4 melanoma.
In the past, cure from stage 4 melanoma was very rare but new treatments, such as immunotherapy and targeted treatments, show encouraging results.
Treatment for stage 4 melanoma is given in the hope that it can slow the cancers growth, reduce symptoms, and extend life expectancy.
You may be offered surgery to remove other melanomas that have grown away from the original site. You may also be able to have other treatments to help with your symptoms, such as radiotherapy and medicine.
If you have advanced melanoma, you may decide not to have treatment if its unlikely to significantly extend your life expectancy, or if you do not have symptoms that cause pain or discomfort.
Its entirely your decision and your treatment team will respect it. If you decide not to receive treatment, pain relief and nursing care will be made available when you need it. This is called palliative care.
Recurrence In Nearby Lymph Nodes
If nearby lymph nodes werenât all removed during the initial treatment, the melanoma might come back in these lymph nodes. Lymph node recurrence is treated by lymph node dissection if it can be done, sometimes followed by adjuvant treatments such as radiation therapy and/or immunotherapy or targeted therapy . If surgery is not an option, radiation therapy or systemic treatment can be used.
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How Is Melanoma Diagnosed
If you have a mole or other spot that looks suspicious, your doctor may remove it and look at it under the microscope to see if it contains cancer cells. This is called a biopsy.
After your doctor receives the skin biopsy results showing evidence of melanoma cells, the next step is to determine if the melanoma has spread. This is called staging. Once diagnosed, melanoma will be categorized based on several factors, such as how deeply it has spread and its appearance under the microscope. Tumor thickness is the most important characteristic in predicting outcomes.
Melanomas are grouped into the following stages:
- Stage 0 : The melanoma is only in the top layer of skin .
- Stage I: Low-risk primary melanoma with no evidence of spread. This stage is generally curable with surgery.
- Stage II: Features are present that indicate higher risk of recurrence, but there is no evidence of spread.
- Stage III: The melanoma has spread to nearby lymph nodes or nearby skin.
- Stage IV: The melanoma has spread to more distant lymph nodes or skin or has spread to internal organs.
What Are The Stages Of Melanoma
Cancerstaging is how doctors describe the extent of cancer in your body. Staging is defined by the characteristics of the original melanomatumor and if/how far it has spread in your body.
Melanoma is divided into stages using five Roman numerals and up to four letters that indicate a higher risk within each stage. The stage is determined mostly by specific details about the tumor and its growth that are tallied in a system called TNM. Read more about the TNM system.
Your stage is important because cancer treatment options and prognoses are determined by stage.
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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.
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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.