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.
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After Melanoma Has Been Diagnosed Tests May Be Done To Find Out If Cancer Cells Have Spread Within The Skin Or To Other Parts Of The Body
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:
The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.
What Are Lymph Nodes
Lymph nodes are small structures that filter substances and help fight infection. They are part of a network that runs throughout the body. Cancer that reaches the lymph nodes is concerning because cancer cells can easily spread to other parts of the body through this interconnected system.
Whether or not a melanoma spreads to one or more lymph nodes, it also may affect nearby skin. Such melanoma tumors are called satellite tumors. They’re defined as being within 2 centimeters of the original tumor and can be seen without a microscope.
Melanoma tumors also may spread to lymphatic channels, thin tubes that resemble blood capillaries, through which lymph fluid flows.
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What Are The Melanoma Stages And What Do They Mean
Early melanomas
Stage 0 and I are localized, meaning they have not spread.
- Stage 0: Melanoma is localized in the outermost layer of skin and has not advanced deeper. This noninvasive stage is also called melanoma in situ.
- Stage I: The cancer is smaller than 1 mm in Breslow depth, and may or may not be ulcerated. It is localized but invasive, meaning that it has penetrated beneath the top layer into the next layer of skin. Invasive tumors considered stage IA are classified as early and thin if they are not ulcerated and measure less than 0.8 mm.
Find out about treatment options for early melanomas.
Intermediate or high-risk melanomas
Localized but larger tumors may have other traits such as ulceration that put them at high risk of spreading.
- Stage II: Intermediate, high-risk melanomas are tumors deeper than 1 mm that may or may not be ulcerated. Although they are not yet known to have advanced beyond the primary tumor, the risk of spreading is high, and physicians may recommend a sentinel lymph node biopsy to verify whether melanoma cells have spread to the local lymph nodes. Thicker melanomas, greater than 4.0 mm, have a very high risk of spreading, and any ulceration can move the disease into a higher subcategory of stage II. Because of that risk, the doctor may recommend more aggressive treatment.
Learn more about sentinel lymph node biopsy and melanoma treatment options.
Advanced melanomas
Clinical Staging And Pathologic Staging
To add to the complexity of staging, the cancer also may have a clinical stage and a pathologic stage.
Clinical staging takes place before surgery, based on blood tests, physical exams or imaging tests such as X-rays, a computed tomography scan, magnetic resonance imaging or positron emission tomography scans.
What doctors discover during surgery may provide more detailed information about the cancers size and spread. Often, some tissue from the surgery will be examined afterward to provide more clues. This process is known as pathologic staging, or surgical staging.
If surgery isnt possible, doctors will use the clinical stage when determining a treatment plan.
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Treating Stage I Melanoma
Stage I melanoma is typically treated by wide excision . The width of the margin depends on the thickness and location of the melanoma. Most often, no other treatment is needed.
Some doctors may recommend a sentinel lymph node biopsy to look for cancer in nearby lymph nodes, especially if the melanoma is stage IB or has other characteristics that make it more likely to have spread. You and your doctor should discuss this option.
If the SLNB does not find cancer cells in the lymph nodes, then no further treatment is needed, although close follow-up is still important.
If cancer cells are found on the SLNB, a lymph node dissection might be recommended. Another option might be to watch the lymph nodes closely by getting an ultrasound of the nodes every few months.
If the SLNB found cancer, adjuvant treatment with an immune checkpoint inhibitor or targeted therapy drugs might be recommended to try to lower the chance the melanoma will come back. Other drugs or perhaps vaccines might also be options as part of a clinical trial.
Treating Stage Iv Melanoma
Stage IV melanomas have already spread to distant lymph nodes or other areas of the body. Skin tumors or enlarged lymph nodes causing symptoms can often be removed by surgery or treated with radiation therapy.
Metastases in internal organs are sometimes removed, depending on how many there are, where they are, and how likely they are to cause symptoms. Metastases that cause symptoms but cannot be removed may be treated with radiation, immunotherapy, targeted therapy, or chemotherapy.
The treatment of widespread melanomas has changed in recent years as newer forms of immunotherapy and targeted drugs have been shown to be more effective than chemotherapy.
Immunotherapy drugs called checkpoint inhibitors such as pembrolizumab or nivolumab are typically the first drugs tried, especially in people whose cancer cells do not have BRAF gene changes. These drugs can shrink tumors for long periods of time in some people. Ipilimumab , a different type of checkpoint inhibitor, is not typically used by itself as the first treatment, although it might be combined with nivolumab or pembrolizumab. This slightly increase the chances that the tumor will shrink, although itâs also more likely to result in serious side effects, which needs to be considered carefully. People who get any of these drugs need to be watched closely for serious side effects..
Itâs important to carefully consider the possible benefits and side effects of any recommended treatment before starting it.
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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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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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Is Stage 2 Melanoma Serious
All stages of melanoma are serious, but stage 2 melanoma is when the cancer becomes relatively more serious. When detected in stage 2, the cancerous mole or growth has spread from the epidermis deep into the dermis and potentially into the underlying fat and tissue. In some cases, cancerous cells may have started to spread to other parts of the body. Generally, surgical removal of the growth and surrounding tissue will get rid of the melanoma and generally has a five-year survival rate of 50% to 80%, which means that about 50% to 80% 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, it’s very important to see a doctor if you notice any changes in existing moles or any new skin growths, since the chance for recovery is better the earlier you treat it.
Diagnosis And Staging What It Means For You
How is melanoma diagnosed?
To diagnose melanoma, a dermatologist biopsies the suspicious tissue and sends it to a lab, where a dermatopathologist determines whether cancer cells are present.
After the disease is diagnosed and the type of melanoma is identified, the next step is for your medical team to identify the stage of the disease. This may require additional tests including imaging such as PET scans, CT scans, MRIs and blood tests.
The stage of melanoma is determined by several factors, including how much the cancer has grown, whether the disease has spread and other considerations. Melanoma staging is complex, but crucial. Knowing the stage helps doctors decide how to best treat your disease and predict your chances of recovery.
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Treating Stage 3 Melanoma
If the melanoma has spread to nearby lymph nodes , further surgery may be needed to remove them.
Stage 3 melanoma may be diagnosed by a sentinel node biopsy, or you or a member of your treatment team may have felt a lump in your lymph nodes.
The diagnosis of melanoma is usually confirmed using a needle biopsy .
Removing the affected lymph nodes is done under general anaesthetic.
The procedure, called a lymph node dissection, can disrupt the lymphatic system, leading to a build-up of fluids in your limbs. This is known as lymphoedema.
Cancer Research UK has more information about surgery to remove lymph nodes.
Why Are There Melanoma Stages
There is a lot to say whether or not this is at a point in time where it can be treated by simply removing the freckle and never hearing of it again. Then again, if it spread to a more important organ in the body, there might not be a chance in saving yourself. How do you distinguish between one and the other?
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What To Ask Your Doctor About Stage Ii Melanoma
When your doctor tells you that you have Stage II 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.
It is often helpful to bring a friend or family member with you to your doctors appointment. This person can lend moral support, ask questions, and take notes.
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 has 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.
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 .
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A Positive Sentinel Node Biopsy: What Happens
If the lymph-node biopsy finds melanoma cells, there are two options. If many cancer cells are present in many lymph nodes, then all the lymph nodes in that area may be surgically removed. If there are only a few cancer cells, your doctor may instead opt to monitor the lymph nodes through ultrasound every few months and start you on immunotherapy or targeted therapy, says Melinda L. Yushak, M.D., assistant professor in the department of hematology and medical oncology at Emory University School of Medicine in Atlanta.
Treating Stage 4 Melanoma
If melanoma comes back or spreads to other organs it’s 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 cancer’s 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 it’s unlikely to significantly extend your life expectancy, or if you do not have symptoms that cause pain or discomfort.
It’s 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.
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Treatment Options For Stage Ii Melanoma
Treatment of Stage II melanoma can include surgery, sentinel lymph node biopsy, immunotherapy, and clinical trials.
Surgery
The standard treatment for Stage II melanoma is surgery, called wide local excision. The purpose of the surgery is to remove any cancer remaining after the biopsy.
In a wide local excision, the surgeon removes any remaining tumor from the biopsy site, the surgical margin , and the underlying subcutaneous tissue, to make certain the whole tumor has been removed.
The width of the margin taken depends upon the thickness of the primary tumor. The surgical margin guidelines adopted and recommended by the National Comprehensive Cancer Network for wide local excision of primary melanomas range from 0.5 cm to 2 cm:
How Is Melanoma Treated
Your melanoma treatment will depend on the stage of the melanoma and your general health.
Surgery is usually the main treatment for melanoma. The procedure involves cutting out the cancer and some of the normal skin surrounding it. The amount of healthy skin removed will depend on the size and location of the skin cancer. Typically, surgical excision of melanoma can be performed under local anesthesia in the dermatologistâs office. More advanced cases may require other types of treatment in addition to or instead of surgery.
Treatments for melanoma:
- Melanoma Surgery: In the early stages, surgery has a high probability of being able to cure your melanoma. Usually performed in an office, a dermatologist numbs the skin with a local anesthetic and removes the melanoma and margins .
- Lymphadenectomy: In cases where melanoma has spread, removal of the lymph nodes near the primary diagnosis site may be required. This can prevent the spread to other areas of your body.
- Metastasectomy: Metastasectomy is used to remove small melanoma bits from organs.
- Targeted cancer therapy: In this treatment option, drugs are used to attack specific cancer cells. This targeted approach goes after cancer cells, leaving healthy cells untouched.
- Radiation Therapy: Radiation therapy includes treatments with high-energy rays to attack cancer cells and shrink tumors.
- Immunotherapy: immunotherapy stimulates your own immune system to help fight the cancer.
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