Staging of Melanoma
Like other cancers, doctors assign a numerical stage (from 0 to IV) to each person diagnosed with melanoma. The purpose of the stage is to give the doctor and the patient an idea of prognosis, and also to help decide on the best method of treatment. The earlier a person’s stage of melanoma, the better the chances are of full and complete cure.
Stage 0 means that the melanoma is in the epidermis but has not gone into the dermis. Stage 0 is also referred to as melanoma in situ. In order for melanoma to spread, it needs to get into the dermis, where there are lymphatic and blood vessels for it to spread to. Since a melanoma in situ does not reach the dermis, the prognosis for complete cure (with surgery) is over 95%.
Stage I melanomas are thicker, that is, they extend deeper into the skin. Stage I melanomas are further divided into IA and IB, depending on how quickly they are dividing and whether the skin over the melanoma has formed an ulcer, which might make it scab or bleed. Stage I melanomas have not spread to the lymph nodes or to any other organs of the body.
Stage II melanomas are even thicker and have spread to local lymph nodes but have not spread to any lymph nodes far away from the melanoma or to any other organs. This stage is further divided into A, B, or C depending on their thickness and ulceration.
Stage III melamoma patients have more lymph nodes involved and have thicker tumors, but have no detectable melanoma in other organs of the body.
Patients with Stage IV melanoma have spread of their tumor to deep levels of skin, to lymph nodes near the tumor and far from it and/or spread to other organs.
A patient is diagnosed with melanoma after having a biopsy of their skin. When the skin is examined under the microscope, the pathologist determines how deep the melanoma is. If it is in situ, ie, not invading the dermis, patients are generally advised to have additional surgery to remove the skin surrounding the melanoma. No other testing or surgery is generally considered necessary, since the chances for complete cure are over 95%.
For melanomas that are deeper, a sentinal lymph node test may be recommended to determine if there are any local lymph nodes involved. Additional scans and blood tests may also be recommended, depending on how deep the melanoma is, how fast its cells are dividing, and whether it is ulcerating. Additional treatments, including surgery and chemotherapy may be recommended.
Patients with early, thin melanomas are generally followed for recurrance only by their Dermatologist, since most melanomas will recur either on the skin or in lymph nodes. Also, since people with melanoma are at higher risk of developing other new skin cancers, the dermatologist is the most qualified to detect these early.
Patients with more advanced melanoma are often referred to Oncologists and/or multispecialty clinics where Dermatologists, Oncologists and other specialists meet patients to figure out the optimal treatment plan for each patient.