Stages of Melanoma
Key Points for this Section
After melanoma has been diagnosed, tests are 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. Talk with your doctor about what the stage of your cancer is.
The following tests and procedures may be used in the staging
- Wide local excision: A surgical procedure to remove some of
the normal tissue surrounding the area where melanoma was found, to check for cancer
- Lymph node
mapping and sentinel lymph node
biopsy: Procedures in which a radioactive substance and/or blue dye is injected
near the tumor. The substance or dye flows through lymph ducts to the
sentinel node or nodes (the first
lymph node or nodes where cancer
cells are likely to have spread). The surgeon removes only the nodes
with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes
for cancer cells. If no cancer cells are detected, it may not be necessary to
remove additional nodes.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma,
pictures may be taken of the chest, abdomen, and pelvis.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron
emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH).
The results of these tests are viewed together with the results of
the tumor biopsy to determine the melanoma stage.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
The staging system is based on the following:
- The thickness of the tumor. The thickness is described using the Breslow scale.
- Whether the tumor is ulcerated (has broken the skin).
- Whether the tumor has spread to the lymph nodes and if the lymph nodes are joined together (matted).
- Whether the tumor has spread to other parts of the body.
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
Stage 0 melanoma in situ. Abnormal melanocytes are in the epidermis (outer layer of the skin).
In stage 0, abnormal melanocytes are found in the
These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.
Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration (break in the skin). In stage IB, the tumor is either not more than 1 millimeter thick, with ulceration, OR more than 1 but not more than 2 millimeters thick, with no ulceration. Skin thickness is different on different parts of the body.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
- Stage IA: In stage IA, the tumor is not more than 1
millimeter thick, with no ulceration.
Stage IB: In stage IB, the tumor is either:
- not more than 1 millimeter thick and it has ulceration; or
- more than 1 but not more than 2 millimeters thick, with
Stage II melanoma. In stage IIA, the tumor is either more than 1 but not more than 2 millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more than 4 millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2 but not more than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Skin thickness is different on different parts of the body.
Stage II is divided
into stages IIA, IIB, and IIC.
Stage III melanoma. The tumor may be any thickness, with or without ulceration (a break in the skin), and (a) cancer has spread to one or more lymph nodes; (b) lymph nodes with cancer may be joined together (matted); (c) cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes; and/or (d) very small tumors may be found on or under the skin, not more than 2 centimeters away from the primary tumor.
In stage III, the
tumor may be any thickness, with or without ulceration. One or more of the following is true:
- Cancer has spread to one or more lymph nodes.
- Lymph nodes may be joined together (matted).
- Cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes.
- Very small tumors may be found on or under the skin, not more than 2 centimeters away from where the cancer first started.
Stage IV melanoma. The tumor has spread to other parts of the body.
In stage IV, the cancer has spread to other places in the body, such as the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract. Cancer may also spread to places in the skin far away from where the cancer first started.