Melanoma is a cancer that starts in cells that make pigment (color) in the skin. It can grow and spread to other parts of the body.
If your GP suspects you have melanoma, they will send you to see a specialist. They will check the spot and take a sample of cells for examination under a microscope.
Stage I
Staging is a process that helps doctors describe how far cancer has spread and plan treatment. Doctors use a combination of exams, lab tests, and other tools to find out your stage. Although each person’s cancer is different, stages tell how serious the tumor is and how it has spread.
Melanoma in situ is a melanoma that has not grown below the thin outer layer of skin (the dermis). It is not invasive and has not spread to nearby lymph nodes. This is Stage 0.
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In Stage II, a melanoma has grown deeper into the skin (the dermis) and may have spread to nearby lymph nodes. It might have a broken surface, called ulceration, or the melanoma could be thicker than in Stage I. The melanoma might have an irregular shape, or it may look different under the microscope. It might have a higher or lower mitotic rate, which is how fast the cells in the melanoma are dividing.
A sentinel lymph node biopsy (SLNB) can help determine whether melanoma has spread to nearby lymph nodes. If the melanoma has not spread to the lymph nodes, your doctor might put you in a more detailed category such as Stage IA. If the melanoma has spread to the lymph nodes, your doctor will put you in a more detailed category such a Stage III.
Stage II
In this stage, the main melanoma is more than 1 but not more than 2 millimeters thick. It can either be a Breslow thickness of less than 4 mm, or it can be more than 2 mm but not more than 4 mm with ulceration. Ulceration means that there is a break in the top layer of skin over the melanoma. Melanomas with ulceration have a greater chance of spreading, so they are staged higher than those without.
Stage III
In stage III, the melanoma has spread to areas of the skin near the primary tumor and to lymph nodes close by. It might also have spread to the liver, lungs, brain, or other organs. Doctors might also put you in a more detailed category such an M1a or M1b based on how much of the cancer has spread and what type of melanoma it is.
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Treatment for Stage III Melanoma
Doctors treat stage III melanoma with surgery, radiation therapy, and sometimes chemotherapy. They might also recommend a biologic therapy, which is an immune system booster.
Doctors might suggest radiation therapy to kill any remaining cancer cells and prevent the melanoma from coming back in the area where it started. They might also suggest chemotherapy, which is a combination of drugs that targets cancer cells. This is usually only recommended if the melanoma has not already spread. Doctors might also recommend isolated limb perfusion, which is when they pump chemotherapy into an arm or leg while the melanoma is still in it. This treatment can be done before or after surgery and might be used as a follow-up to other treatments. It might also be helpful for people who have already had other cancers that have recurred.
