Stages of Melanoma

When a biopsy shows that melanoma is present, the first thing doctors will need to determine is the “stage” of the cancer. There are five stages, Stage 0 and Stages I through IV (one through four). Determining your stage is very important because your stage will help determine your treatment options and prognosis.

Overview of Stages O-IV

Stages are labeled using 0 and Stages I through IV (one through four).

  • A lower number, like one (I), means the melanoma has not spread far.
  • The higher the number, the farther it has spread and the more serious the cancer.

Tis (tumor in situ)
Tumor is limited to the epidermis
No invasion of surrounding tissues or lymph nodes or distant sites
Risk: Very Low

Stage 0 Melanoma (in situ)

In Stage 0 melanoma, the malignant tumor is still confined to the upper layers of the skin. This means that the cancer cells are only in the outer layer of the skin and have not grown any deeper. The term for this is in situ, which means “in place” in Latin. There is no evidence the cancer has spread to the lymph nodes or distant sites (metastasis).

Learn more about Stage 0
Treatment Options for Stage 0

Subclasses 1A, 1B
Differentiated by tumor thickness [Breslow depth]
It hasn’t spread to nearby lymph nodes or distant sites
Risk: Low

Stage I Melanoma (localized tumor)

Stage I melanoma is defined as a melanoma that is up to 2mm thick. A Stage I melanoma may or may not have ulceration. There is no evidence the cancer has spread to lymph nodes or distant sites (metastasis). There are two subclasses of Stage I Melanoma: 1A, 1B.

Learn more about Stage I
Treatment Options for Stage I

Subclasses IIA, IIB, IIC
Differentiated by tumor thickness [Breslow depth]
It hasn’t spread to nearby lymph nodes or distant sites
Risk: Intermediate for occurring again in the same spot or spreading to distant sites

Stage II Melanoma (localized tumor)

Stage II melanoma is defined by tumor thickness, and ulceration. There is no evidence the cancer has spread to the lymph nodes or distant sites (metastasis). There are three subclasses of Stage II: IIA, IIB, IIC.

Learn more about Stage II
Treatment Options for Stage II

Subclasses IIIA, IIIB, IIIC
Defined by number of lymph nodes to which it has spread
It can, but it need not have ulceration
Different whether the spread to lymph nodes can be detected microscoptically or macroscoptically
Risk: Intermediate to high for occurring again in the same spot or spreading to distant sites
Microscoptically = seen by pathologist after biopsy or dissection
Macroscoptically = seen by naked eye or felt by hand

Stage III Melanoma (regional spread)

Stage III melanoma is defined by the level of lymph node involvement and ulceration. In Stage III melanoma, the depth of the melanoma no longer matters. There is no evidence the cancer has spread to distant sites (metastasis). There are three subclasses of Stage III Melanoma: IIIA, IIIB, IIIC.

Learn more about Stage III
Treatment Options for Stage III

Subclasses M1a, M1b, M1c
Characterized by: Location of different metastases, number and size of tumors, and LDH level
M1a: Spread to distant skin, the subcutaneous layer, or to distant lymph nodes, and LDH is normal
M1b: Tumor has metastasized to the lung and LDH is normal
M1c: Tumor has metastasized to vital organs other than the lungs and LDH is normal, or there are any distant metastases with elevated LDH

Stage IV Melanoma (metastasis beyond regional lymph nodes)

Stage IV melanoma occurs when the melanoma has spread beyond the original site and regional lymph nodes to more distant areas of the body. The level of LDH (serum lactate dehydrogenase) may or may not be elevated. The most common sites of metastasis are to vital organs (lungs, abdominal organs, brain, and bone) and soft tissues (skin, subcutaneous tissues) and distant lymph nodes (lymph nodes beyond the primary tumor region).

Learn more about Stage IV
Treatment Options for Stage IV

Brain Metastases

Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma.  They differ from all other metastases in terms of risk factors, diagnosis, and treatment.

Learn More About Brain Metastases

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