Stage III Melanoma

Stage III melanomas are tumors that have spread to regional lymph nodes. There may also be in-transit or satellite involvement.  In Stage III melanoma, the depth of the melanoma no longer matters. There is no evidence of distant metastasis.

Microscoptically = seen by pathologist after biopsy or dissection
Macroscoptically = seen by naked eye or felt by hand

Stage III: Melanoma 'regional spread'

Subclasses IIIA, IIIB, IIIC, IIID

Defined by number of lymph nodes to which it has spread

It can, but it need not have ulceration

Different whether the spread to the lymph nodes, can be detected only under a microscope (clinically occult) or can felt or seen by the naked eye (clinically apparent)

Risk: Intermediate to high for occurring again in the same spot or spreading to distant sites

Stage III Melanomas Are Defined By 3 Primary Characteristics:

  •  Number of lymph nodes to which the tumor has spread
  •  Whether the tumor spread to the lymph node is clinically occult or clinically apparent:
    • Clinically Occult tumors are so tiny they are not visible to the naked eye. They can be detected only by microscopic evaluation after sentinel lymph node biopsy or elective lymph node dissection
    • Clinically Apparent tumors can be felt during physical examination or seen with the naked eye when inspected by a surgeon or pathologist. Their presence is confirmed by lymph node dissection or when the tumor is seen to extend beyond the lymph node capsule.
  • Ulceration: when the epidermis (or top layer of skin) that covers a portion of the primary melanoma is not intact. Ulceration can only be seen under a microscope, not by the naked eye.

There Are 4 Subclasses of Stage III Melanoma

Stage IIIA

If the primary tumor is Not ulcerated

The primary tumor is less than 2.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes AND
no lymph nodes can be seen or felt

If the primary tumor IS ulcerated

The primary tumor is less than 1.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes AND
no lymph nodes can be seen or felt

Stage IIIB

If the primary tumor is Not ulcerated

The primary tumor is less than 2.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes AND
1 of the lymph nodes can be seen or felt

OR

The primary tumor is 2.0mm to 4.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes AND
1 of the lymph nodes can be seen or felt

OR

The primary tumor is any size up to 4.0mm thick AND
there are no lymph nodes involved BUT
there are satellite or in-transit tumors

If the primary tumor IS ulcerated

The primary tumor is less than 1.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes AND
1 of the lymph nodes can be seen or felt

OR

The primary tumor is 1.0mm to 2.0mm thick AND
the melanoma has spread to 1, 2, or 3 lymph nodes OR
1 of the lymph nodes can be seen or felt

OR

The primary tumor is less than 2.0mm thick AND
there is no melanoma in lymph nodes but there are satellite or in-transit tumors

Stage IIIC

If the primary tumor is Not ulcerated

The primary tumor is less than 4.00mm thick AND you have one of the other factors:

  • there are satellite or in-transit tumors and there is melanoma in any lymph node OR
  • there is melanoma in 4 or more lymph nodes that can’t been seen or felt OR
  • there is melanoma in 2 or more lymph nodes that can be seen or felt OR
  • the lymph nodes are clumped together

OR

The primary tumor is 4mm thick or greater AND you have one of the other factors:

  • there is melanoma in any lymph node OR
  • there is satellite or in-transit melanoma OR
  • both of the above

If the primary tumor IS ulcerated

The primary tumor is less than 2.0mm thick AND
there is melanoma in any lymph node AND
there are satellite or in-transit tumors

OR

The primary tumor is less than 2.0mm thick AND you have one of the other factors:

  • melanoma in any lymph node AND there are satellite or in-transit tumors OR
  • there is melanoma in 4 or more lymph nodes OR
  • there is melanoma in 2 or more lymph nodes that can be seen or felt OR
  • the lymph nodes are clumped together

OR

The primary tumor is 2.0mm to 4.0mm thick AND you have one of the other factors:

  • there is melanoma in any lymph node OR
  • there are satellite or in-transit tumors OR
  • both of the above

OR

The primary tumor is 4.0m thick or greater AND you have one of the other factors:

  • the melanoma has spread to 1, 2, or 3 lymph nodes AND no more than 1 of the lymph nodes can be seen or felt OR
  • the melanoma has spread to 1 lymph node AND there are satellite or in-transit tumors

OR

The primary tumor is 2.0mm to 4.0mm thick AND
there are no lymph nodes involved BUT
there are satellite or in-transit tumors

Stage IIID

If the primary tumor is Not ulcerated

There is no IIID category when the primary melanoma is not ulcerated.

If the primary tumor IS ulcerated

The primary tumor is greater than 4.0mm thick and you have one of the other factors:

  • there is melanoma in 4 or more lymph nodes OR
  • the lymph nodes are clumped together OR
  • there is melanoma in 2 or more lymph nodes that can be seen or felt OR
  • the melanoma has spread to 2 lymph nodes AND there are satellite or in-transit tumors

Risk: With treatment, Stage III disease has an intermediate to high risk for local recurrence or distant metastasis. Even within Stage III, the earlier the melanoma is found and treated, the better the outcome. Keep in mind that the statistics shown for survival are averages; everyone’s cancer and survival rate is based on many factors and determined on an individual basis.

Learn about treatment options for Stage III melanoma

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