NCCN Guidelines for Patients
Part 3: Melanoma staging
M = Metastasis
The M category tells you if cancer cells have spread (metastasized) to distant
organs. Melanoma usually spreads to distant skin and lymph nodes first. Next, it
spreads to the lungs, then to the liver, brain, bone, and/or gut. Different patterns
of melanoma spread are also possible. For metastases, subcategories are given
based on where the cancer has spread and whether LDH levels are normal or
means the melanoma hasn’t spread to distant sites.
means the melanoma has spread to distant organs.
means the cancer has spread to distant skin sites, areas under the
skin, or distant lymph nodes, with normal LDH levels.
means the cancer has spread to the lungs, with normal LDH
means the cancer has spread to internal organs with normal LDH
levels or it has spread to any site with high LDH levels.
3.3 Stages of melanoma
The TNM scores are combined to assign the cancer a stage. Often, melanoma
is staged twice. The first staging is the clinical stage. It is based on the physical
exam, imaging tests, and skin biopsy of the primary melanoma tumor. The
second staging is the pathologic stage. It is based on the clinical staging as
well as results from biopsies of lymph nodes and other tissue removed during
surgical treatment. Most of the time, the pathologic stage is the most important
stage. This is because your lymph nodes can only be completely examined for
cancer cells by viewing the biopsy sample with a microscope.
Each stage is represented by Roman numerals ranging from 0 to IV (Table
1). The stages identify tumor types that have a similar prognosis and thus are
treated in a similar way.
Removal of small
amounts of tissue or fluid to
be tested for disease
A substance found in
the blood that is involved in
energy production in cells
groups of special disease-
fighting cells located
throughout the body
formed by cancer cells that
have spread from the first
tumor to other parts of the
A tool that
uses lenses to see things
the eyes can’t
and outcome of a disease