NCCN Guidelines for Patients
Part 3: Melanoma staging
The 5 stages of melanoma
The melanoma is in situ. This means that the abnormal cells are
confined to the epidermis and have not invaded the dermis or other areas of skin.
In stage IA, the tumor is thinner than 1.0 mm, the cells are dividing
slowly, and there is no ulceration. Stage IB tumors are thinner than 1.0 mm and
have a faster dermal mitotic rate or ulceration, or they are a bit thicker without
ulceration. In stage I, there is no cancer in the lymph vessels, lymph nodes, or
This stage is divided into three groups—A, B, and C—based on tumor
thickness and ulceration status. In stage II, there is no cancer in the lymph
vessels, lymph nodes, or distant organs.
In stage III, melanoma has spread to nearby lymph vessels, lymph
nodes, and/or nearby skin (satellites). The clinical stage includes tumors of any
depth with metastases in lymph nodes and/or lymph vessels. Pathologic staging
divides tumors of any size into 3 groups based on ulceration of the primary tumor
and the extent of growth into the lymph vessels, lymph nodes, and nearby skin.
The melanoma has spread to one or more distant sites. The tumor
may be of any thickness and with any range of spread in lymph vessels and
lymph nodes. Stage IV includes all the subcategories (a, b, and c). Although not
required for stage IV, the primary tumor is often thick.
The five stages of melanoma are also grouped into three broad categories—
local, regional, and metastatic melanoma. Local melanoma is when the cancer
cells haven’t spread beyond the primary tumor. This includes in situ melanoma,
which is when abnormal cells are only in the outer layer of skin (epidermis).
Regional melanoma is when cancer cells have spread from the primary tumor
into lymph nodes and/or lymph vessels in the nearby (regional) area. Metastatic
melanoma is when the cancer has spread to other organs and parts of the body
far away from the primary tumor.
Dermal mitotic rate:
measure of how many
cancer cells are actually
growing and dividing
The second layer
The outer layer
cells throughout the body
that carry lymph—a clear
fluid with white blood
cells—throughout the body
formed by cancer cells that
spread from the first tumor
to other parts of the body
top skin layer is broken or
See pages 27–30 for