NCCN Guidelines for Patients
Melanoma, Version 1.2014
Stages of melanoma
The 5 stages of melanoma
The melanoma is in situ—in its original
place. The melanoma cells are only in the epidermis
(the outer layer of skin) and have not invaded
the dermis (the second layer of skin, under the
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 have
ulceration, or they are a bit thicker without ulceration.
In stage I, there is no cancer in the lymph vessels,
lymph nodes, or distant organs.
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,
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 stage I and stage II melanomas,
when the tumor is in the outer layer of skin
(epidermis) and the second layer of skin (dermis).
This group also sometimes includes stage 0 (in
situ melanoma), when melanoma cells are only in
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.
Stage III is considered regional melanoma. Metastatic
melanoma is when the cancer has spread to other
organs and parts of the body far away from the
primary tumor. Stage IV is metastatic melanoma.