Melanoma Stages

Staging is a process of describing how far a cancer has spread. This includes describing the size of the skin tumor and whether it has spread to any other organs. A staging system is a standard way for your health care team to summarize the extent of your cancer.

The American Joint Committee on Cancer (AJCC) staging system is used most often to describe the extent of melanoma. In this system, each cancer is given a T category, an N category, and an M category.

• The T category is based on the tumor’s thickness and whether it is ulcerated (the layer of skin covering the melanoma is absent).
• The N category reflects whether the melanoma has spread to lymph nodes (small bean-shaped collections of immune system cells that help the body fight infections and cancers) near the melanoma. The N category also reflects whether the melanoma cancer cells are beginning to spread and are found in lymphatic channels connecting to the lymph nodes.
• The M category indicates whether there is spread (metastases) to distant organs.

In TNM staging, information about the tumor, lymph nodes, and metastasis is combined according to a process called stage grouping to assign a stage. The stage is described using 0 and Roman numerals from I to IV.

Several tests and procedures are used to gather information about a melanoma and whether it has spread to lymph nodes and distant organs. This information is used to assign T, N, and M categories and a grouped stage.

Descriptions of Grouped Stages

The stages used in these guidelines are as follows:

Stage 0: The melanoma is in situ, meaning that it involves the epidermis but has not spread to the dermis. This is also called Clark level I.

Stage IA: The melanoma is less than or equal to 1.0 mm or about 1/25 inch in thickness and no ulceration is present. Using the Clark system, this can be level II or III. It appears to be localized in the skin and has not been found in lymph nodes or distant organs.

Stage IB: The melanoma is less than or equal to 1.0 mm in thickness and is ulcerated, or Clark IV or V, or it is between 1.01 and 2.0 mm and is not ulcerated. It appears to be localized in the skin and has not been found in lymph nodes or distant organs.

Stage IIA: The melanoma is between 1.01 mm and 2.0 mm in thickness and is ulcerated, or it is between 2.01 and 4.0 mm and is not ulcerated. It appears to be localized in the skin and has not been found in lymph nodes or distant organs.

Stage IIB: The melanoma is between 2.01 mm and 4.0 mm in thickness and is ulcerated, or it is thicker than 4.0 mm and is not ulcerated. It appears to be localized in the skin and has not been found in lymph nodes or distant organs.

Stage IIC: The melanoma is thicker than 4.0 mm and is ulcerated. It appears to be localized in the skin and has not been found in lymph nodes or distant organs.

Stage III: The melanoma has spread to lymph nodes nearest the affected skin area. There is no distant spread.

Stage IV: The melanoma has spread beyond the original area of skin and the nearby lymph nodes to other organs, such as the lung, liver, or brain, or to distant areas of the skin or lymph nodes.

EARLY DETECTION

TREATMENT OF MELANOMA

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

© 2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.