34 NCCN Guidelines for Patients ® : Melanoma, 2018 3 Melanoma staging Review The five stages of melanoma are also grouped into three broad categories—local melanoma, regional melanoma, 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 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 metastatic melanoma. Distant 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 distant metastatic melanoma. Once your doctors know more about your diagnosis and stage of melanoma, they can talk to you about your next steps of care. Talking with your doctor about the cancer stage can help with treatment planning. Shared decision-making is a process in which you and your doctors plan treatment together. Shared-decision making is an important part of your care plan. Review Cancer staging is how doctors rate and describe the extent of cancer in the body. Melanoma is grouped into stages to help plan treatment. Cancer stages are based on the growth and spread of the first tumor. Cancer staging is often done two times—before and after lymph node surgery. Your care plan: ü Keep a list of contact information of all of your health care providers. ü Use a calendar or ask a caregiver to make note of your treatment schedule and follow- up appointments.