Care / Importance of Staging
Once a melanoma is diagnosed the stage of the disease must be determined.
Staging is the process of finding out how far the cancer has spread or metastasized. It includes describing the size of the cancer, as well as the extent to which the cancer has spread to other organs.
Staging is very important. Treatment recommendations and prognostic determinations are based on the stage of the cancer. Stages range from stage 0 to stage IV.
The tumor has not spread and is still limited to the outer layer of the skin.
The tumor is not more than 1 millimeter thick and is or is not ulcerative, or is 1 to 2 millimeters thick and is not ulcerative.
The tumor has spread to the dermis (deep part of the skin), but has not reached the lymph nodes. IIA = the melanoma is 1 to 2 millimeters thick with ulceration or 2 to 4 millimeters thick with no ulceration. IIB = the tumor is 2 to 4 millimeters thick with ulceration or more than 4 millimeters thick with no ulceration. IIC = the tumor is more than 4 millimeters thick and ulcerative.
The tumor has spread to lymph nodes near the affected skin. IIIA = the tumor may have spread to as many as three lymph nodes, but the tumor in the lymph nodes can only be seen under a microscope. IIIB = the tumor has spread to as many as three lymph nodes or the tumor has not spread to the lymph nodes, but has produced satellite tumors. IIIC = the tumor has spread to four or more lymph nodes or has clinically evident positive lymph nodes.
The tumor has spread to other organs, such as the lung, liver, brain or to lymph nodes far away from the original site. Staging of the disease may involve laboratory tests and imaging studies. A physician’s decision to pursue additional studies is based on the thickness of the primary melanoma site and the findings of a thorough medical history and physical examination. Routine studies have limited to no value in the initial work-up of patients without symptoms and are typically not recommended for patients with a melanoma less than 4mm thick.