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Monitoring Melanoma: Staging Explained

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  • How Melanoma Spreads

    How Melanoma Spreads

    Melanoma cells are pigmented (colored) skin cells called melanocytes. Instead of dying as normal cells do, these abnormal cells continue to divide and grow until they form a mass, or tumor. Some of the cells may break off and invade nearby tissues and metastasize, or grow new tumors. 

    If these abnormal melanoma cells enter the bloodstream or the lymphatic system, they can quickly spread throughout the body. They may invade tissues and organs far away from the first tumor where they started.

  • What Is Staging?

    What Is Staging?

    “Stage” is a term used to describe the size and extent of a melanoma cancer. Knowing the stage of a melanoma cancer is an important factor in your healthcare team’s choice of cancer treatment. Determining the stage will also serve to predict the efficacy of a particular treatment, the patient’s chance of recovery, and the risk of the cancer returning. 

  • Tests to Determine Stages

    Tests to Determine Stages

    There are several tests that are performed to assign a stage to a melanoma:

    • physical exam: The doctor checks for moles or birthmarks that appear abnormal in shape, color or texture.
    • lab tests: Blood, urine, and other fluids and tissues are tested.
    • imaging scans: Scans make detailed images of the tumor and surrounding tissues. Imaging scans include CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), and NMRI (nuclear magnetic resonance imaging).
    • biopsy: A sample of the abnormal tissue and some surrounding normal tissue is removed and checked for cancer cells.
  • Different Staging Systems

    Different Staging Systems

    There are different staging systems for different types of cancer, but all staging symptoms indicate the following functions:

    • location of the cancer
    • type of cancer cells
    • size of the cancer tissue
    • whether tumor cells have spread to nearby lymph nodes
    • grade of the tumor 
  • The Stages of Melanoma

    The Stages of Melanoma

    With the staging system, basic information about the cancer is described in five consecutive levels, starting with stage 0. At stage 0, the melanoma cells are isolated in one area on the outer layer of the skin, but there is danger that they’ll spread.

    Each stage describes a more dangerous level of cancer spread. At stage 4, the last stage, the cancer cells have invaded the lymph nodes, tissues, and organs far from the original tumor. 

  • Adding Letters for More Details

    Adding Letters for More Details

    Each melanoma stage can be broken into stages a, b, or c. The staging tool can help a patient’s healthcare team efficiently work together to treat a particular patient. The letters that follow the stage level signify something about the disease. For example:

    • stage 1a: The tumor is no more than one millimeter thick, with no ulceration.
    • stage 2b: The tumor ranges from two to four millimeters thick and has ulcerated (broken through the skin). Or, the tumor is more than four millimeters thick, but with no ulceration.
    • stage 2c: The tumor is both ulcerated and more than four millimeters thick.
  • Treatments Vary for Each Stage

    Treatments Vary for Each Stage

    Surgery is the standard treatment for the first three stages of melanoma. A surgical procedure removes the cancerous tumor, any lymph nodes that are involved, and some healthy surrounding tissue to ensure that no cancerous cells are left behind.

    However, sometimes the cancer can’t be surgically removed. The tumor might be located in a dangerous spot, for instance, or the patient may be in too poor of health for surgery. These circumstances would warrant other cancer treatments. 

    In stage 4 cancer, treatments include targeted therapy, biologic therapy with interleukin-2, chemotherapy and, if necessary, palliative therapy. Palliative therapy relieves symptoms and improves a patient’s quality of life. 

  • What Do Higher Stages Mean?

    What Do Higher Stages Mean?

    With melanoma, the higher the stage, the more difficult the cancer is to treat. A higher stage could mean that the cancer cells have spread to other parts of the body. The lymph nodes, the brain, the lungs, the bones, or the liver may contain cancer cells. 

    When melanoma cancer reaches higher stages, patients are often encouraged to join treatment clinical trials along with standard treatments in the hope that the clinical trial drugs might work.

    But even if the clinical drugs don’t work, patients in clinical treatment trials can help others who require cancer treatment in the future.