If the test results show you have melanoma, your doctor will work out the stage of the cancer. The stage describes how far the cancer has spread. Staging the melanoma helps your health care team decide what treatment is best for you.
The expected outcome of your disease is called the prognosis, but it is only a prediction and some people do not find it helpful or even prefer not to know.
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Staging melanoma
The pathology report and any other test results will show whether you have melanoma and whether it has spread to other parts of the body. This is known as staging and it helps your team recommend the most appropriate treatment for you.
The melanoma will be given an overall stage of 0–4 (usually written in Roman numerals as 0, I, II, III or IV).
Stages of melanoma
| stage 0 (in situ) | The melanoma is confined to the top, outer layer of the skin. | early or localised melanoma |
| stage 1 | The melanoma has not moved beyond the primary site and is less than 1 mm thick with or without ulceration, or 1–2 mm thick without ulceration. | early or localised melanoma |
| stage 2 | The melanoma has not moved beyond the primary site and is 1–2 mm thick and ulcerated, or more than 2 mm thick with or without ulceration. | early or localised melanoma |
| stage 3 | The melanoma has spread to lymph nodes near the primary site, to nearby skin or to tissues under the skin (subcutaneous). | regional melanoma |
| stage 4 | The melanoma has spread to distant skin and/or other parts of the body such as the lungs, liver, brain, bone or distant lymph nodes. | advanced or metastatic melanoma |
Gene mutation testing
If the melanoma has spread (stage 3 or 4), special tests can help work out whether you have a particular gene change (mutation) that may be causing the cancer cells to multiply and grow. These genetic mutations are due to changes in cancer cells – they are not the same thing as genes passed through families.
About 40% of people with melanoma have a mutation in the BRAF gene, and about 15% have a mutation in the NRAS gene. C-KIT is a rare mutation affecting less than 4% of people with melanoma.
Genetic tests can be done on the sample removed during surgery. The test results will help doctors decide whether immunotherapy or targeted therapy may be useful.
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can discuss any concerns you may have.
Melanoma can be treated most effectively in its early stages when it is still confined to the top layer of the skin (epidermis). The more deeply a melanoma grows into the lower layer of the skin (dermis), the greater the risk that it could spread to nearby lymph nodes or other organs.
In recent years, clinical trials have led to new drug treatments that continue to improve the prognosis for people with melanoma that has spread from the primary site (advanced or metastatic melanoma).
→ READ MORE: Your health care team
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A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA.
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