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 test results will help your doctors assign a stage to describe the melanoma. You may also have some other diagnostic tests, including blood tests and imaging tests (ultrasound, CT scan or PET scan), to work out whether the melanoma has spread from the primary site to other parts of the body. Staging the melanoma helps your health care team recommend the most appropriate treatment for you.
Stages of melanoma
| stage 0 (in situ) | The melanoma is confined to the top, outer layer of the skin. |
| stage I | The melanoma has not moved beyond the primary site and is 2 mm or less in thickness (may or may not have ulceration). |
| stage II | The melanoma has not moved beyond the primary site and is greater than 1 mm and ulcerated or greater than 2 mm in thickness (may or may not have ulceration). |
| stage III | The melanoma has spread to lymph nodes near the primary site, to nearby skin or to tissues under the skin (subcutaneous). |
| stage IV | 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. |
Stages 0, I and II are called early melanoma, while stage III is referred to as regional melanoma. Stage IV melanoma has spread to other parts of the body and is called advanced or metastatic.
Gene mutation testing
If the melanoma has spread (stage III or IV), further 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.
Approximately 40% of people with melanoma have a mutation in the BRAF gene and approximately 15% have a mutation in the NRAS gene. C-KIT is a rare mutation affecting less than 4% of people.
Genetic tests can be done on the sample removed during surgery. The test results will help doctors decide whether you are offered immunotherapy or targeted therapy.
Prognosis
Prognosis means the predicted outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Instead, your doctor can discuss any concerns you 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 deeper a melanoma penetrates 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 treatments that continue to improve the prognosis for people with melanoma that has spread from the primary site (advanced melanoma).
A/Prof Victoria Atkinson, Senior Staff Specialist, Princess Alexandra Hospital, Visiting Medical Oncologist, Greenslopes Private Hospital, and The University of Queensland Clinical School of Medicine, QLD; Adjunct Prof John Kelly AM, Consultant Dermatologist, Victorian Melanoma Service, and Department of Medicine at Alfred Health, Monash University, VIC; Dr Alex Chamberlain, Dermatologist, Glenferrie Dermatology, Victorian Melanoma Service and Monash Univeristy, VIC; Alison Button-Sloan, Melanoma Patients Australia; Peter Cagney, Consumer; Prof Brendon J Coventry, Associate Professor of Surgery, The University of Adelaide, Surgical Oncologist, Royal Adelaide Hospital, and Research Director, Australian Melanoma Research Foundation, SA; Dr David Gyorki, Consultant Surgical Oncologist, Peter MacCallum Cancer Centre, VIC; Liz King, Skin Cancer Prevention Manager, Cancer Council NSW; Shannon Jones, SunSmart Health Professionals Coordinator, Cancer Council Victoria; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Richard Scolyer, Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Co-Medical Director, Melanoma Institute Australia and Clinical Professor, The University of Sydney, NSW; Heather Walker, Chair, Cancer Council National Skin Cancer Committee, Cancer Council Australia. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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