Melanoma can be deadly, but not always. When the disease is caught early, a plastic surgeon can remove it with a not too complicated excision surgery. This changes for the worse as the disease advances. Mostly for clinical purposes, melanoma stages are used to denote how advanced the disease has become.
Early stages describe what are known as local tumors. These are tumors from which malignant cells have not broken free to migrate and invade other body parts. Latter stages describe tumors that have released malignant cells into local lymph nodes or distant organs.
What are melanoma stages and what are they used for?
Melanoma staging is a means with which doctors describe how a tumor has spread and how much it has grown. Staging is also used as a tool to describe where a tumor is located and parts of the body it has spread to.
Different types of tests are done for diagnosis depending on the type of melanoma in question. Staging depends on reports from the tests. It therefore cannot be effectively done before the tests have been done. The commonly used ways for staging are:
- 0-4 scale – here, melanomas are put in 5 stages. This mostly depends on extent of metastasis. It is the most commonly used staging system. The system works effectively for melanoma on leg or for rare melanoma types.
- TNM staging – T stands for thickness, N for nodes and M for metastasis. This method describes a melanoma tumor’s thickness, whether it has invaded lymph nodes and if it has reached distant organs. There are subdivisions in this staging system. The subdivisions are very important for precision especially when dealing with melanoma in mouth, eye and mucosal membranes.
- Clark and Breslow staging – this mostly deals with how deep a melanoma has grown into the skin. Breslow’s scale uses millimeters to measure the distance from the tip of a melanoma to the bottommost part.
Before staging, a small tissue from the tumor and surrounding areas is extracted and taken to the lab for observation under a microscope. Staging is very important, for it allows doctors to settle on the best treatment approach.
Stage 0 melanoma definition, signs, treatments and prognosis
In some melanoma definition platforms, this stage is sometimes skipped or merged with stage 1. It describes in situ melanomas. In other terms, tumors at this stage are still in the epidermis. The epidermis is the upper layer of the skin.
Signs and symptoms
Signs largely depend on which type of melanoma in question. Since cutaneous melanoma is most common, early signs may include an irregular mole, blemish, spot, patch or streak in case of the fingers and toes. The ABCDEs are commonly used to check for suspicious signs. It is often hard to catch a melanoma on toe or finger at this stage. Acral lentiginous melanoma pictures may help.
Stage 0 tumors are easy to remove. A qualified surgeon performs an excision surgery after marking excision margins with the help of images from MRIs or CT scans.
Most patients receive effective treatment for melanomas in this stage. Chances of surviving for the next 10 years or more are above 90%. Factors that may lead to poor prognosis include lack of treatment or follow-up appointments.
Stage 1 melanoma subdivisions, signs, treatments and prognosis
Stage 1 melanoma is still in the early stages. As hinted earlier, this stage is often combined with stage 0. This is because tumors in this stage are still in the epidermis. It can be subdivided into 2 other stages:
- Stage 1A – here, tumors have not reached 1mm in thickness. There are no signs of ulceration and cells with ability to rapidly divide are still in small numbers.
- Stage 1B – features that define stage 1B melanomas include ulceration, tumor thickness of 1-2mm and increase in number of fast dividing cells. Ulceration may or may not be present.
Since malignancy in this stage is still confined to melanocytes in the dermis, signs will appear on the skin. Most will revolve around malicious moles, patches or spots on the skin. Again, the ABCDEs may be helpful.
Excision surgery is usually used for tumor removal. If the tumor is more than 1mm thick, tests will be done to check whether malignancy has spread to local lymph nodes. If yes, affected ones will also be surgically removed. Other than the tumor, small tissue of the surrounding areas will also be removed.
Prognosis is still good for this stage melanoma. It is set at about 80% or more. Factors that may lead to poor prognosis include ulceration and involvement of lymph nodes.
Stage 2 melanoma subdivisions, signs, treatments and prognosis
Stage 2 melanoma can be subdivided into 3 other stages. In this stage, tumors have penetrated into the dermis but are still yet to reach the lymphatic and blood systems.
- Stage 2A – tumors are between 1mm and 4mm thick. Ulceration is common but not always present.
- Stage 2B – here, tumors are usually thicker than 2mm. most show signs of ulceration. If not, the tumors reach 4mm in thickness.
- Stage 2C – in this stage, tumors are quite large and show signs of ulceration.
Melanoma warning signs are still confined to the skin but are much more noticeable. Ulceration is one of them. Discoloration may have spread across larger skin regions.
Surgery is usually done on two fronts. One is to get rid of the tumor and the other is to remove local lymph nodes. The latter prevents it from spreading. Other than surgery, doctors often use radiotherapy and chemotherapy to ensure complete removal of the malignant cells.
Prognosis is poorer than the former two stages. This is due to factors such as ulceration and thicker tumors. 5 year survival rate is above 50%.
Stage 3 melanoma subdivisions, causes, treatments and prognosis
Stage 3 melanoma marks the end of early stages. The main unique feature is spread of malignancy to local lymph nodes. Once melanomas have penetrated deeper from the dermis, they may encounter lymphatic vessels. Several cells may break free into the vessels and be emptied in local lymph nodes.
- Stage 3A – some melanomas in this stage may not have yet reached the lymph nodes. If so, the invaded nodes are not swollen.
- Stage 3B – less than 3 lymph nodes located the closest to the primary tumor have been invaded. There are no signs of swelling but melanoma cells can be identified with a microscope.
- Stage 3C – this stage comes early in melanomas located close to lymph nodes that contain melanocytes. In this stage, more than 4 nodes have been invaded. Signs of ulceration on the tumors are common but not always there. Affected nodes are enlarged.
More advanced treatment options are necessary at this stage. The tumor and affected nodes are removed with surgery. After that, radiotherapy is used to stop further spread of the malignant cells. Chemotherapy may also be used to ensure successful prevention of both tumor growth and spread.
Prognosis at this stage is relatively poor. This is mostly due to the fact that malignant cells have entered the lymphatic system. There is a possibility of the melanoma coming back or resisting treatment in several ways. Survival rate for 5 years is set at about 33% to 50%.
Stage 4 melanoma definition, treatments and prognosis
Stage 4 melanoma represents the most advanced stage. This is when melanoma is most deadly. Often, treatment doesn’t succeed in completely removing melanoma cells. The difficulty in treatment arises from the fact that malignancy has spread to distant organs such as the lungs, liver, brain, other lymph nodes, abdominal organs or bones.
Surgery – usually done to remove the primary and accessible secondary tumors. Some forms of surgery may also involve amputation, removal of lymph nodes or entire removal of organs or tissues.
- Chemotherapy – drugs are used to kill cells with the characteristic of rapid division. It succeeds in shrinking most tumors.
- Radiotherapy – done to shrink tumors and prevent their growth rather than for complete removal. It is also commonly used to stop pain associated with spreading tumors.
- Immunotherapy – use of drugs to boost the body’s ability to fight cancer cells. It is quite effective even for small tumors that don’t show in imaging tests.
- Targeted therapy – use of drugs to inhibit certain functions essential for growth of melanoma cells.
Other treatment options may include use of vaccines and support therapy. Patients are encouraged to seek treatment in top centers such as Ocular Melanoma Foundation. This ensures that a team of qualified professionals will be the one coming up with the best treatment approach.
Melanoma statistics indicate that the disease is becoming more common than in past years. This means that there is need to learn the much there is to know about the disease. Luckily, such information is not lacking. Learning more about the disease is perhaps the best prevention measure.
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