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Melanoma and other skin cancers - Staging

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of melanoma and nonmelanoma skin cancers.

Alternative Names

Skin cancer; Squamous cell cancer; Basal cell cancer; Actinic keratosis; Nonmelanoma skin cancer

Staging:

Staging is the process used to determine the size of the tumor and where and how far it has spread. When a cancer spreads, it� ' s said to have metastasized. Staging helps the health care team plan for appropriate treatment.

Basal cell cancer is rarely staged, because it doesn't usually spread to other organs. However, it may be staged if it is very large.
Squamous cell cancer of the skin may rarely be staged in people who have a high risk of the cancer spreading.
Melanoma is always staged.

A number of factors may be used to identify melanoma that is likely to spread and may be hard to treat, including:

The thickness of the main skin cancer lesion. Also important is how many layers of the skin the cancer has invaded.
Open (ulcerated) skin lesions
Primary cancers with small satellites
Evidence that the lymph nodes are involved, and how many lymph nodes are involved
Various other factors determined by looking at the cancer cells under a microscope

Health professionals have come up with various methods for staging the cancer. This report uses the TNM staging system recommended by the American Joint Committee on Cancer.

T = tumor. T is followed by a number to indicate thickness.
N = node. N is followed by numbers to indicate the number of lymph nodes involved.
M = metastasis. Metastasis is the spread of cancer to far away sites.

In addition a stage will include whether the melanoma is ulcerated. This indicates how severe the tumor is. The melanoma is considered ulcerated if skin layers over the tumor appear indistinct under the microscope.

In general, the thicker the lesion and the farther the cancer has spread, the higher the stage. The higher the stage, the worse the long-term outlook.

The earliest melanomas, which do not penetrate beneath the surface of the skin and are known as melanoma in situ, are highly curable and are called stage 0 or not given a stage.
Melanomas less than 4 mm thick suggest Stage I or II cancers. The next step is to try to determine whether they have spread or are likely to spread to the lymph nodes.
Melanomas that are over 4 mm thick indicate later stages. In such cases, the lymph nodes are sometimes removed in an attempt to prevent the cancer from spreading, although about 70% of these melanomas have already spread.

Specific stages are as follows:

Stage I. Cure rates are excellent with surgical removal, since they are least likely to have spread.

Stage 1A. Tumor has not spread to the nodes. It is less than 1 mm and is not ulcerated.
Stage IB. Tumor has not spread to the nodes. It is less than 1 mm, but is ulcerated, or the tumor is between 1.01 and 2 mm but is not ulcerated.

Stage II. Melanomas can be cured, but the success rate lags behind that of Stage I because a small number of cancer cells may have spread to distant sites. In addition to surgery, other forms of therapy may be recommended.

Stage IIA. Tumor has not spread to the nodes. It is between 1.01 and 2 mm and is ulcerated, or it is 2.01 to 4 mm without ulceration.
Stage IIB. Tumor has not spread to the nodes. It is between 2.01 and 4 mm and is ulcerated or greater than 4 mm but is not ulcerated.

Stage III. Survival rate is lower than earlier stages.

Stage IIIA. Tumor has spread to 1 node and it is up to 4 mm without ulceration. Sentinel biopsy has found evidence of tumor cells in the node (micrometastasis).
Stage IIIB. Tumor is up to 4 mm without ulceration and has spread to one node, or there is evidence of micrometastasis in two nodes.
Stage IIIC. Tumor is any thickness and ulceration may or may not be present. It has spread to 2 or 3 nodes. Additional "satellite" melanomas on the skin more than 2 cm (about an inch) from the original lesion may be present; these are sometimes called "metastases in transit."

Resources

www.aad.org -- American Academy of Dermatology
www.cancer.org -- American Cancer Society
www.asds.net -- American Society for Dermatologic Surgery
www.mpip.org -- Melanoma Patients' Information Page
www.cancer.gov -- National Cancer Institute
www.nccn.org -- National Comprehensive Cancer Network
www.skincancer.org -- The Skin Cancer Foundation
www.epa.gov/sunwise/uvindex.html -- UV index information

References

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Basal cell and squamous cell cancers: NCCN Medical Practice Guidelines and Oncology;V.1.2009. Accessed July 15, 2009.

Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy In Dermatology, 2005. J Am Acad Dermatol. 2005;56:125-143.

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Reviewed last on: 7/30/2009
Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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