Staging is a method describing the progression of cancer. It is performed after excision of the melanoma and after examining the lymph nodes and other parts of the body to determine the cancer extension. Staging helps doctors to indicate the best method of treatment available. Staging evaluates:
- The tumor thickness and depth
- The ulceration of the melanoma skin
There are different melanoma stages:
- The melanoma that invade only the superficial layer of skin - called the 0 melanoma stage or melanoma in situ - it is indicated surgical treatment to remove the lesion or nevus, together with 0, 5 cm (0.2 inches) safety margin of normal skin tissue.
- Melanoma stage I - surgery is indicated to remove the lesion and 1 cm (0.39 inches) margin of healthy tissue around and below the lesion
- Melanoma stage II- surgically removal of the tumor with 3cm (1.18 inches) of healthy tissue around and below the lesion. Plastic surgery procedures may be necessary to remedy the arrears scar after surgery, especially if it is located on the face or the hands
- Primary melanoma stage III - in which lymph nodes are invaded - surgery is indicated to remove the primary melanoma and all lymph nodes and lymphatic tissue in the region of primary melanoma. Even if melanoma has already spread through lymph nodes by the distance from the primary tumor
Adjuvant therapy (additional) is commonly used after surgery to combat melanoma symptoms. Adjuvant therapy is the treatment carried out before and after surgery to increase the chance of healing and to destroy remaining cancer cells. The use of interferon may increase the survival rate of people with stage III melanoma.
Disease progression - melanoma stages
Melanoma is treated according to the stages of the disease progression.
The status is determined by measuring how deep the melanoma has penetrated the skin (the Breslow scale), if it is ulcerated (cracked or bleeding) and if / how far the cancer it spread to the lymph nodes or other organs. The correct and accurate staging of this disease is important because the treatment and the prognosis of the disease vary according to melanoma stage at diagnosis:
- Melanoma in situ: Melanoma is now present in the upper layers of the skin;
- Stage I A/B: the tumor is progressively thicker, is confirmed to the upper layers of skin and it is not metastatic;
- Stage II A/B/C: The tumor has invaded the deeper layers of the skin, but it is not metastatic;
- Stage III A/B/C: The tumor can be of any thickness, and it has metastases in the regional lymph node. The patients with deep primary melanoma (Stage II B / C) or those with metastatic melanoma in loco-regional nodes (Stage III) are considered at high risk of recurrence;
- Stage IV: The tumor may be of any thickness, it has metastatic regional lymph nodes in other tissues or organs, most commonly in the lung, liver or brain.
Additional treatment options:
The advanced melanoma stage II or III is at high risk of recurrence after surgery; preventive or adjuvant therapy may include immunotherapy (therapy that stimulates the immune system to kill malignant cells), chemotherapy and radiotherapy.
IV stage melanoma treatment leads to cure only a small subset of patients and generally is focused on stabilizing the disease, relieving symptoms and maintaining patients at a higher quality of life as possible.
The treatment of melanoma that develops in other parts of the body depends on the location.
Localizations of melanoma include:
- Eyeball (ocular melanoma) - In the past, ocular melanoma required removal of the eye, but nowadays radiotherapy represents an alternative for treating some of these cases.
- The skin of the fingers of the hand or foot or under the nail. Melanoma in these locations is treated by removing the affected tissue (excision). Sometimes it is necessary the removal of the hand finger or of the toe of the foot entirely.