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 (epidermis). | very 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 with ulceration, or more than 4 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 or subcutaneous tissues 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), you may have tests for a particular gene change (mutation). These gene mutations are due to changes in cancer cells – they occur during a person’s lifetime, and are not the same thing as genes passed through families.
About 30–40% of people with melanoma have the BRAF mutation gene, which makes the cancer cells grow and divide faster. About 15% have a mutation in the NRAS gene, which controls how cells divide. C-KIT is a rare mutation affecting less than 4% of people with melanoma.
Genetic tests can be done on the tumour tissue sample removed during surgery. The test results will help doctors work out whether particular drug therapies 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, new drug treatments such as immunotherapy and targeted therapy have improved the prognosis for people with melanoma that has spread from the primary site (advanced or metastatic melanoma) or is at very high risk of spreading.
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Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland, Diamantina Institute, and Consultant, Dermatology Department, Princess Alexandra Hospital, QLD; A/Prof Matteo Carlino, Medical Oncologist, Blacktown and Westmead Hospitals, Melanoma Institute Australia and The University of Sydney, NSW; Prof Anne Cust, Deputy Director, The Daffodil Centre, The University of Sydney and Cancer Council NSW, Chair, National Skin Cancer Committee, Cancer Council and faculty member, Melanoma Institute Australia; Prof Diona Damian, Dermatologist, Head of Department, Dermatology, The University of Sydney at Royal Prince Alfred Hospital, NSW, and Melanoma Institute Australia; A/Prof Paul Fishburn, General Practitioner – Skin Cancer, Norwest Skin Cancer Clinic, NSW and The University of Queensland; Claire Kelly, National Support Manager, and Emma Zurawel, Telehealth Nurse, Melanoma Patients Australia; Prof John Kelly, Consultant Dermatologist, Victorian Melanoma Service, The Alfred Melbourne and Monash University, VIC; Liz King, Manager, Skin Cancer Prevention Unit, Cancer Council NSW; Lee-Ann Lovegrove, Consumer; Lynda McKinley, 13 11 20 Consultant, Cancer Council Queensland; Angelica Miller, Melanoma Community Support Nurse, Melanoma Institute Australia incorporating melanomaWA, and Cancer Wellness Centre, WA; Dr Amelia Smit, Research Fellow, Melanoma and Skin Cancer, The Daffodil Centre, The University of Sydney and Cancer Council NSW; Prof Andrew Spillane, Professor of Surgical Oncology, The University of Sydney, The Mater and Royal North Shore Hospitals, NSW, and Melanoma Institute Australia; Kylie Tilley, Consumer; A/Prof Tim Wang, Radiation Oncologist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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