If you or a loved one is dealing with a diagnosis of melanoma, our multidisciplinary clinic- The Melanoma and Skin Center of Excellence has a comprehensive care team with some of the nation’s experts in melanoma at West Cancer Center & Research Institute to help you. We also want to provide you with resources and information to help you manage your melanoma diagnosis.

What is Melanoma?

Melanoma is the most serious form of skin cancer that develops in the cells that produce melanin (the pigment that gives your skin color) Knowing the warning signs and seeking treatment early can provide successful results and help prevent spread to other parts of the body.

Ocular Melanoma (OM) or uveal melanoma is the most common primary cancer of the eye in adults. Melanoma of the eye is markedly different than skin melanoma with different behavior characteristics. There are approximately 2,000 cases of OM diagnosed in the United States every year. In partnership with UT Hamilton Eye Institute, the Melanoma and Skin Cancer Center of Excellence treats over 100 cases of OM each year, one of the highest numbers in the country.

Stages of Melanoma

The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors.

To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.

The stage of melanoma depends on the following:

Thickness of the tumor. The thickness of the tumor is measured from the surface of the skin to the deepest part of the tumor.

Whether the tumor is ulcerated (has broken through the skin).

Whether cancer is found in lymph nodes by a physical exam, imaging tests, or a sentinel lymph node biopsy.

Whether the lymph nodes are matted (joined together).

Whether there are:

  • Satellite tumors: Small groups of tumor cells that have spread within 2 centimeters of the primary tumor.
  • Microsatellite tumors: Small groups of tumor cells that have spread to an area right beside or below the primary tumor.
  • In-transit metastases: Tumors that have spread to lymph vessels in the skin more than 2 centimeters away from the primary tumor, but not to the lymph nodes.

Stage 0

Abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.

Stage IA

The tumor is not more than 1 millimeter thick, with or without ulceration.

Stage IB

The tumor is more than 1 but not more than 2 millimeters thick, without ulceration.

Stage IIA

The tumor is either:

  • more than 1 but not more than 2 millimeters thick, with ulceration; or
  • more than 2 but not more than 4 millimeters thick, without ulceration.

Stage IIB

The tumor is either:

  • more than 2 but not more than 4 millimeters thick, with ulceration; or
  • more than 4 millimeters thick, without ulceration.

Stage IIC

The tumor is more than 4 millimeters thick, with ulceration.

Stage IIIA

The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration. Cancer is found in 1 to 3 lymph nodes by sentinel lymph node biopsy.

Stage IIIB

(1) It is not known where the cancer began or the primary tumor can no longer be seen, and one of the following is true: cancer is found in 1 lymph node by physical exam or imaging tests; or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. or (2) The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration, and one of the following is true: cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. or (3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true: cancer is found in 1 to 3 lymph nodes; or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

Stage IIIC

(1) It is not known where the cancer began, or the primary tumor can no longer be seen. Cancer is found: in 2 or 3 lymph nodes; or in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. or (2) The tumor is not more than 2 millimeters thick, with or without ulceration, or not more than 4 millimeters thick, without ulceration. Cancer is found: in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or  in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. or  (3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any number of lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin. or (4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

Stage IIID

The tumor is more than 4 millimeters thick, with ulceration. Cancer is found: in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

Stage IV

The cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), gastrointestinal (GI) tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.

Symptoms of Melanoma

If you are experiencing any of these symptoms, we urge you to speak to your provider as soon as possible for further examination.

  • An unusual growth or pigmentation change on your skin
  • A change in an existing mole:
    • A-asymmetric shape
    • B-border with irregular or scalloped edge
    • C-color change
    • D-diameter growth of more than ¼”
    • E-evolving changes in size, color, shape and symptoms
  • Hidden symptoms:
    • Vision changes-Ocular Melanoma
    • Mucous membrane changes –Mucosal Melanoma
    • Fingernail or toenail changes-Acral-Lentiginous Melanoma

How to Diagnose Melanoma

If your provider would like to further investigate the possibility of a melanoma, one or more of the following diagnostic procedures may be performed:

EXCISIONAL BIOPSY

Removal and analysis of the entire mole or growth with a border of healthy looking skin

INCISIONAL BIOPSY

Removal and analysis of the most irregular part of the mole or growth.

PUNCH BIOPSY

A circular tool is used to remove a round piece of skin around the mole or growth.

SKIN CANCER SCREENINGS

Periodic skin exams by a physician, plus self-exams can help detect melanoma early.

SHAVE BIOPSY

Usually used for small lesions in a cosmetically sensitive area with a razor blade.

Types of Melanoma Treatments

Your melanoma treatment plan will vary depending on multiple factors including, but not limited to, your stage of diagnosis, as well as the location of your cancer. Your dedicated team of cancer experts will discuss your treatment options and plan with you, allowing you and your loved ones to consider all possible treatment options for your diagnosis.

CLINICAL TRIALS

You may be a candidate for a clinical trial for your skin cancer, ask our specialist if this is a treatment option for you.

LYMPH NODE DISSECTION

This surgery involves removing  all of the lymph nodes around the primary melanoma.

SENTINEL LYMPH NODE DISSECTION

This procedure removes the sentinel nodes, the first place the cancer is likely to spread, to see if the cancer has spread from the skin.

WIDE LOCAL EXCISION

A surgeon will remove the tumor as well as a margin of normal appearing skin and underlying tissue.

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