Melanoma is a form of cancer that begins in melanocytes (cells that make the pigment
melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented
tissues, such as in the eye or in the intestines1.
Stages of Melanoma:
Stage 0 (Melanoma in Situ): In 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 I: In stage I, cancer has formed. Stage I is divided into stages IA
- Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration.
- Stage IB: In stage IB, the tumor is either: not more than 1 millimeter thick and
it has ulceration; or more than 1 but not more than 2 millimeters thick, with no
Stage II: Stage II is divided into stages IIA, IIB, and IIC.
- Stage IIA: In 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, with
- Stage IIB: In stage IIB, the tumor is either: more than 2 but not more than 4 millimeters
thick, with ulceration; or more than 4 millimeters thick, with no ulceration.
- Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.
Stage III: In stage III, the tumor may be any thickness, with or without
ulceration. One or more of the following is true:
- Cancer has spread to one or more lymph nodes.
- Lymph nodes may be joined together (matted).
- Cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes.
- Very small tumors may be found on or under the skin, not more than 2 centimeters
away from where the cancer first started.
Stage IV: In stage IV, the cancer has spread to other places in the body,
such as the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract.
Cancer may also spread to places in the skin far away from where the cancer first
Treatment of Melanoma:
Four types of standard treatment are used:
Surgery to remove the tumor is the primary treatment of all stages of melanoma.
The doctor may remove the tumor using the following operations:
- Local excision: Taking out the melanoma and some of the normal tissue around it.
- Wide local excision with or without removal of lymph nodes.
- Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined
to see whether they contain cancer.
- Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph
node the cancer is likely to spread to from the tumor) during surgery. A radioactive
substance and/or blue dye is injected near the tumor. The substance or dye flows
through the lymph ducts to the lymph nodes. The first lymph node to receive the
substance or dye is removed for biopsy. A pathologist views the tissue under a microscope
to look for cancer cells. If cancer cells are not found, it may not be necessary
to remove more lymph nodes.
Different types of treatment are available for patients with melanoma. Some treatments
are standard (the currently used treatment), and some are being tested in clinical
trials. A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer. When
clinical trials show that a new treatment is better than the standard treatment,
the new treatment may become the standard treatment. Patients may want to think
about taking part in a clinical trial. Some clinical trials are open only to patients
who have not started treatment.
Skin grafting (taking skin from another part of the body to replace the skin that
is removed) may be done to cover the wound caused by surgery. Even if the doctor
removes all the melanoma that can be seen at the time of the operation, some patients
may be offered chemotherapy after surgery to kill any cancer cells that are left.
Chemotherapy is given after surgery, to lower the risk that the cancer will come
back, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer
cells, either by killing the cells or by stopping them from dividing. When chemotherapy
is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream
and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy
is placed directly into the cerebrospinal fluid, an organ, or a body cavity such
as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb
perfusion. This technique sends anticancer drugs directly to the arm or leg in which
the cancer is located. The flow of blood to and from the limb is temporarily stopped
with a tourniquet, and a warm solution containing anticancer drugs is put directly
into the blood of the limb. This allows the patient to receive a high dose of drugs
in the area where the cancer occurred. The way the chemotherapy is given depends
on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types
of radiation to kill cancer cells or keep them from growing. There are two types
of radiation therapy. External radiation therapy uses a machine outside the body
to send radiation toward the cancer. Internal radiation therapy uses a radioactive
substance sealed in needles, seeds, wires, or catheters that are placed directly
into or near the cancer. The way the radiation therapy is given depends on the type
and stage of the cancer being treated.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or
restore the body’s natural defenses against cancer. This type of cancer treatment
is also called biotherapy or immunotherapy.
For some patients, taking part in a clinical trial may be the best treatment choice.
Clinical trials are part of the cancer research process. Clinical trials are done
to find out if new cancer treatments are safe and effective or better than the standard
treatment. Many of today's standard treatments for cancer are based on earlier clinical
trials. Patients who take part in a clinical trial may receive the standard treatment
or be among the first to receive a new treatment. Patients who take part in clinical
trials also help improve the way cancer will be treated in the future. Even when
clinical trials do not lead to effective new treatments, they often answer important
questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer
Some clinical trials only include patients who have not yet received treatment.
Other trials test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming
back) or reduce the side effects of cancer treatment3.
Search for clinical trials in Georgia.
Adapted from the National Cancer Institute's PDQ Database:
(Accessed August 2013)
(Accessed August 2013)
(Accessed August 2013)