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Staging of Melanoma cancer is a method used to evaluate and explain where the cancer is situated in the body, whether it has infected other parts or not and its influence on the rest of the human body. Medical examiners use diagnostic and medical tests to figure out the cancers stage. When melanoma is detected in a patient, the most important thing doctors must do is determine the stage of the cancer. This will help give the patients the best and most recommended medical care and treatment options as well as help doctors predict the patient’s prognosis, their chance of recovery.

There are five stages of melanoma cancer, starting at stage 0 through to stage 4. The first stage of melanoma is stage 0, then continues on from stage 1 to 4. The theory of melanoma staging states that the lower the stage, the less spreading of cancer thus less effect it has on your body. Whereas, a higher stage of melanoma, generally indicates a larger cancer spread and a severe effect on the body.

Once a patient is diagnosed, medical examiners and oncologists, people who study tumours must identify whether the cancer has spread, if so, how deep has it grown into the skin and its thickness. Each stage of melanoma relates to how severe it is and its effect on the human body.

For doctors to be certain about the melanoma cancer stage, the lesion and other surrounding tissue are surgically removed, tested and analysed under the microscope. Doctors and pathologists that test the melanoma, usually write up a pathology report, which includes information about the cancer including its thickness, whether ulceration is present or not, the type of melanoma and other characteristics which help determine the right therapy and care options. With this information, doctors could establish how deep and thick the tumour is, where it is located, whether it has spread and if it has affected other body parts. All these tests and results are combined to conclude the stage of melanoma.

Doctors use 2 common systems and scales to help describe how deep and serious the melanoma is in the body. These include:

-      TNM system

-      Clark scale

The Clark scale is mainly used to describe how deeply the melanoma has gone into the skin, whereas the TNM system helps categorise and assign the stage of melanoma based on certain elements including the growth rate, its spread, its size and its effect on other body systems.

TNM system
The most common system used to help stage melanoma is the TNM scheme, which is based on 3 key sections:

-      The depth of the tumour (T): how deep has the cancer has grown in the skin?

-      Did the melanoma affect the lymph nodes (N): Has the cancer spread?

-      The metastasis to other body parts (M): Has the cancer spread to distant lymph nodes and organs including the lungs and brain?

The tumour phase of the TNM system is focused on the thickness and ulceration of the melanoma. To determine the width of the tumour, doctors use the Breslow depth/scale. It is measured in millimetres using a microscope, as it cannot be seen with a human eye.

The thicker the tumour, the higher probability it might have metastasised (spread) to other sites of the body. Smaller and less thick melanomas have a better result, as it can be treated immediately, rather than grow more severe.

The scale used to describe and evaluate the thickness of the tumour is outlined below. There are 5 main stages used to describe the wideness of the melanoma tumour. Melanomas less than 1 millimetre (mm) thick have a less chance of developing and increasing length. As the melanoma becomes thicker, it has a greater chance of increasing in size.

The wound that develops on the skin as a result of the tumour is usually called ulceration. It is usually described as a destruction of the skin over the melanoma. Ulceration of the melanoma tumour usually means that the epidermis/top layer of the skin, which covers the melanoma is broken. The infected and ulcerated site cannot be seen with the naked eye, instead with a microscope.

The node phase includes 4 different stages which describe whether the cancer cells have reached nearby lymph nodes. This stage also describes whether the cancer can be seen with a microscope, if there are clear signs of cancer in the lymph nodes and if there are other melanoma cells surrounding the primary melanoma. The Metastasis phase, usually known as the ‘spread’ phase usually consists of whether the cancer has spread and affected different parts of the body. There are two main stages of metastasis, M0 and M1. M0 usually means that the cancer hasn’t increased nor spread while M1 means the cancer has increased and began affecting other parts of the body.



M1 is split into M1a, M1b and M1c.

·       M1a means that melanoma cells are in the skin and other parts of the body

·       M1b means the melanoma cells have reached the lung

·      M1c means the melanoma has affected other organs.

Once a patient’s Tumour, Node, and spread information have been tested, it is combined assign an overall stage of melanoma.

The Clark scale
The Clark scale is a method that measures how deep and intense the melanoma has grown in the skin and which layers of the skin it affects. The Clark scale has 5 main levels:

Level 1 is usually called melanoma in situ which means that the melanoma cells present on the epidermis, the outer layer of the skin.

Level 2 usually means that the melanoma cells have bypassed the skin surface and entered   the dermis, the layer directly under the epidermis.