Has my melanoma spread?

Author: Vanessa Ngan, Staff Writer; Copy Editor: Clare Morrison; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, October 2013. About Melanoma is sponsored by the New Zealand Dermatological Society Incorporated.

So you’ve been to your doctor and your pathology report has come back positive for melanoma. Looking on the bright side, you’ve now got a diagnosis and can move forward and plan your road to recovery.

What happens next depends very much on how deeply your melanoma has grown into the skin and whether or not melanoma cancer cells have spread to other parts of your body. Your pathology report refers to this as the pathological stage of melanoma and it helps in planning the next steps.

Your doctor will examine your lymph nodes. If they are enlarged, a sample may be taken using a fine needle (FNA or fine needle aspirate).

If they are not enlarged, sentinel node biopsy may be recommended to find out if melanoma cells have spread to the lymph nodes.

Clinical staging of melanoma

Clinical staging is assessed by your doctor after examining your lymph nodes.

Melanoma stageWhat does this mean?What happens next?
Stage 0 (in situ) Melanoma only found in the top layer of skin. No further investigation or treatment is needed.
Stage I A thin melanoma that has invaded less than 2 mm into the skin. There is no sign of spread to lymph nodes or other parts of the body. No further investigation or treatment is needed.
Stage II Melanoma has grown thicker and is more than 2 mm in thickness. There is no sign of spread to lymph nodes or other parts of the body. No further investigation or treatment is needed.
Stage III Melanoma can be any thickness but it has spread to involve nearby lymph nodes or melanoma has been found on nearby skin (see local recurrence and in-transit metastases below). Further surgery is undertaken to cut out the lymph nodes and any melanoma in the nearby skin.
Stage IV Melanoma has spread to other parts of the body such as the lungs, brain or skin far away from the original site. These are melanoma metastases Further surgery is undertaken if possible to cut out melanoma metastases. Additional treatment with radiotherapy, chemotherapy, immunotherapy or targeted therapy drugs may be offered to fight or kill the cancer cells.

When melanoma is removed at its earliest stage (stage 0 or in situ), the cure rate is almost 100%. If melanoma is successfully removed in stage I or II, over 90% of people make a full recovery.

Stage III and IV melanoma are called advanced melanoma.

Metastatic melanoma

Metastatic melanoma is another name for melanoma that has spread to other sites of the body. It is classified into four types:

Local recurrence

Local recurrence is melanoma that grows within 2 cm of the surgical scar of a primary or original melanoma. This sometimes occurs even when the primary melanoma was completely removed by earlier surgery.

In-transit metastasis

In-transit metastasis is melanoma found inside the lymphatic system more than 2 cm from the site of a primary melanoma. The lymphatic system is the body’s drainage system in which a milky fluid called lymph circulates. This collects unwanted particles and infectious organisms.

Nodal metastasis

When melanoma spreads through the lymphatic system, cancer cells may settle in lymph nodes around the neck, in the armpits or in the groin. The lymph nodes catch foreign or harmful substances such as bacteria and cancer cells. When this happens the nodes can become swollen and tender to touch.

Haematogenous spread

Haematogenous spread is when melanoma spreads into the blood stream. Once in the blood stream, melanoma cells can travel around the body. The cells can settle anywhere and start growing. The new growths of metastatic melanoma can make you very sick. Melanoma often grows in the lungs, the liver and brain. Melanoma may also grow in bone, heart, pancreas, adrenal glands, digestive tract, spleen, kidneys and thyroid glands.

The outlook of metastatic melanoma is poor, especially if there is nodal metastasis and haematogenous spread to internal organs. Less than 20% of people survive melanoma when it reaches these later stages.

 

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