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Melanocytes are the cells that give skin its brown or tan pigment, and melanoma is a type of skin cancer that can develop when those cells grow out of control. Physicians use a system of melanoma staging to determine whether the cancer has spread beyond the epidermis, or top layer of skin, and if so, how far. The stages of melanoma are assessed during or after a patient’s diagnosis in order to better understand the extent of the cancer and assist the oncology team during the development of an individualized treatment plan. The stage of a patient’s melanoma is based on several factors, such as the size and thickness of the tumor or skin growth, as well as whether or not the cancer cells have metastasized, or spread, to other areas of the body.

How are melanoma stages determined?

A variety of tests may be necessary to accurately stage a case of melanoma. For example, imaging tests like a CT scan or MRI may be used to determine if the cancer has spread or metastasized. Or a physician may perform a fine needle aspiration biopsy of lymph nodes near the melanoma to get a sample of cells for closer examination.

Melanoma cancer stages are usually identified numerically, from Stage 0 to Stage 4, as follows:

Stage 0, also known as ‘melanoma in situ’

At this stage, there are precancerous, abnormal cells affecting only the skin or epidermis. They may appear as a mole or freckle that has an irregular shape, a ragged border or mixed colors of red, brown and tan. Or they may be moles that shrink and grow, change color and bleed or itch. It’s important to examine your whole body on a monthly basis. Pay attention to changes in skin lesions and have them checked by your dermatologist to make sure they don’t signal the beginning stages of melanoma.

Stage 1, the early stage of melanoma

This stage refers to melanoma that has grown deeper than in Stage 0 but is still small. Stage 1 melanoma is broken down into subgroups of 1A and 1B, which are determined by the exact depth of the melanoma, whether it appears ulcerated (the skin appears broken or disintegrated) and how quickly the cells are growing.

Stage 2 melanoma

For patients at this stage, the cancer still has not spread beyond the skin but has extended through the epidermis into the dermis, or the inner layer of skin. This stage is divided into three subgroups, 2A, 2B and 2C, depending on the melanoma’s thickness and whether there is ulceration present.

Stage 3 melanoma

In stage 3, the melanoma has spread to lymph nodes near the site of the tumor. The third stage of melanoma is divided into substage 3A, B, C or D, depending on the size and depth of the tumor, whether it appears ulcerated under a microscope and how many lymph nodes are affected. During stage 3, however, the melanoma has not spread to distant parts of the body.

Stage 4, or metastatic melanoma

As the most advanced stage of melanoma, this classification means the cancer cells have spread to distant areas of the body, such as the liver, lungs, brain or faraway lymph nodes or skin tissue. Although the size can vary, stage 4 melanoma tumors tend to be quite thick, often more than 4 millimeters deep.

During this stage, patients may also notice hardened lumps under their skin and experience metastatic melanoma symptoms, such as trouble breathing, loss of appetite, weight loss, bone pain and fatigue.

What melanoma staging means for your treatment at Moffitt

The Cutaneous Oncology Program at Moffitt Cancer Center is home to a multispecialty team of skin cancer experts. These professionals are highly experienced in the diagnosis and staging of melanoma, and take a comprehensive approach to individualized treatment and care. Members of Moffitt’s skin cancer team (including surgical oncologists, dermatologists, pathologists, radiologists, plastic surgeons, medical oncologists, dermatopathologists and other specialists) meet weekly in a tumor board to review complicated cases, which ensures that every patient receives the best possible treatment.

If you have questions about melanoma staging or want to make an appointment, call 1-888-663-3488, or complete our new patient registration form online. After a cancer diagnosis, every day counts, and we want to support you every step of the way. When you reach out to us, we’ll put you in touch with a cancer expert quickly after being scheduled so you can get started on your personalized treatment as soon as possible.


American Cancer Society: Melanoma Skin Cancer Stages

American Cancer Society: What is Melanoma Skin Cancer?

Healthline: What Do the Symptoms of Stage 4 Melanoma Look Like?

WebMD: Metastatic Melanoma