Staging
After the Tests: Staging
Staging is the process of finding out how widespread the cancer is. This includes finding out how big it is and whether it has spread to the lymph nodes or any other organs. The tests described above are used to help decide the stage of the melanoma. Staging is very important because the treatment and the outlook (prognosis) for recovery depend on the stage of the cancer.
Stages are labeled using 0 and the Roman numerals I through IV (1-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.
There are really 2 types of staging for melanoma. The clinical stage is based on what is found in the physical exam, biopsy, x-rays, CT scans, and so on. The pathological stage uses all of this information plus what is found during biopsies of lymph nodes or other organs. So the clinical stage (which is done first) may be lower than the pathologic stage, which is found after the biopsy.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you decide on the best treatment for you.
Thickness of the melanoma and mitotic rate
The thickness of the melanoma as seen in the skin biopsy is called the “T category.” The thinner the melanoma, the better the outlook. For the most part, melanomas less than about 1/25 of an inch deep (about the size of a period or a comma) have a very small chance of spreading. Thicker melanomas have a greater chance of spreading. The thickness of the melanoma also guides the choice of treatment. To measure the thickness of the melanoma, the doctor uses a device something like a small ruler. This is called the Breslow measurement.
Another important aspect for tumors is the mitotic rate. To measure this, the doctor counts the number of cells that are in the process of dividing in a certain amount of melanoma tissue. A higher mitotic rate (having more cells that are dividing) means that the cancer is more likely to grow and spread.
In either system, the melanoma is said to have a worse prognosis if it is ulcerated; this means that there is no covering layer of skin.
Survival Rates for Melanoma
Some people with cancer may want to know the survival rates for their type of cancer. Others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about survival rates is up to you.
These survival rates are based on patients who were part of the 2008 AJCC Melanoma Staging Database. These are observed survival rates. This means they include some people with melanoma who may have later died from other causes, such as heart disease. So the percentage of people surviving the melanoma itself may be higher.
Stage 5-year survival 10-year survival
IA 97% 95%
IB 92% 86%
IIA 81% 67%
IIB 70% 57%
IIC 53% 40%
IIIA 78% 59%
IIIB 59% 43%
IIIC 40% 24%
IV 15% to 20% 1 0% to15%
While numbers provide an overall picture, keep in mind that every person’s situation is unique and that statistics can’t predict exactly what will happen in your case. Many factors other than the stage can also affect a person’s outlook, such as the genetic changes in the cancer cells and how well the cancer responds to treatment. Talk with your cancer care team if you have questions about your own chances of a cure, or how long you might survive your cancer. They know your situation best.