Skin Cancer Staging: How It Affects Treatment and Prognosis

What is skin cancer?

Skin cancer is a dangerous disease that often involves the growth of abnormal cells in your skin tissues. Normally, when a skin cell gets mature, it dies, and new cells replace it. When these processes don’t work properly—if any person gets exposed to UV light from the sun, the majority of skin cells start to grow quickly. In most cases, these cells may be noncancerous (benign); they won’t spread or cause harm to people. Sometimes they can be cancerous.

Symptoms and causes

The most common sign of cancer in skin is experiencing a change in your skin. It typically starts with experiencing a new growth and/or a change in an existing growth or mole in your skin. 

Here are some of the most common symptoms of skin cancer:

• A new mole or a mole that changes its size, shape, or color or starts to bleed
• A waxy bump on your face, ears, or neck
• A flat or pink/red/or brown-colored patch or bump
• There are certain areas on your skin that look like scars.
• Crusty sores with a depression in the middle start to bleed often. 
• A wound or sore that won’t heal or heals and comes back again
• A rough, scaly lesion that might start to itch, bleed, and become crusty

Skin cancer staging

The stages of skin cancer often range from stage 0 to stage IV. In general, the higher the number, the more cancer has spread to other organs, and the harder it gets to treat the cancer in patients. The staging of this type of cancer such as melanoma is different from non-melanoma cancers, which often start in the basal or squamous cells.

Melanoma staging involves:

Stage 0: Melanoma in situ

In stage 0, the melanoma is only found in the top layer of skin, which is also known as the epidermis. This is the early and initial stage of melanoma, often considered a highly curable form of cancer.

Treating stage 0 melanoma

Melanoma in situ has often not grown deeper than the top layer of the skin, also known as the epidermis. 

Treatment of melanoma cancer by stage 0:

• Surgery: In stage 0, melanoma is treated with surgery; a wide excision is performed to remove the cancer and a small margin of normal skin around it. The removed sample is often checked under a microscope. If any cancerous cells are found in the sample, a second and wide excision is performed.
• Radiation therapy: In some cases, radiation therapy is performed after surgery when not all the cancer cells are removed from the body. 
• Mohs surgery: This can be performed when the melanoma is developed in sensitive areas such as the face; then Mohs surgery is performed.

Stage I

In stage I, the cancer is low risk, and there is no evidence that the cancer has spread to other organs. Stage I melanoma is generally curable with treatments such as surgery.

Treating stage I melanoma

Stage I cancer might have grown into deeper layers of the skin, but it won’t grow beyond the area where the cancer has started originally.

• Surgery: This treatment is performed by wide excision to remove the tumor along with the margin of normal skin around it. The width of the margin always depends on the thickness and location of the melanoma. In most cases, no other treatments are needed. 
• Sentinel lymph node biopsy: This treatment is often performed to identify any cancer spread to nearby lymph nodes, especially if the cancer is stage IB or has other traits that make it more likely to spread.
• Adjuvant therapy with immune checkpoint inhibitors: When Sentinel lymph node biopsy finds the cancer, then an adjuvant treatment often performed with immune checkpoint inhibitors. 
• Targeted therapy: In some cases, the doctor might use targeted therapy to treat the cancer. It might be used to reduce the chance of melanoma coming back in patients. 

Stage II

In stage II, there are some features that are present that are indicating the increased risk of recurrence in people. However, in this stage there is no proper evidence of spread into other body parts.

Treating stage II melanoma

Stage II melanomas started to grow or spread deeper into the skin when compared to stage I cancer, but they still haven’t grown beyond the area in the skin where they started. 

• Surgery: This treatment is often performed to remove the melanoma and a margin of normal skin around it. This is the standard treatment for these types of cancers.  
• Sentinel lymph node: This treatment is often performed when the melanoma has spread into nearby lymph nodes.
• Immune checkpoint inhibitors: This treatment is often given to patients to reduce the risk of the recurrence of cancer. 
• Radiation therapy: This might be given to patients when the melanoma has a chance of recurrence. 
• Targeted therapy: This might be recommended to patients who are at risk of reducing the chance of recurrence of cancer. 

Stage III

In this stage, the melanoma has started to spread to nearby lymph nodes or nearby skin in the body. Stage III has progressed beyond the starting site in the skin and also spread to other regional areas. 

Treating stage III melanoma

• Surgical treatment: The treatment is usually performed with wide excision of the primary tumor, as in earlier stages, along with lymph node dissection, where all the nearby lymph nodes are surgically removed. 
• Immune checkpoint inhibitors: In some cases, this treatment is performed with adjuvant therapies or with targeted therapy because it might reduce the chance of cancer coming back. 
• Targeted therapy: This treatment is often used in people with melanoma with a BRAF or C-KIT gene mutation. 
• Radiation therapy: This treatment is often given to the areas where the lymph nodes are removed, particularly when the nodes contain cancer. 
• Chemotherapy: This treatment is often given when the melanoma affects the arm or leg. The other option might be limb perfusion or isolated limb infusion.

Stage IV

Stage IV melanoma, also known as metastatic melanoma, is the most advanced stage of cancer. In this stage, the cancer has spread to more distant lymph nodes or skin. Stage IV even starts to spread to internal organs.

Treating stage IV melanoma

In stage IV melanoma, it has already spread to other parts of the body, such as distant lymph nodes, areas of skin, or other organs. This stage is also known as metastatic melanoma.

• Surgery: There are skin tumors, and enlarged lymph nodes start to cause several symptoms, which are often removed by surgery.
• Radiation therapy: These treatments are often performed to treat several symptoms in patients. 
• Immunotherapy: These types of treatments often use drugs known as checkpoint inhibitors as the primary line of treatment. These drugs are mostly used to shrink or destroy tumors for long periods of time in many patients.
• Targeted therapy: In half of the cases, the cancer cells have BRAF genes. These types of melanomas often respond to the treatment of targeted therapy. 
• Chemotherapy: These treatment measures often help patients who have tried other treatments first.