Stages of Skin Cancer

rcog-breast-cancer-stages

If biopsy results determine that skin cancer is present, your oncologist will need to know the stage (extent) of the disease. Staging is a careful attempt to learn how thick the tumor is, and if it has spread. If the tumor is thick, the doctor may order additional tests, such as chest x-rays, blood tests, and scans of the liver, bones, and brain.

Knowing the stage of your cancer helps the oncologist:

  • Understand the seriousness of the cancer and your chances of survival
  • Plan the best course of treatment 
  • Identify clinical trials that may be options for treatment

There might be times when the oncologist needs to check the lymph nodes to stage the cancer (such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease).

The stage of the skin cancer is based on:

  • The size of the growth
  • How deeply it has grown beneath the top layer of skin
  • Whether it has spread to nearby lymph nodes or to other parts of the body

Roman numerals I through IV are used to indicate the stage of the cancer. Stage I cancers are small and limited to the area where they began. Stage IV indicates advanced cancer that has spread to other areas of the body.

Nonmelanoma Skin Cancer Staging

Doctors use the results from diagnostic tests and scans to answer questions about each patient’s individual cancer and then stage it in the following way:  

  • Stage 0: This is called carcinoma in situ or a precancerous lesion. Cancer cells are found only in the top layers of the skin.
  • Stage I: The primary tumor is 2 centimeters (cm) or smaller at its widest part. The cancer has not spread to the lymph nodes or to other parts of the body.
  • Stage IIA: The tumor is larger than 2 cm and has not spread to the lymph nodes or other parts of the body.
  • Stage IIB: The tumor has grown into nearby tissues, such as muscles, cartilage, or bone. It has not spread to the lymph nodes or elsewhere in the body.
  • Stage III: The cancer has spread to the lymph nodes. The tumor can be any size and may have spread to nearby bone, muscle, connective tissue, or cartilage.
    • Stage IIIA: The tumor is any size or may have grown into nearby tissues. Biopsy or surgery has found that the cancer has spread to nearby lymph nodes. The cancer has not spread to other parts of the body. Or, there is no sign of a tumor, but cancer was found in a nearby lymph node during an exam or with imaging scans. Its presence was confirmed using a microscope.
    • Stage IIIB: The tumor is any size or may have grown into nearby tissues. The cancer has spread through the lymphatic system, either to a regional lymph node located near where the cancer started or to a skin site on the way to a lymph node, called “in-transit metastasis.” In-transit metastasis may have reached these other lymph nodes. The lymphatic system is part of the immune system and drains fluid from body tissues through a series of tubes or vessels.
  • Stage IV: The tumor has spread to distant parts of the body, such as the liver, lung, bone, or brain.

Melanoma Staging

The following stages are used for melanoma:

  • Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.Stage 0 is also called melanoma in situ.
  • Stage I: Melanoma in stage I is thin:
    • Stage IA: The tumor is not more than 1 millimeter thick, with or without ulceration.
    • Stage IB: The tumor is more than 1 but not more than 2 millimeters thick, without ulceration.
  • Stage II is broken into IIA, IIB, and IIC: 
    • Stage IIA: The tumor is either:
      • more than 1 but not more than 2 millimeters thick, with ulceration; or
      • more than 2 but not more than 4 millimeters thick, without ulceration.
    • Stage IIB: The tumor is either:
      • more than 2 but not more than 4 millimeters thick, with ulceration; or
      • more than 4 millimeters thick, without ulceration.
    • Stage IIC: The tumor is more than 4 millimeters thick, with ulceration.
  • Stage III is divided into stages IIIA, IIIB, IIIC, and IIID
    • Stage IIIA: The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration. Cancer is found in 1 to 3 lymph nodes by sentinel lymph node biopsy.
    • Stage IIIB:
      • (1) It is not known where the cancer began or the primary tumor can no longer be seen, and one of the following is true:
        • cancer is found in 1 lymph node by physical exam or imaging tests; or
        • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
          or
      • (2) The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration, and one of the following is true:
        • cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or
        • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
          or
      • (3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true:
        • cancer is found in 1 to 3 lymph nodes; or
        • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
    • Stage IIIC:
      • (1) It is not known where the cancer began, or the primary tumor can no longer be seen. Cancer is found:
        • in 2 or 3 lymph nodes; or
        • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
        • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
        • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
          or
      • (2) The tumor is not more than 2 millimeters thick, with or without ulceration, or not more than 4 millimeters thick, without ulceration. Cancer is found:
        • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
        • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
        • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
          or
      • (3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any number of lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
        or
      • (4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
    • Stage IIID: The tumor is more than 4 millimeters thick, with ulceration. Cancer is found:
      • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
      • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
  • Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
  • Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.