Melanoma Skin Cancer is less common than some other types of skin cancer, but it is more likely to grow and spread. If you have melanoma or are close to someone who does, knowing what to expect can help you cope. Here you can find out all about melanoma, including risk factors, symptoms, how it is found, and how it is treated. Melanoma accounts for only about 1% of skin cancers but causes a large majority of skin cancer deaths. If you have been diagnosed with melanoma skin cancer or are worried about it, you likely have a lot of questions. Learning some basics is a good place to start.

What Is Melanoma Skin Cancer?

Melanoma is a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Melanoma is much less common than some other types of skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not found and treated early.Most skin cancers start in the top layer of skin, called the epidermis. There are 3 main types of cells in this layer:

• Squamous cells: These are flat cells in the upper (outer) part of the epidermis, which are constantly shed as new ones form.
• Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer. These cells constantly divide to form new cells to replace the squamous cells that wear off the skin’s surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells.
• Melanocytes: These are the cells that can become melanoma. They normally make a brown pigment called melanin, which gives the skin its tan or brown color. Melanin protects the deeper layers of the skin from some of the harmful effects of the sun.

The epidermis is separated from the deeper layers of skin by the basement membrane. When a skin cancer becomes more advanced, it generally grows through this barrier and into the deeper layers. Melanoma is a cancer that begins in melanocytes. Most melanomas start in the skin. Another name for these cancers is cutaneous melanoma. Melanomas can start anywhere on the skin, but in people with lighter skin color they are more likely to start on the trunk (chest and back) in men and on the legs in women. The neck and face are other common sites. People with darkly pigmented skin have a lower risk of melanoma at these more common sites.

Types of melanoma skin cancer

There are different types of skin melanoma. The most common types are:

• Superficial spreading melanoma: This type makes up about 7 in 10 melanomas of the skin. These tumors tend to grow outward on the surface of the skin (at least at first), so they might be noticed as a dark spot on the skin that is changing shape and/or getting bigger. Some of these melanomas start in existing moles but others do not.
• Nodular melanoma: This type accounts for about 2 in 10 skin melanomas. These tumors often appear as a distinct, raised bump (nodule) on the skin that is often dark brown or black, but it can also be pink or red. This can make them hard to find early. Nodular melanomas tend to grow down into deeper layers of the skin fairly early, so they’re often at a more advanced stage than superficial spreading melanomas by the time they are found.
• Lentigo maligna melanoma: This type of melanoma tends to occur in older people. It often first appears as an abnormally shaped tan or brown spot in an area that gets a lot of sun (such as the face, ears, or arms), and it tends to grow slowly (or change in other ways) over time.
• Acral lentiginous melanoma (acral melanoma): This type of melanoma starts in areas that don’t get a lot of sun exposure, such as the palms of the hands, soles of the feet, or under the nails. Acral melanomas make up a large portion of melanomas in people with darker skin tones.

Melanomas in other parts of the body

Melanomas can also form in other parts of the body, such as:

• Inside the eye (known as ocular melanomas). Most of these start in the uvea (the middle layer of the eyeball) and are known as uveal melanomas.
• Inside the nose, mouth, throat, genital, or anal area (known as mucosal melanomas)

These are much less common than melanoma of the skin.

Other types of skin cancer

There are many other types of skin cancer. Skin cancers that are not melanomas are sometimes grouped as non-melanoma skin cancers because they develop from skin cells other than melanocytes. They tend to behave very differently from melanomas and are often treated with different methods.

Basal cell and squamous cell skin cancers

Basal cell cancer (BCC) and squamous cell cancer (SCC) are by far the most common types of skin cancer. These cancers (especially BCCs) are much less likely to spread (metastasize) to other parts of the body than are melanomas, so they are usually less concerning and are treated differently. These cancers are discussed in Basal and Squamous Cell Skin Cancer.

Less common skin cancers

Other types of non-melanoma skin cancer are much less common than basal and squamous cell cancers and are treated differently. They include: Merkel cell carcinoma, Kaposi sarcoma, Cutaneous (skin) lymphoma, Skin adnexal tumors (tumors that start in hair follicles or skin glands), and Various types of sarcomas. Together, these types account for less than 1% of all skin cancers. Many types of benign (non-cancerous) tumors can develop from different types of skin cells.

Benign tumors that start in melanocytes

A mole (nevus) is a benign skin tumor that develops from melanocytes. Almost everyone has some moles. Nearly all moles (nevi) are harmless, but having some types can raise your risk of melanoma.

A Spitz nevus is a kind of mole that sometimes looks like melanoma. It’s more common in children and teens, but it can also be seen in adults. These tumors are typically benign and don’t spread. But sometimes doctors have trouble telling Spitz nevi from true melanomas, even when looking at them under a microscope. Therefore, they are often removed, just to be safe.

Benign tumors that develop from other types of skin cells

• Seborrheic keratoses: tan, brown, or black raised spots with a “waxy” texture and a “stuck on” appearance
• Hemangiomas: benign blood vessel growths, often called strawberry spots
• Lipomas: soft growths made up of fat cells
• Warts: rough-surfaced growths caused by some types of human papillomavirus (HPV)

Most of these tumors rarely, if ever, turn into cancers. There are many other kinds of benign skin tumors, but most are not very common.

 

Key Statistics for Melanoma Skin Cancer

Cancer of the skin is by far the most common of all cancers in the United States. Melanoma accounts for only about 1% of skin cancers but causes a large majority of skin cancer deaths.

How common is melanoma?

The American Cancer Society’s estimates for melanoma in the United States for 2025 are:

• About 104,960 new melanomas will be diagnosed (about 60,550 in men and 44,410 in women).
• About 8,430 people are expected to die of melanoma (about 5,470 men and 2,960 women).

Changes in the rates of new melanomas vary by age and sex. In people younger than 50, the rates have been stable among women and have declined by about 1% a year in men since the early 2000s. In people ages 50 and older, rates increased in women by about 3% per year but have stayed stable among men. Melanoma death rates declined rapidly from 2013 to 2022, largely because of advances in treatment.

Risk of getting melanoma

Having a lighter skin color is a major risk factor for melanoma. Overall, the lifetime risk of getting melanoma is about 3% (1 in 33) for White people, 0.1% (1 in 1,000) for Black people, and 0.5% (1 in 200) for Hispanic people.  But each person’s risk can be affected by several factors, which are described in Risk Factors for Melanoma Skin Cancer.

The risk of melanoma increases as people age. The average age of people when it is diagnosed is 66. But melanoma is not uncommon even among those younger than 30. It’s one of the most common cancers in young adults (especially young women).

Causes and prevention

Sunlight and ultraviolet (UV) radiation

Some research suggests there are 2 main ways that exposure to UV rays is linked to melanoma, but there is likely some overlap.

The first link is to sun exposure as a child and a teenager. People with melanoma often have an early history of sunburns or other intense sun exposures, although not everyone does. This early sun exposure may damage the DNA (genes) in skin cells called melanocytes, which starts them on a path to becoming melanoma cells many years later. This might help explain why melanomas often occur on the thighs (in women) and trunk (in men), areas that generally aren’t exposed to the sun as much in adulthood.

The second link is to chronic sun exposure. This type of exposure may be the cause of many melanomas that occur on the arms, neck, and face – areas that often get a lot of sun.

Researchers are studying whether melanomas that develop from these different patterns of UV exposure have different gene changes that might require them to be treated differently.

Public education

Most melanomas (and other skin cancers) can be prevented. The best way to lower the number of skin cancers and the serious problems they can cause is to educate people, especially parents, about risk factors and warning signs, and symptoms. Health care professionals and skin cancer survivors need to remind everyone about the dangers of too much UV exposure (both from the sun and man-made sources such as tanning beds) and about the ways you can protect your skin from UV rays.

Along with recommending staying in the shade, the American Cancer Society uses a slogan popularized in Australia as part of our skin cancer prevention message in the United States. Slip! Slop! Slap! and Wrap! is a catchy way to remember when going outdoors to slip on a shirt, slop on sunscreen, slap on a hat, and wrap on sunglasses to protect your eyes and the sensitive skin around them.

Melanoma genetics

Scientists have made a great deal of progress in understanding how some of the DNA (gene) changes inside normal skin cells can lead them to become melanoma cells.

Some people inherit gene changes (mutations) from their parents that raise their risk of melanoma. For example, changes in the CDKN2A (p16) gene cause some melanomas that run in certain families. People who have a strong family history of melanoma might want to speak with a cancer genetic counselor or a doctor experienced in cancer genetics to discuss the possible benefits, limits, and downsides of testing for changes in this gene (and others) that can increase melanoma cancer risk.

Researchers are also looking at other gene changes (or even patterns of gene changes) in melanoma cells to learn more about how they grow and how best to treat them. For example:

• Melanoma cells with certain gene changes might be more likely to spread, and therefore might need more intensive testing or treatment.
• Some gene changes make it more likely that the cancer will respond to certain treatments, such as targeted drugs or immunotherapy.

These topics are discussed in more detail below.

Early detection and diagnosis

Melanoma can often be found early, when it is most likely to be cured. Monthly skin self-exams and awareness of the possible warning signs may be helpful in finding most melanomas when they are at an early, curable stage.

The American Academy of Dermatology (AAD) sponsors annual free skin cancer screenings throughout the country. Many local American Cancer Society offices work closely with the AAD to provide volunteers for registration, coordination, and education efforts related to these free screenings. Look for information in your area about these screenings or contact the American Academy of Dermatology for more information.

Smartphone apps

In recent years, many smartphone apps have been developed that claim to help identify skin cancers, including melanomas. Recent advances in artificial intelligence (AI) may help make these apps better at identifying concerning areas on the skin that need to be looked at by a doctor.

While these tools may eventually prove to be helpful, it’s not yet clear how accurate they are, and more research is needed before expert groups would recommend them. For now, it’s best to have any area you’re concerned about looked at by a trained health professional.

Newer approaches to help determine if a tumor is a melanoma

Sometimes it can be hard for health care providers – even dermatologists – to tell if an abnormal area is likely to be a melanoma (and therefore should be biopsied) just based on how it looks. Because of this (and because of how dangerous melanomas can be), many skin biopsies are done on areas that turn out not to be melanomas.

Some newer devices can be placed over the skin to help health care providers get a better idea if an abnormal area is likely to be a melanoma, without needing to remove it.

For example, dermatologists sometimes use a technique known as reflectance confocal microscopy (RCM), in which a low-powered laser is aimed at the suspicious area. The light from the laser enters the upper layers of the skin and reflects off the structures there. This can be used to create a very detailed, three-dimensional image of the area, which can help the doctor determine if the area needs to be biopsied.

Other handheld devices might be especially helpful for primary care providers and other health professionals who don’t usually see as many skin cancers as dermatologists do. These types of devices are typically placed over the skin, and the tip of the device sends out beams of light or electrical signals, which then bounce off the skin cells and are detected by the device. The patterns of signals from cancer cells tend to be different from those of normal cells. The device can analyze the pattern coming from the area and let the provider know if it’s likely to be a melanoma (and therefore further testing is needed).

Another newer technique is adhesive patch testing. Instead of cutting into the skin to get a biopsy sample, a sticky patch is placed over the suspicious area. When it’s removed it takes some of the top layers of skin with it, which can then be tested for certain gene changes that are often linked with melanoma. If one of those gene changes is found, a standard biopsy of the area can then be done. If no gene changes are found, a biopsy isn’t needed, and the area can be watched instead.

Lab tests to help determine prognosis (outlook)

Most melanomas found at an early stage can be cured with surgery. But a small portion of these cancers eventually spread to other parts of the body, where they can be hard to treat.

Some research has shown that certain gene expression patterns in melanoma cells can help predict if early-stage melanomas are likely to spread or to come back after treatment. A lab test based on this research, known as DecisionDx-Melanoma, is now available. This test can be used to divide stage I to III melanomas into 3 main groups, based on their gene expression patterns:

• Class 1A melanomas have a lower risk of spreading or coming back.
• Class 1B or 2A melanomas have an intermediate risk of spreading or coming back.
• Class 2B melanomas have a higher risk of spreading or coming back.

This test might be used (along with other information about the melanoma) to help tell if someone with early-stage melanoma should get a sentinel lymph node biopsy (SLNB) or additional treatment, or if they need to be followed more closely after treatment to look for signs of recurrence. Tests of other genes and gene patterns are now being studied as well.

Treatment

While early-stage melanomas can often be cured with surgery, more advanced melanomas can be harder to treat. In recent years, newer types of immunotherapy and targeted therapy drugs have changed the treatment of this disease.

Immunotherapy

This type of treatment helps the body’s immune system attack melanoma cells more effectively. Some forms of immune therapy are now used to treat some melanomas (see Immunotherapy for Melanoma Skin Cancer), and others are now being studied.

Immune checkpoint inhibitors: Some newer drugs block “checkpoint” proteins that normally suppress the T-cell immune response against melanoma cells. These drugs are now one of the mainstays of treatment for advanced melanomas. Researchers are now looking for ways to make these drugs work even better. One way to do this might be by combining different checkpoint inhibitors or using them with other treatments, such as other types of immunotherapy or targeted drugs.

Researchers are also studying how useful these drugs can be for earlier-stage melanomas, as an adjuvant (additional) treatment after surgery. Some have already been shown to be useful after surgery for melanomas that have reached the lymph nodes, where they can help lower the chance that the cancer will come back. Researchers are now studying to see if these drugs might be helpful for even earlier-stage melanomas, or if they might be helpful if used before surgery (called neoadjuvant treatment) for some people. Newer immune checkpoint inhibitors with slightly different targets are now being studied as well.

Adoptive cell therapy with tumor-infiltrating lymphocytes (TILs): Some studies have shown that treating advanced melanomas with tumor-infiltrating lymphocytes (TILs) can shrink tumors and possibly prolong a person’s life as well. This treatment is now an option for some people with advanced melanomas if other treatments are no longer working.

TILs are immune system cells that have entered (infiltrated) a tumor to attack the cancer cells. Once a tumor is removed with surgery, the TILs can be separated out and then multiplied in the lab, after which they can be given back to the person as an IV infusion. In studies done so far, people are usually given chemotherapy before this treatment to help the body accept the TILs. After getting the TILs, people might also be given another type of immunotherapy, such as interleukin-2 (IL-2), which might help these immune cells better attack the cancer. Newer studies are looking at changing certain genes in the TILs before they are given to see if this can make them more effective at fighting the cancer. This approach looks promising in early studies.

Melanoma vaccines: Vaccines to treat melanoma are being studied in clinical trials.

These vaccines are, in some ways, like the vaccines used to prevent diseases such as polio, measles, and mumps that are caused by viruses. Such vaccines usually contain weakened viruses or parts of a virus that can’t cause the disease. The vaccine stimulates the body’s immune system to destroy the more harmful type of virus.

In the same way, killed melanoma cells or parts of cells (antigens) can be used as a vaccine to try to stimulate the body’s immune system to destroy other melanoma cells in the body. Usually, the cells or antigens are mixed with other substances that help boost the immune response. But unlike vaccines that are meant to prevent infections, these vaccines are meant to treat an existing disease.

Making an effective vaccine against melanoma has proven to be harder than making a vaccine to fight a virus. The results of studies using vaccines to treat melanoma have been mixed so far, but many newer vaccines are now being studied and may hold more promise.

Other immunotherapies: Other new forms of immunotherapy are also being studied. In addition, many studies are now looking at combining different types of immunotherapy, which may be more effective than any single treatment for advanced melanoma.

Targeted drugs

Targeted therapy drugs are designed to attack parts of melanoma cells that make them different from normal cells. These drugs work differently from standard chemotherapy drugs. As researchers have learned more about some of the changes in melanoma cells that make them different from normal cells, they’ve developed drugs that target these changes. Some of these drugs are now commonly used to treat melanomas with certain gene changes, while others are still being studied.

Drugs that target cells with BRAF gene changes: About half of all melanomas have changes in the BRAF gene, which helps the cells grow. Drugs that target the BRAF protein or the related MEK proteins have been shown to shrink many of these tumors, especially when BRAF and MEK inhibitors are combined.

Drugs that target cells with changes in the C-KIT gene: A small number of melanomas have changes in the C-KIT gene. This is more likely in melanomas that start on the palms of the hands, soles of the feet, under the nails, or in certain other places. Drugs that target cells with changes in C-KIT can often help treat these melanomas.

Drugs that target other genes or protein changes: Several drugs that target other abnormal genes or proteins are also being studied in clinical trials. Researchers are also looking at combining some of these targeted drugs with other treatments, such as chemotherapy or immunotherapy.

What Causes Melanoma Skin Cancer?

While there are many known risk factors for melanoma, it’s not always exactly clear how they might cause cancer. For example, while most moles never turn into a melanoma, some do. Researchers have found some gene changes inside mole cells that may cause them to become melanoma cells. But it’s still not known exactly why some moles become cancerous while most don’t.

Gene changes that might lead to melanoma

DNA is the chemical in each of our cells that makes up our genes, which control how our cells function. We usually look like our parents because they are the source of our DNA. But our genes affect more than just how we look.

Some genes control when our cells grow and divide into new cells, repair mistakes in DNA, or cause cells to die when they’re supposed to. If these genes aren’t working properly, it can lead to cells growing out of control. For example:

• Changes in genes that normally help cells grow, divide, or stay alive can lead to these genes being more active than they should be, causing them to become oncogenes. These genes can result in cells growing out of control.
• Genes that normally help keep cell division under control or cause cells to die at the right time are known as tumor suppressor genes. Changes that turn off these genes can result in cells growing out of control.
• Some genes normally help repair mistakes in a cell’s DNA. Changes that turn off these DNA repair genes can result in the buildup of DNA changes within a cell, which might lead to them growing out of control.

Mutations or other changes in any of these types of genes might lead to cells growing out of control. Changes in several different genes are usually needed for a cell to become a cancer cell.

Acquired gene mutations

Most often, gene changes related to melanoma are acquired during a person’s lifetime and are not passed on to a person’s children (inherited). Sometimes these acquired mutations seem to happen randomly within a cell, without having a clear cause. At other times, they likely happen as the result of exposure to an outside cause.

For example, ultraviolet (UV) rays are a major cause of melanoma. Most UV rays come from sunlight, but some can come from man-made sources such as tanning beds. UV rays can damage the DNA in skin cells. Sometimes this affects certain genes that control how the cells grow and divide. If these genes no longer work properly, the affected cells may become cancer cells.

In many cases, a melanoma might not appear until many years after the DNA damage from UV rays has occurred. Children and young adults often get a lot of intense sun exposure that might not result in cancer until many years or even decades later.

The most common change in melanoma cells is a mutation in the BRAF oncogene, which is found in about half of all melanomas. Other genes that can be affected in melanoma include NRAS, CDKN2A, and NF1. (Usually only one of these genes is affected.)

Melanomas that start on the palms of the hands, soles of the feet, or under the nails (known as acral lentiginous melanomas), or on internal surfaces such as the mouth and vagina (mucosal melanomas), often have different gene changes than those in melanomas that develop in sun-exposed areas, such as changes in the C-KIT (or just KIT) gene.

Inherited gene mutations

Less often, people inherit gene changes from a parent that clearly raise their risk of melanoma.

Familial (inherited) melanomas most often have changes in tumor suppressor genes, such as CDKN2A (also known as p16), CDK4, or BAP1, that prevent these genes from doing their normal job of controlling cell growth. This could eventually lead to cancer.

For some people who have a strong family history of melanoma or who have had several melanomas (or melanomas that started at an early age), doctors might advise genetic counseling and testing to see if they have a mutation in one of these genes (or possibly other genes) that increases their risk.

Some people, such as those with xeroderma pigmentosum (XP), inherit a change in one of the XP (ERCC) genes, which normally help to repair damaged DNA inside the cell. Changes in one of these genes can lead to skin cells that have trouble repairing DNA damaged by UV rays, so these people are more likely to develop melanoma, especially on sun-exposed parts of the body.

Gene mutations can sometimes affect treatment

Some of the gene changes found in melanoma cells have proven to be good targets for drugs to help treat this disease. For example, drugs that specifically target cells with changes in the BRAF gene or the KIT gene are now used to treat advanced melanomas with these changes.

Possible signs and symptoms of melanoma

• The most important warning sign of melanoma is a new spot on the skin or a spot that is changing in size, shape, or color.
• Another important sign is a spot that looks different from all of the other spots on your skin. (This is sometimes known as "the ugly duckling sign.")

If you have one of these warning signs, have your skin checked by a doctor.

What should a normal mole look like?

Most people have moles, and almost all moles are harmless. A normal mole is:

• Usually an evenly colored brown, tan, or black spot on the skin
• Either flat or raised
• Round or oval
• Generally smaller than 6 millimeters (about ¼ inch) across (about the width of a pencil eraser)

Some moles can be present at birth, but most appear during childhood or young adulthood. New moles that appear later in life should be checked by a doctor. Once a mole has developed, it will usually stay the same size, shape, and color for many years. Some moles may eventually fade away. It’s important to recognize changes in a mole's size, shape, color, or texture. These changes could suggest that a melanoma is developing.

The ABCDE rule for signs of melanoma

The ABCDE rule is another guide to the usual signs of melanoma. Be on the lookout and tell your doctor about spots that have any of the following features:

• A is for Asymmetry: One half of a mole or birthmark does not match the other.
• B is for Border: The edges are irregular, ragged, notched, or blurred.
• C is for Color: The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white, or blue.
• D is for Diameter: The spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this.
• E is for Evolving: The mole is changing in size, shape, or color.

Some melanomas don’t fit these rules. It’s important to tell your doctor about any changes or new spots on your skin, or growths that look different from the rest of your moles.

Other signs of melanoma on the skin

Other warning signs are:

• A sore that doesn’t heal
• Spread of pigment from the border of a spot into surrounding skin
• Redness or a new swelling beyond the border of the mole
• Change in sensation, such as itchiness, tenderness, or pain
• Change in the surface of a mole – scaliness, oozing, bleeding, or the appearance of a lump or bump

Be sure to show your doctor any areas that concern you. It’s sometimes hard to tell the difference between melanoma and an ordinary mole, even for doctors, so it’s important to show your doctor any mole that you are unsure of.

Signs of hidden melanoma

While most melanomas start on sun-exposed skin, a small portion of melanomas start in places that aren't exposed to the sun. These might look different from melanomas on the skin. For example:

• Under a fingernail or toenail (acral melanoma): May appear as a dark line or streak in the nail.
• On the palms or soles (acral melanoma): May appear as dark, irregular areas.
• In the eye (uveal melanoma): May appear as a dark spot in the colored part of the eye (iris).
• In the mouth, nose, and genitals (mucosal melanoma): May develop as dark spots or irregular areas in these tissues.

It’s important to show a doctor anything that concerns you in these areas as well.

How is the stage determined?

The staging system most often used for melanoma is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

The main (primary) tumor (T): How deep has the cancer grown into the skin? Is the cancer ulcerated?

• Tumor thickness: The thickness of the melanoma is called the Breslow measurement. In general, melanomas less than 1 millimeter (mm) thick (about 1/25 of an inch) have a very small chance of spreading. As the melanoma becomes thicker, it has a greater chance of spreading.
• Ulceration: Ulceration is a breakdown of the skin over the melanoma. Melanomas that are ulcerated tend to have a worse outlook.

Spread to nearby lymph nodes (N): Has the cancer reached nearby lymph nodes?

Spread (metastasis) to distant parts of the body (M): Has the cancer spread to distant lymph nodes, skin, or other organs? (Melanoma can spread almost anywhere in the body, but the most common sites of spread are the lungs, liver, brain, bones, and the skin or lymph nodes in other parts of the body.)

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.

Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage melanomas are stage 0 (melanoma in situ), and then range from stages I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage.

There are 2 main types of staging for melanoma.

• The clinical stage is based on the results of physical exams, biopsies, and any imaging tests that have been done .
• After the skin biopsy to confirm the diagnosis, if surgery is done (to remove more of the area around the skin tumor, as well as to check nearby lymph nodes for cancer), the pathological stage (also called the surgical stage) can be determined.

The clinical stage can be used to help determine if more tests need to be done, to help plan treatment, and to give an idea of a person’s outlook. Sometimes, though, the cancer might have spread farther than the clinical stage estimates, so it may not predict a person’s outlook as accurately as a pathological stage.

Stages of melanoma

The table below is a simplified version of the clinical stages in the most recent TNM system, effective as of 2018. If your cancer has been pathologically staged, it is best to talk to your doctor about your specific stage.

Melanoma staging can be very complex, so if you have any questions about the stage of your cancer or what it means, ask your doctor to explain it to you in a way you understand.

AJCC Clinical  Stage	Stage Description
0	The cancer is confined to the epidermis, the outermost skin layer (Tis). There are no signs the cancer has spread to nearby lymph nodes (N0) or to distant parts of the body (M0). This stage is also known as melanoma in situ.
I	The main tumor is no more than 2 mm (about 2/25 of an inch) thick and might or might not be ulcerated (T1 or T2a). There are no signs the cancer has spread to nearby lymph nodes (N0) or to distant parts of the body (M0). (Stage I is further divided into stages IA and IB, based on tumor thickness and if it’s ulcerated.)
II	The main tumor is more than 1 mm thick (T2b or T3) and may be thicker than 4 mm (T4). It might or might not be ulcerated. There are no signs the cancer has spread to nearby lymph nodes (N0) or to distant parts of the body (M0). (Stage II is further divided into stages IIA, IIB, and IIC, based on tumor thickness and if it’s ulcerated.)
III	The main tumor can be any thickness, and it might or might not be ulcerated (any T). The cancer has spread to nearby lymph nodes and/or it has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (N1, N2, or N3). There are no signs the cancer has spread to distant parts of the body (M0).
IV	The main tumor can be any thickness, and it might or might not be ulcerated (any T). The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body, such as: Areas of skin or lymph nodes in other parts of the body (M1a) The lung(s) (M1b) Any other organs outside the central nervous system (M1c) The central nervous system, including the brain, spinal cord, and the coverings of the brain and spinal cord (M1d)

Treating Melanoma Skin Cancer

If you've been diagnosed with melanoma, your treatment team will discuss your treatment options with you. It's important to weigh the benefits of each treatment option against the possible risks and side effects.

How is melanoma skin cancer treated?

Based on the stage of the cancer and other factors, your treatment options might include: Surgery for Melanoma Skin Cancer, Immunotherapy for Melanoma Skin Cancer, Targeted Therapy Drugs for Melanoma Skin Cancer, Chemotherapy for Melanoma Skin Cancer, Radiation Therapy for Melanoma Skin Cancer

Common treatment approaches

Early-stage melanomas can often be treated with surgery alone, but more advanced cancers often require other treatments. Sometimes more than one type of treatment is used. 

Who treats melanoma skin cancer?

Depending on your situation, you may have different types of doctors on your treatment team. These doctors may include:

• A dermatologist: a doctor who treats diseases of the skin
• A surgical oncologist (or oncologic surgeon): a doctor who uses surgery to treat cancer
• A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy, immunotherapy, or targeted therapy
• A radiation oncologist: a doctor who treats cancer with radiation therapy

Many other specialists may be involved in your care as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, pharmacists, psychologists, social workers, rehabilitation specialists, and other health professionals.

Making treatment decisions

It’s important to discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs. Some important things to consider include:

• Your age and overall health
• The stage (extent) of your cancer
• The likelihood that treatment will cure your cancer or help in some other way
• The possible side effects from treatment

You may feel that you need to make a decision quickly, but it’s important to give yourself time to absorb the information you have just learned. Ask questions if there is anything you’re not sure about. If time permits, it is often a good idea to seek a second opinion. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.

 

Help getting through cancer treatment

People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care. Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.  Different types of programs and support services may be helpful, and they can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.

Choosing to stop treatment or choosing no treatment at all

For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life. Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but it’s important to talk to your doctors as you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your supportive care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.