Melanoma: A Patient’s Guide
What Does "Staging" Mean?

Once someone is diagnosed with melanoma, it is important to find out how deep into the layers of the skin the melanoma has grown and if it has spread to areas close to where it started such as the lymph nodes, or to more distant areas such as the liver, lungs or brain. To find this out, the physician may order a variety of blood tests, X-rays, scans and other special tests. This process is called "staging." Treatment is based on what stage the melanoma is in at the time of diagnosis.

The first step in staging is surgical removal of the melanoma. Then the pathologist, a physician specially trained in diagnosing disease, examines the melanoma under a microscope to determine its type. The pathologist determines how deep into the skin layers the melanoma has grown.

Wallace Clark, Jr., M.D., University of Pennsylvania Medical School, developed a classification system. You may view a picture of the normal skin layers with Clark's Level classification on the right side. When melanoma has grown into the deeper layers of the skin, there is a higher risk that it might spread to other areas of the body.

Another method for determining how deeply melanoma has invaded is to measure the depth. A direct measurement of the depth is often called Breslow's Level. Both Clark's Level and Breslow's Level can provide reliable information regarding the risk of the melanoma spreading. The important feature is that the risk of death from melanoma increases as the depth of the melanoma increases, regardless of the method used to assess the depth.

If the melanoma has not spread beyond where it started, it is considered "local" and is generally treated by surgery only. If the melanoma has gained access to the lymphatic channels and has spread to the local lymph nodes, it is considered regional. Finally, if the melanoma spreads beyond the local lymph nodes, it is considered metastatic.

After Clark's Level and Breslow's Level have been determined, the physician will "stage" the melanoma based on the results of the other tests that have been done (X-rays, scans, blood tests). "Staging a tumor" refers to the process by which the physician determines exactly where the melanoma is in the body. It is an important process because treatment is based on the stage of the melanoma. Below is a summary of the stages for melanoma:

In Situ
Clark's Level 1, precancerous cells

Stage 1
Clark's Level 2 or 3 that has not spread to nearby lymph nodes or any other area in the body

Stage 2
Clark's Level 4 or 5 that has not spread to nearby lymph nodes or any other organ

Stage 3
Any Clark's Level that has spread to one group of nearby lymph nodes or to the skin or subcutaneous tissue more than 2cm from the primary tumor

Stage 4
Any Clark's Level, but the melanoma has spread to more than one lymph node group or any other organ (lungs, liver, etc.) or any other area of skin

Once the tumor has been staged, a treatment plan can be developed. It is important to remember that this plan may need to change frequently based upon a patient's individual response to treatments.

What treatment should I receive?

Melanoma - A Guide For Patients

Cancer Care Information