Stephen J. Schueler, M.D.

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Cancer Melanoma Evaluation

The evaluation of malignant melanoma begins with a history and physical exam.

Physical findings in moles that may indicate malignant melanoma include:

  • Irregular border
  • Mixed color
  • Irregular shape
  • Rapid change in size or shape
  • Rapid change in color, such as black
  • Size larger than 6 mm (about the size of a pencil eraser)

Tests that may be used to evaluate malignant melanoma include:

More advanced tests to look for distant spread of cancer in the body include:

Cancer Melanoma Staging

Staging a melanoma is an important process because it guides treatment decisions and helps to predict outcome. There are a number of factors that are considered when staging melanoma.

These include:

  • Tumor thickness:
    • Usually reported using Breslow's thickness scale (measured in millimeters)
    • Breslow's thickness is the single most important feature determining outcome and treatment.
  • Clark's level of invasion:
    • Determined by the doctor looking at the cells under the microscope
    • The deeper the penetration into the layers of the skin the higher the Clark's score.
  • Presence of ulceration:
    • Ulcerated lesions are more prone to spread
  • Level of mitosis in the melanoma:
    • Mitosis is a process that cells go through in order to multiply.
    • Higher levels of mitosis indicate a faster growing melanoma

Staging melanoma:
  • Tx: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Melanoma in-situ:
    • Limited to the superficial layer of skin, without spread to deeper layers.
  • T1: Melanoma is less than or equal to 1 mm thick; with or without ulceration
    • T1a: Melanoma is less than or equal to 1 mm thick with no ulceration and Clark's level 2 or 3
    • T1b: Melanoma is less than or equal to 1 mm thick with ulceration and Clark's level 4 or 5
  • T2: Melanoma is 1 to 2 mm thick; with or without ulceration
    • T2a: Melanoma is 1 to 2 mm thick with no ulceration
    • T2b: Melanoma is 1 to 2 mm thick with ulceration
  • T3: Melanoma is between 2 and 4 mm thick; with or without ulceration
    • T3a: Melanoma is between 2 and 4 mm thick with no ulceration
    • T3b: Melanoma is between 2 and 4 mm thick with ulceration
  • T4: Melanoma is over 4 mm thick; with or without ulceration
    • T4a: Melanoma is over 4 mm thick with no ulceration
    • T4b: Melanoma is over 4 mm thick with ulceration

Additional staging factors include:
  • Presence or absence of regional lymph node spread
  • Presence or absence of distant metastasis:
    • Spread to another organ such as the lungs, liver, brain, bone, GI tract, pancreas, lymph nodes, and to distant sites on the skin.

Continue to Cancer Melanoma Treatment

Last Updated: May 25, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Cancer Melanoma References
  1. Brown TJ, Nelson BR. Malignant melanoma: a clinical review. Cutis. 1999 May;63(5):275-8, 281-4. [10349543]
  2. Ruiz-Maldonado R, Orozco-Covarrubias ML. Malignant melanoma in children. A review. Arch Dermatol. 1997 Mar;133(3):363-71. [9080898]
  3. Schuchter LM. Review of the 2001 AJCC staging system for cutaneous malignant melanoma. Curr Oncol Rep. 2001 Jul;3(4):332-7. [11389818]
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