If your biopsy comes back positive for skin cancer, your doctor is likely to refer you to a cancer specialist, called an oncologist. The oncologist will determine the extent (stage) of the disease. This will help determine the right treatment plan for you.
Skin cancer 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 chest x-rays, blood tests, and scans of the liver, bones, and brain to see if it has grown into these areas. In some cases, the oncologist may check your 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 is based on:
- The size of the growth
- How deeply it has penetrated the top layer of skin
- Whether it has spread to nearby lymph nodes or to other parts of the body (metastasized)
Roman numerals I through IV are used to indicate a cancer's stage. 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
These are the stages of skin cancer:
- Stage 0: Cancer involves only the top layer of skin. It is carcinoma in situ.
- Stage I: The growth is 2 centimeters wide (three-quarters of an inch) or smaller.
- Stage II: The growth is larger than 2 centimeters wide (three-quarters of an inch).
- Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other places in the body.
- Stage IV: The cancer has spread to other places in the body.
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 I: Melanoma in stage I is thin:
- The tumor is no more than 1 millimeter (1/25 inch) thick. The outer layer (epidermis) of skin may appear scraped. (This is called an ulceration).
- Or, the tumor is between 1 and 2 millimeters (1/12 inch) thick. There is no ulceration. The melanoma cells have not spread to nearby lymph nodes.
- Stage II: The tumor is at least 1 millimeter thick:
- The tumor is between 1 and 2 millimeters thick. There is ulceration.
- Or, the thickness of the tumor is more than 2 millimeters. There may be ulceration. The melanoma cells have not spread to nearby lymph nodes.
- Stage III: The melanoma cells have spread to nearby tissues:
- The melanoma cells have spread to one or more nearby lymph nodes.
- Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.
- 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.