Diagnosis and Staging Skin Cancer
At HOA, our team is dedicated to guiding patients following a skin cancer diagnosis. We assess biopsy results to determine the type, stage, and treatment options for the cancer.
Detecting and Diagnosing Skin Cancer
Skin cancer is typically identified by a dermatologist or primary care physician (PCP), who may perform a biopsy to confirm the diagnosis. A biopsy involves removing a suspicious area of skin and sending it to a laboratory for examination by a pathologist. This is the only definitive method to diagnose skin cancer.
Skin biopsies are usually performed in the doctor's office or as an outpatient procedure in a clinic or hospital under local anesthesia.
In some cases, a biopsy may be the only treatment needed. However, if cancer cells are confirmed and further treatment is necessary, the dermatologist may refer you to an oncologist.
Next Steps After a Diagnosis
If you are diagnosed with skin cancer, the next step is to determine the extent or stage of the cancer. Skin cancer cells often spread to nearby lymph nodes first. Therefore, your doctor may check the lymph nodes around your neck, underarms, or groin, near the affected skin. Once your doctor knows the stage of your cancer, your treatment team can develop a personalized treatment plan tailored to your needs.
Stages of Skin Cancer
Staging describes how advanced skin cancer is and helps guide treatment decisions. Both melanoma and non-melanoma skin cancers may require imaging tests and lymph node evaluation for accurate staging.
Knowing the stage of your cancer will help your cancer doctor understand the seriousness of your cancer and chances of survival, allowing them to create a personalized treatment plan that may include clinical trials.
To determine the extent of skin cancer, physicians most commonly use the American Joint Committee on Cancer (AJCC) TNM staging system. This system is based on three key factors, which guide treatment planning:
- Tumor (T): This describes the size and depth of the primary tumor and how far it has grown into the skin. For melanoma, doctors also evaluate whether the tumor is ulcerated, meaning the skin over the melanoma has broken down.
- Nodes (N): This indicates whether the cancer has spread to nearby lymph nodes.
- Metastasis (M): This refers to whether the cancer has spread to distant areas of the body, such as other organs (like the lungs, liver, brain, or bones) or distant lymph nodes and skin.
Letters and numbers following T, N, and M provide more detailed information about each category. Oncologists use the Roman numerals I through IV to indicate a cancer's stage. Higher numbers typically indicate more advanced disease.
Non-melanoma Skin Cancer Staging
These are the stages of skin cancer:
- Stage 0: The cancer is localized to the top layer of skin (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.
- Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other areas of the body.
- Stage IV: The cancer has spread (metastasized) to other parts of the body.
Melanoma Staging
The following stages are used for melanoma:
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Stage 0: Melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
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Stage I: Melanoma in stage I is thin:
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The tumor is no more than 1 millimeter (1/25 inch) thick. The outer layer (epidermis) of skin may appear scraped (ulceration).
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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.
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Stage II: The tumor is at least 1 millimeter thick:
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The tumor is between 1 and 2 millimeters thick. There is ulceration.
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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: 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: Melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
Recurrent Skin Cancer
Recurrent disease means that the cancer has returned after treatment. It may have recurred in the original site or in another part of the body.
If you or a loved one was recently diagnosed with skin cancer, request a consultation with one of our skin cancer doctors.
