The Stages of Melanoma

The risk of your cancer spreading (metastasizing) is directly related to the size of your tumor. The term stage refers to the extent the tumor has spread. The stage is important in determining the likelihood of cure with treatment.

Small lesions are much less likely to have spread and have a higher likelihood of cure with treatment. Your surgeon will assign a stage to your cancer, but this often occurs after your surgery when the pathology results are available.

What Is Breslow Thickness?

Your physician, using an instrument called an ocular micrometer, will measure how thick your melanoma lesion is.

Generally, the thinner the lesion, the better your prognosis. The scale used is referred to as the Breslow thickness.

Breslow Thickness               5-Year Survival Rate

 Less than 1 mm

 95 to 100 percent

 1 to 2 mm

 80 to 96 percent

 2.1 to 4 mm       

 60 to 75 percent

 Greater than 4 mm

 37 to 50 percent


What Is the Clark Level?

Another measurement system your physician may use to help determine your prognosis is the Clark level. The Clark level is your dermatologic surgeon’s estimate of how deep your tumor has penetrated through your layers of skin. It’s made at the time of surgical excision.

Melanoma is described with a system of Roman numerals to detail the invasion of cancer in your skin. Your physician will assign a stage according to the specific involvement of your cancer, which helps guide your treatment.

Clark Level

Level I

 In situ (not invasive)

Level II

 Involves epidermis and papillary dermis

Level III

 Invades to the papillary–reticular dermal junction

Level IV

 Invades the reticular dermis

Level V

 Invades the structures deep to the skin (fat, muscle)

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How Does Melanoma Spread?

Melanoma spreads throughout your body in three ways:

  • Invades surrounding healthy tissue
  • Invades your lymph system and travels to other parts of your body
  • Invades your blood and travels through your veins and capillaries to other parts of your body

To determine if your melanoma has spread, your physician may order one or more of the following tests:

  • CT scan
  • Chest X-ray
  • MRI
  • PET scan
  • Bone scan

Recurrent melanoma is cancer that has returned (recurred) after treatment. It may come back in some other part of your body. You may need a combination of treatments to manage recurrent cancer.

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