Medium stage melanoma (Stage 2 and 3)
This page tells you about treatment for stage 2 and 3 melanoma skin cancer. There is information about
Treating medium stage melanoma
Medium stage melanoma means stage 2 or 3. Stage 2 melanomas are more than 1 mm thick. They may have broken the surface of the skin (ulcerated). The melanoma cells are only in the skin and there is no sign that they have spread to lymph nodes or other parts of the body. Stage 3 melanomas have spread into nearby lymph nodes, skin, or lymph vessels.
Your first treatment is surgery to remove the melanoma. You then have another operation to remove more tissue to lower the risk that any melanoma cells were left behind in the area. Doctors measure how deeply the melanoma cells have gone into the skin.
Your doctor may do a test called a sentinel node biopsy to see how likely the melanoma is to come back and whether you need further treatment. This technique finds the first lymph node to drain tissue fluid from the area of the primary melanoma. A pathologist then checks the node for melanoma cells. If the sentinel node doesn't contain any melanoma cells, you won’t need any further surgery. If the node does contain melanoma cells, you will have another operation to remove all the other nodes in the area in case they contain melanoma cells too.
Removing your lymph nodes
Removing the all the lymph nodes in the area can be quite a big operation. The type of surgery you have will depend on where your melanoma was.
The treatment team
A team of health professionals working together plan your treatment. They are specialists in the treatment of stage 2 and 3 melanoma. The team is called a Specialist Skin Cancer Multidisciplinary Team (SSMDT).
If the melanoma comes back
If the melanoma comes back after initial treatment, you may have surgery to remove the melanoma. Or you may have laser treatment to destroy the melanoma areas. If the melanoma is on an arm or leg you may have chemotherapy into the affected limb (regional chemotherapy).
You can view and print the quick guide for treating medium stage melanoma.
Medium stage melanoma means it is stage 2 or 3. Stage 2 melanomas are thicker than 2mm. Or they may be thicker than 1mm and ulcerated. Ulcerated means that the covering layer of skin is broken. Stage 2 melanomas are only in the skin and there is no sign that they have spread to nearby lymph nodes or any other part of the body.
Stage 3 melanoma means that cancer cells have spread into skin, lymph vessels, or lymph glands close to the melanoma.
Stage 2 and 3 melanomas are more likely to spread to other parts of the body than stage 1 melanomas because the melanoma cells have grown deeper into the skin. So some melanoma cells may reach the blood vessels or lymph vessels just under the skin and may be carried to other parts of the body in the bloodstream or lymph fluid.
Your first treatment is surgery to remove the melanoma. You then have further surgery called a wide local excision. This operation removes more tissue to lower the risk of the melanoma coming back in the future.
The British Association of Dermatologists have produced guidelines for melanoma treatment. The guidelines recommend that
- For melanomas between 1 and 2mm deep the surgeon should take away 1 to 2cm of tissue all the way around
- For melanomas between 2 and 4mm deep the surgeon should take away 2 to 3cm of tissue all around
- For melanomas deeper than 4mm the surgeon should take away at least 3cm of tissue all around
Between 15 and 35% of stage 2A melanomas come back after surgery. Between 40 and 70% of stage 2B and 2C melanomas come back. More than half of stage 3 melanomas come back. Your individual chance of the melanoma coming back will depend on how deeply it has gone into the skin, whether it has ulcerated, and whether it has spread into surrounding tissue or lymph nodes. Your own doctor can give you information about the risk of your melanoma coming back.
Your melanoma may be at higher risk of spreading to other areas of the body if you have
- Areas of melanoma cells in the skin close to the main melanoma (called satellite metastases)
- In transit metastases – clusters of melanoma cells that have grown more than 2cm away from the primary melanoma, but have not reached the nearest group of lymph nodes
At the same time as the wide local excision, your doctor may do a test called a sentinel lymph node biopsy (SLNB). A SLNB checks whether the melanoma cells have spread into lymph nodes close to the melanoma. This test can help to find out how likely the melanoma is to come back and whether you need further treatment. The technique finds the first lymph node to drain tissue fluid from the area of the primary melanoma. A pathologist then tests the node for cancer cells. There is detailed information about sentinel lymph node biopsy on the page about further tests for melanoma.
If the sentinel node doesn't contain any cancer cells, you won’t need any further surgery. If the node does contain cancer cells, the doctor may offer you another operation to remove all the other nodes in the area in case they contain cancer cells too.
We know that sentinel node biopsy is a useful way to find the stage of melanoma. It can tell you whether your melanoma has spread into the lymph nodes. But it is not a treatment for the melanoma itself. At the moment, it is still unclear how useful it is to do a sentinel node biopsy. So not all hospitals offer these tests. You can talk to your doctor about sentinel node biopsy. They can help you decide whether or not to have this test. There is research looking into this.
Removing lymph nodes can be quite a big operation. It is called lymph node dissection. The type of surgery you have will depend on where your primary melanoma was in your body. There are large groups of lymph nodes in the
So, for example, if you had a melanoma on your leg, the lymph nodes in the groin on the same side will be removed. If you had a melanoma on your scalp or head, the lymph nodes on the same side of your neck would be removed.
There are some side effects from this type of surgery. You are likely to be in some pain after the operation. This should get better as the area heals. But a few people (less than one in ten) have pain that continues after this time, particularly if the lymph nodes in the neck are removed.
Shoulder stiffness and pain are the most common problems after the lymph nodes under the arm have been taken out. You may find that you cannot move your arm as freely as you could before the surgery.
If you have lymph nodes removed from the groin or armpit, swelling of the leg or arm on the same side is the most common problem after surgery. The swelling is called lymphoedema. It can usually be controlled with a combination of exercise, massage, and wearing an elastic sleeve or stocking on the affected arm or leg.
Treatment after surgery for cancer to try to prevent it coming back is called adjuvant treatment. There is no strong research evidence at the moment to show that any adjuvant treatment helps to stop melanoma from coming back or spreading. For this reason, you should only be offered adjuvant treatment within a clinical trial. You may be asked to join a trial if your lymph nodes contained cancer cells.
As adjuvant treatment for melanoma in clinical trials, you may have
Unfortunately, very little is known about which is the best adjuvant treatment for melanoma. A type of biological therapy called interferon has been widely used to try to prevent stage 2 or 3 melanoma from coming back. Although it can help to stop melanoma coming back in a small number of people it also causes side effects such as tiredness and depression. The side effects can lower people's quality of life and so doctors don't currently recommend interferon as a standard treatment. We need more research to find out if there is a better way of using interferon as an adjuvant treatment for melanoma.
Clinical trials are going on all the time to try to find out the best treatment approach. You can find details of current trials for melanoma on our clinical trials database.
A team of health professionals will work together to plan your care. They are specialists in the care of people with stage 2 and 3 melanomas. The team is called a Specialist Skin Cancer Multidisciplinary team (SSMDTs). It includes specialist surgeons and cancer doctors, a specialist nurse, an occupational therapist, camouflage make up specialist and a counsellor or psychologist.
After stage 2 or 3 melanoma is removed some people are cured and have no further problem. But in some people the melanoma comes back in the nearby area. This is called locoregional recurrence. The usual treatment is surgery to remove the new area of melanoma. If there is more than one area, you may have laser treatment. This treatment uses a carbon dioxide laser to destroy the melanoma cells.
If this treatment does not get rid of the melanoma or if the areas of melanoma go deeply into the skin, your doctor may recommend chemotherapy as capsules or into a vein. Or they may recommend radiotherapy to the area of the melanoma.
If the melanoma is on an arm or leg your doctor may advise that chemotherapy into the affected limb is the most appropriate treatment.
The doctor may offer you a clinical trial looking at a new treatment. You can find out more about clinical trials for melanoma on our clinical trials database.
If the melanoma has spread to another area of the body, this is a stage 4 melanoma. There is information about the treatment on the page about treatment for advanced melanoma.
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