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Early melanoma (Stage 1)

Men and women discussing melanoma skin cancer

 This page tells you about treatment for early (stage 1) melanoma skin cancer. There is information about

 

A quick guide to what's on this page

The treatment team

NHS guidelines emphasise that people with melanoma should be looked after by a team of health professionals who work together. The team includes surgeons and cancer doctors, a specialist nurse, an occupational therapist, and a counsellor or psychologist.  

Treating early melanoma (stage 1)

Very early melanomas are stage 1 on the number staging system. This means they are thinner than 2mm, or less than 1mm thick but have broken the surface of the skin (an ulcerated area). They have not spread anywhere else in the body. The chances of a very early stage 1 melanoma spreading are low.

Your doctor will remove the affected mole. They will then do a further operation to remove some of the surrounding skin and tissue. This operation is called a wide local excision. As long as your doctor is sure that there was a border of healthy tissue removed from all around the area of the melanoma, this is all the treatment you need.

What happens after treatment

You will need to have follow up appointments. Between appointments, you need to contact your specialist to arrange an extra check up if you notice

  • Any changes in other moles
  • Dark, mole like spots appearing near where your mole was removed
  • Any enlarged glands (lymph nodes) close to where you had the mole removed

Once you have been diagnosed with a melanoma, you need to take care to protect your skin from the sun. This is very important because your risk of developing another melanoma is higher than average.

 

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The treatment team

NHS guidelines emphasise that people with melanoma should be under the care of a multidisciplinary team. This is a team of health professionals who work together to decide on the best way forward for each patient. Local teams that treat melanoma and other skin cancers are called Local Skin Cancer Multidisciplinary teams (LSMDTs). They include surgeons and cancer doctors, a specialist nurse, an occupational therapist, and a counsellor or psychologist. They work together to plan your care.

 

What early stage melanoma is

Very early melanomas are stage 1 on the melanoma number staging system. This means they are either thinner than 2mm, or less than 1mm thick but have broken the surface of the skin (an ulcerated area). They have not spread anywhere else in the body. The chances of a very early, stage one melanoma spreading are low. The melanoma has not grown deeply enough into the skin to allow the melanoma cells to break away and spread. 

The risk of the melanoma spreading increases as it becomes thicker or if the surface is ulcerated. Doctors may use the tumour thickness scales to help work out the risk of your melanoma coming back.

 

How doctors treat early stage melanoma

Doctors usually diagnose melanoma by removing an abnormal mole during an operation, together with a small area of surrounding skin. You have this operation under local anaesthetic. The doctor sends this tissue to the laboratory to check that it is melanoma. 

If it is melanoma, you have a second operation to remove a larger area of healthy tissue around where the melanoma was. Removing the surrounding tissue is called a wide local excision. As long as your doctors are sure that they removed enough tissue, this is all the treatment you need.

The surgeon usually removes between 1cm and 2 cm of tissue from all around the melanoma. This depends on how thick the melanoma was. You may have this operation under local anaesthetic. But you may have a general anaesthetic if your surgeon is also going to do a test to check the lymph nodes. The test is called a sentinel lymph node biopsy and there is information about it on the further tests for melanoma page.

 

What happens after treatment

If you had a very early melanoma that was only in the very top layer of skin (called an in situ or stage 0 melanoma) you will have one appointment at the follow up clinic.

Your doctor or nurse will show you what signs to look out for that would tell you if your melanoma has come back. These include

  • Changes in other moles
  • Dark, mole like, spots appearing near where your melanoma was removed
  • Enlarged glands (lymph nodes) close to where you had the melanoma removed

If you notice any of these changes, contact your specialist or nurse to arrange an appointment to go back to the clinic.

If you had a stage 1A melanoma you have an appointment to show you which signs to look for. You then have 2 to 4  follow up appointments in the outpatient clinic over the following year. After that if all is well your doctor may discharge you. 

If you had a stage 1B melanoma you have an appointment to show you which signs to look for. You then have appointments in the outpatient clinic every 3 months for 3 years. After that you have appointments every 6 months for another 2 years.

Protecting your skin

Staff at the clinic will also tell you how to protect your skin from the sun. Once you have had a melanoma, you should no longer sunbathe or use sunbeds. This is very important because your risk of developing another melanoma is higher than average. There is more information about looking after your skin after melanoma in the living with melanoma section.

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Updated: 21 January 2014