Diagnosis & Treatment

STAGING SUBUNGUAL MELANOMA (SM)

When all surgical and any imaging tests have been completed and pathology reports have been received the doctors will try to figure out if the cancer has spread, and if so, how far. This process is called staging. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer’s stage when talking about prognosis and survival statistics. A preliminary clinical stage is assigned after the physical examination and initial biopsy. The final pathology report determines the pathologic stage and helps to determine the treatment options.

Melanoma stages are based on several factors. The staging system used for melanoma is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information

T (thickness of the tumour)
N (lymph node involvement)
M (metastasis)

Each letter is then assigned a numerical value which has more details about the cancer associated with it. The results of this analysis are grouped into five stages (0, I, II, III, and IV).

(T) Thickness of the Tumour

(T): The the thickness of the tumour. How deep has the cancer grown into the skin? The thickness of the melanoma is called the Breslow measurement. In general, melanomas less than 1 millimeter (mm) thick (about 1/25 of an inch) have a very small chance of spreading. As the melanoma becomes thicker, it has a greater chance of spreading. Is the cancer ulcerated? Ulceration is a breakdown of the skin over the melanoma. The ulceration status tells us whether or not the tumour’s top skin is present or broken or missing (ulcerated).
Melanomas that are ulcerated tend to have a worse outlook. The T category is further divided into levels 1 to 4, base on how deep the tumour has grown into the skin, measured in millimetres (mm).

(N) The Spread to the Lymph Nodes

Has the cancer spread to nearby lymph nodes?

(M) The Spread (Metastasis) to the Distant Sites

Has the cancer spread to distant lymph nodes or distant organs such as the lungs or brain?

Estimate Survival Brain Metastases Tool

Brain metastases are a common problem, with incidence estimates ranging from 100,000 to 300,000 patients per year. The Melanoma – Graded Prognostic Assessment (GPA) is a diagnosis-specific prognostic index for patients with brain metastases. Additional factors, including BRAF status, have been found to be prognostic. Those factors, weighted by significance, have been incorporated into the new Melanoma-molGPA. The GPA will help patients and their doctors select appropriate treatment and is also used for the arrangement of clinical trials.

Please note this tool is used as an estimation guide and does not replace the advice or opinion of your health care specialist.Visit Site

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