Stage 1

Patient Guide

STAGE I MELANOMA

What is Stage I melanoma?

Stage I melanoma is the thinnest form of the disease, with no spread to the lymph nodes or other parts of the body (metastasis). At this stage the cancer cells are only in the first two layers of the skin — the epidermis and dermis. It is sometimes known as a localised melanoma, as it has not spread beyond the original tumour site. Stage I melanoma can be divided into two subgroups: Stage IA and Stage IB.

More information to help you understand melanoma staging

 

T1a means all of the following:

  • the melanoma is less than 0.8mm thick
  • the layer of skin over the tumour is not broken (it is not ulcerated)

T1b can mean either:

  • the melanoma is less than 0.8mm thick and the skin is broken (ulcerated)

Or

  • the melanoma is between 0.8mm and 2mm and the skin is intact (without ulceration)

You may see a little ‘p’ on the report (e.g. pT1b). This means that the melanoma has been examined by a Pathologist.  For more information on how melanoma is staged, see here.

Note that if you have a T1b melanoma, you may be offered a sentinel lymph node biopsy, which we cover below.

How is Stage I melanoma diagnosed?

The diagnosis is made by testing a skin biopsy, (where a small sample of skin taken). Although a doctor may suspect melanoma when the biopsy is performed, this cannot be known for sure until the biopsy has been tested and examined under a microscope. This commonly takes two weeks. 

View our ‘Waiting for a Diagnosis- FAQs and What to Expect’ page

Who will be involved in my care?

Your case and biopsy will be discussed by a Local Skin Cancer Multi-Disciplinary Team (MDT). 

This team includes the following members:

  • Dermatologist (skin doctor)
  • Plastic surgeon
  • Specialist cancer nurse
  • Pathologist (who reviews the biopsy) 
  • Possibly other types of medical support staff.

>See our page who is involved in your care

What can I expect after a diagnosis of Stage I melanoma?

Stage I melanoma treatment is usually straightforward. If the results confirm that it is Stage 1A melanoma, you will have a minor surgery to remove any tumour remaining after the biopsy.

This is known as a wide local excision.

Wide load excision: What to expect

  • The melanoma is removed with minor surgery by a dermatologist or plastic surgeon
  • It is sometimes carried out under local anaesthetic in a doctors surgery
  • An area of skin of between 1cm to 2cm around where the melanoma is situated is also removed (known as a surgical margin)
  • The surgical margin increases in size depending on how thick the tumour is
  • Stitches will be used to close up the skin
  • This type of small operation will leave a linear, or straight-line scar
  • At sensitive sites, such as the face or hands, different options should be explained to you to suit your individual needs to minimise scarring
  • Options to avoid scarring could include a local flap (nearby spare skin is moved around) or a skin graft (a piece of your skin is used as a dressing

See more detailed information on a wide local excision

Follow up appointments

After the removal of a Stage IA melanoma you should have an initial follow-up appointment, where you will be shown what to look out for in future and to address any questions or concerns that you may have. You may also have further appointments for the doctors to examine you.  You can find out more information on follow up of melanoma here.

Sentinel Lymph Node Biopsy

If the Pathologist tells your doctor you have a T1b melanoma, you may be offered a procedure called a sentinel lymph node biopsy to see if the melanoma has spread to the lymph nodes.  This procedure is often performed at the same time as a wider excision of your scar.

The ‘sentinel’ lymph node is the first lymph node to receive drainage from a primary tumour, and the site where melanoma commonly spreads to first. This involves removing and examining the lymph node for the presence of cancer cells.

See more detailed information on sentinel lymph node biopsy

If your sentinel lymph node biopsy is negative’ or you do not have this test, you will be offered follow up for a stage I melanoma.  You can find more information on the follow up of melanoma here

If your sentinel lymph node biopsy is ‘positive’, or further melanoma is found in the wider excision sample, this means you have a Stage III melanoma.  You can find out more information about stage 3 melanoma and the various treatment options here.

Stage I further considerations

If you are diagnosed with Stage I melanoma you are unlikely to have further recurrence of your disease, and almost everyone is cured by their surgery.

Stage I melanoma: Questions you may have for your doctor

  • How was it confirmed that I have Stage 1 melanoma?

  • Will I have a wide local excision?

  • How can scarring be minimised for the procedure?

  • Was there any ulceration on the tumour?

  • If yes, then is it Stage IB, and will I need a sentinel lymph node biopsy (SNLB)?

  • Do you have a recommendation for a surgeon to carry out an SNLB?

  • Do I have any other moles of concern on my body?

  • Will I need a follow up?

  • How do I reduce the risk of developing another melanoma?

NB: The information we provide here should be used as part of a discussion with your medical team about the most appropriate treatment for your melanoma. Patients should also be aware that they may not be suitable for all the diagnostic interventions and treatments we outline.