Stage 3

Patient Guide

Stage 3

What is Stage 3 (III) melanoma?

Stage 3 melanoma means that cancer cells have spread into skin, lymph vessels, or lymph glands close to the melanoma. The melanoma, however, has not spread further to other distant parts of your body.

Stage 3 can be subdivided into stages 3A, 3B, 3C and 3D

Stage 3A 

The stage means ALL the following:

  • The melanoma is no more than 2mm thick and it may or may not be ulcerated
  • Up to 3 nearby lymph nodes contain melanoma cells
  • These nodes are not enlarged and the cells can only be seen under a microscope (post sentinel lymph node biopsy)

Stage 3B 

This stage means ONE of the following:

There is no sign of the primary melanoma AND:

  • It has spread to only one lymph node OR
  • It has spread to very small areas of nearby skin (satellite sites) or to the lymphatic system between the primary melanoma and the draining lymph node

OR

The melanoma is no more than 4mm thick. It might or might not be ulcerated AND:

  • It has spread to up to 3 lymph nodes OR
  • It has spread to very small areas of nearby skin (satellite sites) or to the lymphatic system between the primary melanoma and the draining lymph node

Stage 3C

This stage means one of the following:

There is no sign of the primary melanoma AND:

  • it has spread to one or more lymph nodes OR
  • it has spread to very small areas of nearby skin (satellite sites) or to the lymphatic system between the primary melanoma and the draining lymph nodes OR
  • it has spread to any lymph nodes that are clumped together

OR

The melanoma may or may not be ulcerated AND:

  • it has spread to one or more lymph nodes OR
  • it has spread to very small areas of nearby skin (satellite sites) or to skin lymphatic system between the primary melanoma and the draining lymph nodes OR
  • it has spread to lymph nodes that are clumped together

Stage 3D

This stage means the following:

The melanoma is thicker than 4mm and is ulcerated AND:

  • It has spread to 4 or more lymph nodes OR
  • It has spread to very small areas of nearby skin (satellite sites) or to skin lymphatic system between the primary melanoma and the draining lymph nodes OR
  • It has spread to lymph nodes that are clumped together

How is stage 3 (III) 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 by a pathologist. This commonly takes two weeks. 

Most but not all types of stage 3 melanoma involve spread of cancer cells to lymph nodes.

Your doctor may detect that lymph nodes near your melanoma are involved, if they are swollen and your doctor can feel them. A test called a sentinel lymph node biopsy, where the lymph node nearest the melanoma is removed and examined for cancer cells is also undertaken. 

If your lymph nodes are involved in your melanoma then you are likely to have stage 3A (IIIA), 3B (IIIB), 3C (IIIC) or 3D (IIID) melanoma.

>See more on sentinel lymph node biopsy

Who will be involved in my care?

You should be cared for by a Specialist Skin Multidisciplinary Team (SSMDT)

This team includes the following members:

  • A dermatologist (skin doctor)
  • A plastic surgeon
  • An oncologist (cancer doctor)
  • A specialist nurse
  • A pathologist (who reviews the biopsies)
  • A radiologist (x-ray/scan doctor)
  • Possibly some other types of medical support staff.

See more information on medical teams involved in care for melanoma

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

Your doctors will try to remove the melanoma with surgery. Adjuvant treatment will also be discussed with you. If your melanoma is considered inoperable, you may be considered for immunotherapy or targeted therapy. 

Your melanoma may be tested to see if it carries a faulty BRAF gene sometimes called a BRAF mutation. The results of this test can take a few weeks. If you do have this faulty gene, which may be called BRAF positive, your melanoma produces more BRAF proteins and may grow quicker. It helps to know whether you are BRAF positive as doctors have the option of giving you targeted therapies that block BRAF and therefore treat your melanoma in this way.

View our video for further information on BRAF

See more information on adjuvant therapy

Stage 3 melanoma includes where the melanoma has spread to areas of skin, near the original cancer but away from the primary tumour. These are called in-transitor satellite lesions. In such cases, doctors will try and remove these melanomas. If the melanoma cannot be easily removed, you could be considered for other treatments that include electrochemotherapy, isolated limb perfusion/infusion or T-VEC.

Learn more about other treatments when your melanoma cannot be removed with surgery 

Stage 3 (III) melanoma: Questions you may have for your medical team

  • What are the potential benefits of having treatment?
  • Will I need a sentinel lymph node biopsy (SNLB)?
  • What happens if I choose not to have a sentinel lymph node biopsy or treatment?
  • Will my melanoma be tested for BRAF mutation?
  • If I am BRAF positive, what does that mean for my treatment?
  • If I am BRAF negative, what does that mean for my treatment?
  • What treatment options are available for me?
  • What are the advantages and disadvantages of these options?
  • How important is it to have oral treatment or treatment in hospital?How much time will I spend having treatment?
  • How could the treatment affect my lifestyle and work?
  • What are the possible side effects of the treatments?
  • Should I consider a clinical trial?