Early-Stage Melanoma: Skin Cancer Treatment

Early-stage melanoma (0, 1, or 2) generally means your prognosis is good. Stages are how healthcare providers determine how far cancer has progressed, whether it has spread, and what that may mean for outcomes.

Melanoma is the most aggressive form of skin cancer, but it is often curable in the early stages. From immunotherapy drugs to surgery, there are several possible treatment options that can be used, depending on the stage.

This article discusses what the melanoma stages mean. It also presents some of the common treatment options for people with an early-stage melanoma diagnosis.

Stage 0 (In Situ) Melanoma

Stage 0 is the earliest stage of melanoma. In this stage, symptoms may be subtle, such as the appearance of a flat or slightly raised spot on your skin or a mole that changes appearance. Early stage melanoma doesn't usually cause the same symptoms that might be present in later stages, like weight loss or feeling unusually tired. 

Stage 0 melanoma is sometimes also called "in situ" lesions. This means the cancer cells have not metastasized, or spread, beyond the top layer of skin called the epidermis. When compared with invasive melanoma, the rates of in situ melanoma cases are on the rise in the United States.

These stage 0 melanomas usually are treated through surgery. This means the cells are removed, or excised, from the skin. The provider also removes about a half-centimeter (cm) of the surrounding normal skin, called the margin. This is done to ensure they have removed the cancer cells.

Radiation therapy may be used at this early stage, usually when surgery is not an option.

The drug Aldara (imiquimod), used as a cream, is a type of immunotherapy drug. These medications are designed to help the body's own immune system fight back against cancer cells. It can be used at this early stage to stimulate an immune response, but not in later stages of melanoma.

Some studies suggest that Aldara may be effective in treating melanoma in situ in parts of the body where surgery may need to be avoided for cosmetic reasons, such as the face.

Stage 1 Melanoma

Stage 1 melanoma is broken down into two categories, which are based on a value called the Breslow thickness. This measures how thick the melanoma is on the layers of the skin, with lower numbers suggesting less chance the melanoma will spread.

In Stage 1A, the size of the lesion is 0.8 millimeter (mm) thick or less.

Stage 1B applies to tumors that are either less than 1 mm thick with ulceration at the site, or between 1 mm and 2 mm thick without any skin damage from ulceration.

Usually, a stage 1 melanoma is treated by surgical removal of the cells and about 1 cm to 2 cm of skin surrounding them. Depending on the location of the melanoma, most people can now have this procedure performed in an outpatient clinic or healthcare provider's office.

When stage 1 melanoma is more than 1 mm in thickness, your healthcare provider may want to perform a lymph node dissection. This is because cancer can spread through lymph nodes, which are a key part of your immune system. The procedure can lead to more precise staging and treatment plans.

Stage 2 Melanoma

With stage 2 melanoma, the cancer is bigger than in stage 1 but it has not spread to other parts of the body. The substages of stage 2 melanoma cover lesions up to 4 mm thick.

Surgical removal is the usual treatment in stage 2, but how much margin of normal tissue is removed depends on the size of the cancer. If the melanoma is:

• Between 1 mm and 2 mm thick, then 1 cm to 2 cm of healthy skin will be removed
• Between 2 mm and 4 mm thick, then 2 cm of healthy skin will be removed

A sentinel node biopsy also allows the surgeon to determine if a melanoma has begun to spread, which may change the assigned cancer stage. It is often recommended for stage 2 melanoma, and occasionally for stage 1 as well.

In this procedure, a weak radioactive dye is injected into the melanoma. It is used to trace through the lymphatic system and identify the sentinel nodes, which are closest to the cancer and most likely to be affected first if the cancer spreads.

In stage 2 melanoma, your healthcare provider may also consider immunotherapy drugs as a treatment option after surgery. However, the evidence is limited on how effective these drugs or radiation treatments may be in this case.

Immunotherapy drugs that may benefit people with some stage 2 cancers include:

• Keytruda (pembrolizumab)
• Opdivo (nivolumab)
• Tecentriq (atezolizumab), in cases involving a specific BRAF V600 gene mutation and when used in combination with Cotellic (cobimetinib) and the chemotherapy drug Zelboraf (vemurafenib)

Summary

Melanoma is less common than some other types of skin cancer, but it is an aggressive form that is more likely to grow and spread. Your chances of surviving a melanoma cancer are much better when it's caught at an early stage.

In most cases, treatment for people with stage 0 through stage 2 melanoma involves surgery to remove the cancer. Surgeons also remove small amounts of healthy tissue around the cancer site, which will vary depending on the size of the tumor.

Other treatments, such as radiation and immunotherapy drugs, may be possible in specific cases or when surgery is not an option. It's still more common, though, for these treatment options to be used in the later stages of melanoma.

A Word From Verywell

Newer treatments are becoming available for melanoma all the time and even more are being researched. Talk to your healthcare provider about whether you may be a candidate for any of these studies. It's important to be your own advocate in your cancer care.