Treatment Plan

The staging of skin cancer is a way to communicate to the care team how to proceed with treatment. "Stage" means how far a cancer has spread and is based on clinical history, biopsy results and other tests.

Squamous cell carcinoma and basal cell cancers rarely metastasize and early, localized lesions are usually treated successfully by surgical excision. All of the staging information is provided in the biopsy report, which states if the tumor has been removed entirely. There is usually no further diagnostic work up or need for treatment of early non-melanoma skin cancers after they are completely removed. However, if the biopsy report shows that cancer cells have spread beyond the surgical specimen, imaging tests (such as a CT scan) would be done to search for metastasis. An additional surgical procedure, such as a "re-excision" would be done to remove the rest of the cancer and to achieve a clear (negative) border with no cancer cells. Radiation treatment and chemotherapy may be considered.

Melanoma staging is more involved because metastasis is more likely. Even a small melanoma removed completely will require a re-excision to remove additional area around the original lesion. According to the National Institutes of Health (NIH), melanomas that are thin (less than 1 millimeter in depth) can usually be cured by removing the lesion or biopsy site along with a half-centimeter border of the surrounding normal skin and a layer of underlying tissue. Studies indicate the eight-year survival rate with this treatment approach is 95 percent. Larger melanomas require more extensive diagnostic studies to rule out metastasis and wider excisions. Often, lymph nodes and normal tissue must be removed with surgery. Chemotherapy and/or immunotherapy and other treatments would be planned based on the additional staging information depending on the risk analysis for recurrent melanoma.

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This article was reviewed and updated June 2007.