Stage 3 Melanoma

Stage III melanoma, also known as regional melanoma, has metastasized (spread) to nearby lymph nodes, lymph vessels, or skin. Lymph nodes are an important part of the lymphatic system, which is a vast network of tissues and organs that helps rid the body of waste, toxins, and other unwanted materials. The lymphatic system also helps support the immune system by transporting infection-fighting white blood cells throughout the body.

Stage III melanoma is divided into four subgroups based on ulceration of the primary tumor and the extent of growth into the lymph nodes, lymph vessels, and nearby skin:

Subtypes

Note: The full criteria for each Stage 3 subtype are included below. While this information is dense, it is included so that patients and their loved ones have all available information about their condition.

3A

Stage IIIA Melanoma:
The melanoma tumor is up to 1.0 millimeter thick (the size of a sharpened pencil point) with or without broken skin (ulceration) when looked at under a microscope or more than 1.0 millimeter and less than 2.0 millimeters (the size of a new crayon point) without ulceration (broken skin) when looked at under a microscope. The melanoma has spread to up to three nearby lymph nodes–detected by biopsy of the sentinel lymph node–but has not yet spread to distant sites.

3B

Stage IIIB Melanoma:
The melanoma tumor is up to 1.0 millimeter thick (the size of a sharpened pencil point) with or without broken skin (ulceration) or more than 1.0 millimeter and less than 2.0 millimeters (the size of a new crayon point) without broken skin (ulceration) when looked at under a microscope; AND:

The melanoma has spread to one lymph node detected clinically; OR
The melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; OR
The melanoma has spread to up to three lymph nodes detected clinically; AND
The melanoma has not yet spread to distant sites.

OR
The melanoma tumor is more than 1.0 millimeter and less than 2.0 millimeters thick (the size of a new crayon point) with broken skin (ulceration) or more than 2.0 to 4.0 millimeters thick without broken skin (ulceration) when looked at under a microscope; AND:

The melanoma has spread to one lymph node detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to one lymph node detected clinically; OR
The melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; OR
The melanoma has spread to two or three lymph nodes detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to two or three lymph nodes, of which one was detected clinically; AND
The melanoma has not yet spread to distant sites.

OR
There is no sign of the primary tumor; AND:

The melanoma has spread to one lymph node detected clinically; OR
The melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; AND:
The melanoma has not yet spread to distant sites.

3C

Stage IIIC Melanoma:
The melanoma tumor is up to 2.0 millimeters thick (the size of a new crayon point) with or without broken skin (ulceration) or more than 2.0 millimeters and less than 4.0 millimeters thick without broken skin (ulceration) when looked at under a microscope; AND:

The melanoma has spread to one lymph node detected clinically or by biopsy of the sentinel lymph node; AND the melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them;

The melanoma has spread to four or more lymph nodes detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to four or more lymph nodes, at least one of which was detected clinically, or the presence of any number of nodes that are clumped together; OR
The melanoma has spread to two or more lymph nodes detected clinically or by biopsy of the sentinel lymph node, and/or the presence of any number of nodes that are clumped together; AND
The melanoma has not yet spread to distant sites.

OR
The melanoma tumor is more than 2.0 millimeters and less than 4.0 millimeters thick (the size of a new crayon point) with broken skin (ulceration) or more than 4.0 millimeters thick without broken skin (ulceration) when looked at under a microscope, AND

The melanoma has spread to one or up to four or more lymph nodes; OR
The melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; OR
The melanoma has spread to lymph nodes that are clumped together; AND
The melanoma has not yet spread to distant sites.

OR
The melanoma tumor is more than 4 millimeters thick without broken skin (ulceration) when looked at under a microscope, AND

The melanoma has spread to one lymph node detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to one lymph node detected clinically; OR
The melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; OR
The melanoma has spread to two or three lymph nodes detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to two or three lymph nodes, at least one of which was detected clinically; OR
The melanoma has spread to one lymph node that was detected clinically or by biopsy of the sentinel lymph node, and the melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; AND
The melanoma has not yet spread to distant sites.

OR
There is no sign of the primary tumor; AND:

The melanoma has spread to two or three lymph nodes, at least one of which was detected clinically; OR
The melanoma has spread to one lymph node that was detected clinically or by biopsy of the sentinel lymph node, and the melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them; OR
The melanoma has spread to four or more lymph nodes, at least one of which was detected clinically, or the presence of any number of nodes that are clumped together; OR
The melanoma has spread to two or more lymph nodes detected clinically or by biopsy of the sentinel lymph node and/or the presence of any number of nodes that are clumped together; AND
The melanoma has not yet spread to distant sites.

3D

Stage IIID Melanoma:
The melanoma tumor is more than 4 millimeters thick with broken skin (ulceration) when looked at under a microscope, AND

The melanoma has spread to four or more lymph nodes detected by biopsy of the sentinel lymph node; OR
The melanoma has spread to four or more lymph nodes, at least one of which was detected clinically, the presence of any number of nodes that are clumped together; OR
The melanoma has spread to two or more lymph nodes detected clinically or by the biopsy of the sentinel lymph node and/or the presence of any number of nodes that are clumped together, and the melanoma has spread to very small areas of skin near the primary tumor, sometimes called “satellite tumors” or has begun to travel through lymph channels toward lymph nodes but has not yet reached them, AND
The melanoma has not yet spread to distant sites.

About Staging

‍Melanoma staging is based on the American Joint Committee on Cancer (AJCC) staging system. The system assigns a stage based on tumor-node-metastasis (TNM) scores as well as additional prognostic factors. The goal is that melanomas of the same stage will have similar characteristics, treatment options, and outcomes. Learn more about melanoma staging.

Treatment for Stage 3 Melanoma

‍Stage III melanoma treatment varies greatly depending on whether the melanoma is completely resectable. When melanoma is completely resected, it has been removed entirely surgically. Melanoma that is unresectable cannot be removed completely through surgery alone. Learn more about melanoma treatment options.

Resectable Stage III Melanoma

Treatment for resectable Stage III melanoma includes surgical removal of the melanoma with wide excision, and a sentinel node biopsy may be recommended to determine if the melanoma has spread to the nearest lymph node. If melanoma is detected in this biopsy, your doctor may recommend a complete lymph node dissection (removing all lymph nodes in a specific area of the body surgically); however, this is not recommended in all instances.

Adjuvant Therapy

‍Patients with high-risk melanoma may choose to help delay or prevent the recurrence of melanoma through adjuvant therapy. Adjuvant therapy is additional treatment given after the primary treatment for melanoma (usually surgery). The goal of adjuvant therapy is to reduce the risk of melanoma returning. Learn more about adjuvant therapy.

Neoadjuvant Therapy

‍In some instances, your doctor may recommend trying to shrink the tumor before surgery. This is referred to as neoadjuvant therapy and is typically offered through clinical trials.

High-risk melanoma usually is defined as melanoma that is deeper or thicker (more than 4 millimeters thick) at the primary site or involves nearby lymph nodes. This disease has a high risk of recurrence because some melanoma cells may remain in the body even after the surgery removed the visible melanoma tumors successfully.

Unresectable Stage III Melanoma

‍Treatment options for unresectable Stage III melanoma have expanded greatly in the last 10 years and frequently combine surgery with immunotherapy or targeted therapy. Learn more about melanoma treatment options

Clinical Trials

‍Clinical trials offer patients access to treatment approaches that may prove more beneficial than those approved by the U.S. Food and Drug Administration (FDA) currently. In addition, clinical trials expand our understanding of melanoma and improve future treatment options for all patients. Given the very rapid development of new agents and combinations, patients and their physicians are highly encouraged to consider treatment in a clinical trial for initial treatment and at the time of disease progression. Learn more about clinical trials.

Prognosis for Stage 3 Melanoma

‍With appropriate treatment, Stage III melanoma is considered intermediate to high risk for recurrence or metastasis. With all melanoma, the earlier it is detected and treated, the better. The 5-year survival rate as of 2018 for regional melanoma (Stage III) is 63.6%. Learn more about melanoma survival rates.

Follow-Up Care for Stage 3 Melanoma

‍After achieving No Evidence of Disease (NED) following treatment for Stage III melanoma, you should conduct monthly self exams of your skin and lymph nodes and have an annual, full-body skin exam performed by a trained dermatologist for the rest of your life. You should also undergo a physical exam by your doctor every 3 to 6 months for the first 2 years, then every 3 to 12 months for the next 3 years, and then annually as needed. Imaging tests may be ordered every 3 to 12 months or as needed to monitor for recurrence.

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