Cancer has a language all of its own. Figuring out what some of those words mean can be a daunting task, especially when you or a loved one is dealing with a melanoma diagnosis. Our glossary can help you better understand complex skin cancer terms.
Adjuvant cancer therapy is a secondary or additional cancer treatment designed to lower the risk of cancer returning after surgery. For skin cancer, adjuvant cancer therapy, such as immunotherapy with interferon, chemotherapy or radiation, may follow a primary treatment such as surgery. Doctors often recommend adjuvant cancer therapy for those who have stage III or stage IV cancer.
This gene can mutate, or change, producing a mutated BRAF protein that leads to uncontrolled cancer cell growth. More than half of melanoma cases are linked to mutations in the BRAF gene. The so-called V600E mutation is quite common in these cases.
These medications can inhibit the effects of mutated BRAF proteins and slow down cancer growth even leading to tumor shrinkage in some patients.
This gene typically suppresses tumor growth. When it mutates, cancer cells can grow uncontrollably. Families with lengthy histories of melanoma may carry this gene mutation. CDKN2A stands for cyclin-dependent kinase inhibitor 2A.
This systemic treatment uses drugs to stop the growth of cancer cells, either by destroying them or preventing them from dividing. Patients can receive chemotherapy in oral pill form or intravenously.
This stage of research involving patients follows the completion of laboratory and animal studies. The goal is to determine if a medical treatment, device, or strategy is safe and effective for people to use. Researchers explore whether a treatment leads to improvements in outcome, no benefit, or potential harm.
This treatment involves combining two or more treatments, such as two immunotherapy agents or two targeted therapy drugs, for more effective results.
This protein helps melanoma cells flourish by suppressing the immune system’s response to them. Immunotherapy can target this protein.
Researchers conducting clinical trials use this measurement to gauge whether a tumor is responding to treatment. It includes the length of time (usually in months) that a tumor or cancerous area shows improvement as a result of treatment.
This refers to the study of the body’s immune system. The immune system defends the body against viruses, bacteria and infections.
This cancer therapy uses immunity-boosting treatments to stimulate the body’s immune system to fight cancer cells. Immunotherapy most commonly uses drugs that target PD-1 or CTLA-4. It is also a term that describes other approaches that activate the immune system differently. Learn more about Immunotherapy.
Melanoma that spreads through small lymphatic channels, the vessels of the immune system, and starts to grow more than 2 centimeters from the primary melanoma tumor.
The proteins made by both the MEK gene and BRAF gene act on the same signaling pathway inside cells. Cancer cells send signals through BRAF and MEK allowing them to grow and spread. In combination therapy, MEK-inhibiting drugs may be combined with BRAF inhibitors to slow cancer growth or shrink tumors in some patients.
Stage IV melanoma that has spread from the original lesion to distant sites in the skin, lymph nodes, brain, or organs such as the liver or lungs.
This statistic refers to the percentage of people who survive a certain type of cancer for a specified amount of time following their initial diagnosis. An overall survival rate typically refers to a period of five or 10 years.
A protein found on the surface of immune system T cells and other white blood cells. It is used to signal the cells to shut down so that the immune system doesn’t get overstimulated. Cancer cells can activate this PD-1 signal and prematurely shut down T cells. This interferes with the immune system’s ability to detect and destroy cancer cells.
A protein found on the surface of cancer cells that helps them evade detection and destruction by the immune system. PD-L1 interacts with PD-1 to turn off the immune system inappropriately. It is sometimes also called CD274.
During this phase, researchers conduct first-time testing of a new drug or treatment. The goal is to determine safe dosage amounts, check for safety, identify side effects and evaluate early evidence of efficacy.
Phase II expands the drug or treatment testing to a larger group of people often at the dose (or doses) that appear most promising from Phase I trial results. The goal is to continue monitoring for safety, side effects and evidence of efficacy.
This phase expands the drug or treatment testing to hundreds, sometimes thousands, of people. Some patients receive the new, or experimental, treatment alone or in combination with the standard therapy. Other patients may get the standard therapy by itself. The goal is to provide data on efficacy, safety and side effects. The information from Phase III studies is often required to gain regulatory approval from groups like the U.S. Food and Drug Administration (FDA) or the European Medicines Agency (EMA).
After a drug or treatment receives approval for use in the general population, researchers continue to gather information on the drug’s effects including any side effects associated with long-term use.
This treatment uses energy rays, such as X-rays, to destroy cancer cells. Doctors usually use radiation to treat melanoma in patients for whom surgery is a high risk or not possible.
This refers to the percentage of patients whose melanoma tumor decreases in size or becomes undetectable in response to treatment.
Abnormal cells found in the topmost layer of skin. These cells have the potential to become cancerous and spread. Stage 0 also is known as melanoma in situ.
This refers to cancers that are not more than 2 millimeters thick, are not ulcerated and that haven’t spread.
This refers to cancers that are between 2 and 4 millimeters thick. They may be ulcerated, but haven’t spread.
The cancer is of any thickness and has spread from its primary location to the lymph nodes with no detectable evidence of distant spread.
The cancer has spread from its primary location to one or more distant sites which could be in the skin, lymph nodes, lung, brain or other organs.
This primary melanoma treatment involves cutting and removing a cancerous area. Wide local excision can often cure early-stage melanoma.
Treatment in which medications travel through the bloodstream to all parts of the body to fight cancers that have spread from their original location. The majority of targeted and immunotherapies are systemic.
A type of drug therapy that aims to shut down abnormal molecules within cancer tumor cells that signal those cells to divide uncontrollably. For instance, BRAF- and MEK-inhibitors target melanomas with specific gene mutations. Learn more about Targeted Therapy
A type of white blood cell that bolsters immune function and helps the body fight cancer cells. T cells get their name from the thymus gland, the small organ that makes them.
Melanomas that have grown through the epidermis, or the outermost layer of skin giving the tumor the appearance of an ulcer.
This term describes genes that have no mutation and are normal. For example, some people have melanoma with mutations in BRAF, while others have so-called wild type BRAF melanoma, meaning there’s no known mutation present.
Melanoma staging is based on the American Joint Committee on Cancer (AJCC) staging system that uses three key pieces of information for assigning Tumor-Node-Metastasis (TNM) classifications. The “Tumor” designation defines the size of the tumor. The “Node” designation defines lymph node involvement, if any, and the “Metastasis” designation defines whether the melanoma has spread to other parts of the body. When designated with a lowercase “c” (example: cT1), the assessment was done after a biopsy and is called clinical staging. When designated with a lowercase “p” (example: pN1), the assessment was done after surgery and is called pathologic staging.
Not normal. An atypical lesion can be non-cancerous (benign), likely to become cancer (precancerous), or cancer (malignant).
The removal of a sample of cells or tissues from a lesion for assessment by a pathologist.
Measures how deep a melanoma is. Used in staging the melanoma. Maximum tumor (Breslow) thickness is measured from the top of the granular layer of the overlying epidermis or base of a superficial ulceration to the deepest malignant cells invading the dermis layer of the skin to the nearest 0.1 mm. Also called Breslow depth.
These tests look at all the genes in a cancer tumor — called the genome — to see if there are mutations that have accumulated over time.
Other names for broad molecular profiling include:
- Next-generation sequencing
- Comprehensive genomic profiling
- Molecular profiling
Broad molecular profiling is different from genomic testing because it looks at the entire genome of the cancer. Genomic tests only look at a particular set of genes that affect how likely the cancer is to come back.
A scale of how deep the tumor is in your skin. Although the use of the Clark Level has been replaced with a newer system of staging, Clark levels may still show up on your pathology report. A Clark Level test will indicate the results on a scale of one to five using Roman numerals: I, II, III, IV, V, with V being the deepest.
Computed tomography (also called CAT scan) uses X-rays to take pictures of the inside of the body.
Margins are the edge of a biopsy or surgical excision specimen. The deep margin is at the bottom of the specimen. If melanoma extends to the edge of the deep margins, it may not have been completely removed. The presence or absence of tumor cells at the biopsy margin also indicates whether the entire lesion was available for analysis and provides guidance for further management of the lesion.
A measure of how fast cancer cells are dividing and growing. This is found by counting the number of dividing cells in the tissue and is reported as the number of mitotic cells per square millimeter (mm2) of tissue. This test helps to stage the melanoma. Generally, a lower mitotic rate is linked to a higher survival rate.
A pathologist that specializes in examining skin pathology.
Border of tumors.
Outermost layer of skin.
Surgical removal of tissue from the body. This primary melanoma treatment involves cutting and removing a cancerous area. Typically, a rim of normal tissue around the suspicious area is also removed. Wide local excision can often cure early-stage melanoma.
Genetic testing uses a blood or saliva sample to look for changes in genes (called mutations) that increase the risk of cancer. These mutations are present in all cells of a person’s body including egg and sperm cells, and thus can be inherited (passed down from parent to a child). Genetic testing is sometimes done for people with a personal or family history of melanoma.
Distinct from genetic testing, genomic testing looks at genes or sets of genes for changes that are present only in the tumor cells and not the person’s entire body. These tumor-specific changes are not passed down from a parent to a child. Because the results of genomic testing provide information about the tumor, they can guide treatment decisions.
Gross description or gross examination is a general inspection of and assessment of the tissue specimen with the naked eye. The gross description is recorded by the pathologist after the excision. The sample will be described using size, color, weight, etc.
Two types of growth, radial and vertical, are typically assessed in cutaneous melanoma. In the radial growth phase, melanoma cells grow sideways; tumor cells may have invaded the dermis. The vertical growth phase, which is reported as present or absent, is when the melanoma cells have invaded and begun to extend and grow into the dermis layer of the skin.
In its original place. For a cancer that is considered in situ, abnormal cells are found only in the place where they first formed and have not spread.
An area of abnormal tissue that may be benign (not cancer) or malignant (cancer).
Clear fluid that travels through a system of nodes and vessels called the lymphatic system that helps get rid of waste. Cancer cells can travel through the lymphatic system to spread from one place in the body to very far locations.
A structure of the lymphatic system that filters lymph in the body to eliminate bacteria, viruses, cancer cells, and other unwanted substances. When lymph nodes are removed, the pathologist will look to see if they contain cancer cells. If so, there is a higher risk that the cancer has spread to other places in the body, and the pathology report will say positive and state how many lymph nodes were positive. If there are no cancer cells in the lymph nodes, the report will say negative or benign.
White blood cells that are part of the immune system. Lymphocytes work to defend the body against bacteria, viruses, and cancer cells. Lymphocytes present in a melanoma are described as brisk, non-brisk, sparse, and absent. Brisk is associated with a better prognosis. However, this is controversial, and not all pathology reports show it.
The presence of tumor cells in blood vessels or lymphatic vessels. Melanoma that has spread from the primary tumor site to the nearby lymph nodes is a melanoma at a higher stage. Vascular invasion means cancer cells are present in the blood vessels. Lymphatic invasion means cancer cells are present in the lymph channels. Lymphatic and vascular invasion are typically grouped together in the pathology report and called lymphovascular invasion. Options are present or absent.
Malignant cells grow in an uncontrolled manner, can invade nearby tissues, and can spread to other places in the body.
Skin cancer.
Cells in the skin and eyes that contain a pigment called melanin.
Melanoma that started somewhere else on the skin, detached from the original location, and spread within the skin tissue to the current site.
Small groups of tumor cells beyond the primary tumor found in the biopsy specimen. The presence or absence of microscopic satellites in the biopsy specimen must be reported for accurate staging.
Cell division in which one cell divides into two identical cells.
Magnetic resonance imaging (MRI) uses magnets and radio waves rather than X-rays to take pictures of the inside of the body.
An abnormal mass that occurs when cells divide more than they should or fail to die when they should. Neoplasms can be cancerous (malignant) or non-cancerous (benign). Also called a tumor.
A growth that can be cancerous (malignant) or non-cancerous (benign).
The thin top layer of the dermis (the inner layer of the skin), which contains connective tissue and blood vessels that nourish the epidermis (the outer layer of the skin) and that help control the temperature of the skin.
A doctor who specializes in examining cells and tissues with a microscope and interpreting those results to determine potential diseases.
PD-L1 is a protein found on the surface of cancer cells that helps them evade detection and destruction by the immune system. PD-L1 interacts with PD-1 to turn off the immune system inappropriately. Testing the melanoma tumor for PD-L1 can help determine eligibility for immunotherapy.
When tumor cells have extended into the nerve endings or neural structures in the vicinity of the tumor. Also called neurotropism, perineural invasion is reported as present or absent.
The side edge or border of the cancer removed during surgery. The pathologist reports the margin as negative or clean or uninvolved when no cancer cells are present at the edge of the tumor, suggesting that all of the cancer was removed. The margin will be reported as positive or involved when cancer cells are present at the edge of the tumor, suggesting that not all of the cancer was removed.
A positron emission tomography (PET) scan uses a radioactive tracer to find cancer in the body. It is often combined with a CT scan.
Variation in the size and shape of the nucleus of cells. Nuclear pleomorphism describes how different the nuclei of cancer cells are from that of non-cancerous cells.
The likely outcome of a disease, including the chance of recovery or recurrence.
An increased number of nucleoli and prominent nucleoli are seen in some cancers. Their presence is a negative (not favorable) prognostic factor.
The rim of non-cancerous tissue around a tumor that was surgically removed.
The thick bottom layer of the dermis (the inner layer of the skin) that contains blood vessels, connective tissue, hair follicles, oil glands, sweat glands, and other structures.
Also called local metastasis, these are small areas of melanoma located between 0.05 mm and 2 cm from the primary melanoma. Options are present or absent. Macroscopic satellite lesions can be seen with the naked eye, whereas smaller, microscopic satellite lesions can only be seen by a pathologist. If present, macroscopic and/or microscopic satellite lesions will be indicated in the pathology report.
Areas of dividing cells near the main tumor.
Tissue sample that was removed and studied for the presence of cancer.
If you had treatment before surgery to remove the cancer (called neoadjuvant treatment), treatment effect will be reported and may include:
Tumor bed size: The size of the cancer found during surgery.
Tumor bed cellularity: The percentage of cells that are cancerous in the area of the tumor. If no cancer is seen after neoadjuvant treatment, the pathology report will state “no residual carcinoma”.
TILs are lymphocytes (white blood cells of the immune system) in a melanoma. The options for TILs in a pathology report are present or absent. If present, options are brisk, non-brisk, or sparse. The presence of TILs is generally a favorable sign, as this indicates that the immune system has recognized and is trying to attack the cancer. Given the advent of new drugs that stimulate the immune system to treat cancer, experts have begun exploring numerical TIL scoring systems.
Refers to dead cancer cells in the specimen. The presence of tumor necrosis suggests that the cancer is more aggressive.
An area of tissue where it appears there had been melanoma cells, but they were destroyed by the immune system and replaced with inflammation or scar tissue. Regression is described as present or absent. If it is present, the extent of regression is noted.
When the top layer of the skin (epidermis) has been broken down or lost. This is measured by viewing the sample through a microscope. Ulcerated melanomas have grown through the epidermis or the outermost layer of skin, giving the tumor the appearance of an ulcer. This result will typically be yes/present or no/absent.
