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Stage 1 Melanoma

You might hear your doctor or nurse say that you have “Stage 1” melanoma. This will mean that you have been diagnosed quite early, hence the number 1 being referred to.

Your melanoma is likely to be quite thin, less than 2mm Breslow thickness (the distance the melanoma grows vertically from the epidermis, the outermost layer of the skin) but might have broken the surface of the skin (you might hear “ulcerated” being used). At this point it is unlikely that the melanoma has grown deep enough into the skin to spread elsewhere. The risk of spread is related to the thickness of the melanoma, and whether it has other significant features such as ulceration.

Early stage melanoma is usually diagnosed by the removal of an unusual or abnormal mole and a small section of surrounding skin (2mm) where the lesion occurs. The tissue will be referred to the laboratory to test for melanoma. If melanoma is confirmed you will require another operation and you will hear the term wide local excision used (WLE).

It is important to check ones lymph nodes for spread of melanoma if one has Stage Ib melanoma (1-2mm Breslow thickness). There are three ways to do this: clinical examination, ultrasound (with a fine needle aspirate if required) and sentinel lymph node biopsy (SLNB). SLNBis performed at the same time as WLE (see blog post) Your surgeon will discuss this with you – in brief it is a procedure where the lymph node (or nodes) that is most likely to harbour spread of melanoma (if that is to occur) is identified, removed and closely examined. If the node is negative, then clinical examination is all that one will need. If the node is positive, then you will be upstaged to Stage IIIa, and may need closer surveillance, and be considered for a clinical trial of adjuvant therapy. If there is melanoma in a lymph node at SLNB you may be offered ultrasound surveillance or a lymph node dissection.

Stage 1A

You may be told that you have a Stage 1a melanoma. This means that the tumour is no more than 1.0mm in thickness, it has no signs of ulceration and with a mitotic rate of less than 1mm. There will likely be no spread to lymph nodes and no evidence of metastasis to distant sites.

Stage 1B

If you are told you are stage 1B, this may mean that the melanoma is thin, but that the skin over it is broken (ulcerated): or it is between 1 and 2mm and is not broken. Melanoma in situ (Tis)
Following the surgery, if you are advised that you have an early melanoma that was in the top layer of skin (you might hear “in situ” used – which means it is in one place) you will be given further appointments to be followed up in clinic and advised to keep a close eye on your skin in the future.

Dermatological Surveillance and Prevention of Recurrence

You should be given information about what to keep a look out for: changes in moles, dark spots around the area, feel for enlarged glands close to where the original melanoma was discovered. If you notice any changes at all, you must contact your medical team immediately.
If you would like to discuss anything mentioned above in private, please get in touch today on 0808 171 2455 or email us

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