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Patient guides by stage

Pick your stage to see what it means, what usually happens next, and which questions to bring to your next visit.

Not sure of your stage? The stage appears on your pathology report or in your doctor's notes, often written as pT followed by a number, or as a Roman numeral. Your care team can tell you. How staging works
Stage 0

Melanoma in situ

The melanoma cells are confined to the epidermis, the thin top layer of the skin. They have not reached the deeper layer where blood and lymph vessels run, so they have no route to spread.1

Questions to ask

  • Were the margins on my biopsy clear?
  • How wide will the excision be, and what will the scar look like?
  • How often should I have a full skin exam from now on?
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What usually happens next

  • A wide local excision removes the biopsy site with a margin of normal skin, usually under local anesthesia.2
  • On the face, surgeons may use Mohs surgery or a staged excision to spare tissue. Imiquimod cream or radiation are options when surgery is not practical.2
  • No lymph node biopsy or scans are needed.

Read next

Melanoma in situ and lentigo maligna→Wide local excision→Wound care and scars→
Stage I and II

Melanoma confined to the skin

The melanoma has grown into the dermis but has not spread to lymph nodes. Thickness and ulceration separate the 2 stages. Stage I melanomas are thin: up to 1 millimeter, or up to 2 millimeters without ulceration. Stage II melanomas are thicker, or measure between 1 and 2 millimeters with ulceration.1 About 77% of melanomas are found while still localized.3

Questions to ask

  • What is my Breslow thickness, and was the tumor ulcerated?
  • Do you recommend a sentinel node biopsy for me? Why or why not?
  • If I am stage IIB or IIC, what are the benefits and risks of treatment after surgery?
  • What follow-up schedule do you recommend?
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What usually happens next

  • A wide local excision is the main treatment. Margin width depends on Breslow thickness.2
  • Doctors recommend a sentinel lymph node biopsy for melanomas thicker than 1 millimeter and discuss it for some thinner ones with higher-risk features.4
  • People with stage IIB or IIC melanoma may be offered a checkpoint inhibitor after surgery. Observation is also an accepted choice.2

Read next

Breslow depth, ulceration, and mitotic rate→Sentinel lymph node biopsy→Treatment after surgery→Follow-up after melanoma→
Stage III

Melanoma in lymph nodes or nearby skin

Melanoma cells have reached at least 1 nearby lymph node, or have formed small deposits in the skin or lymph channels near the original tumor.1 Stage III covers a wide range of risk. In the database behind the current staging system, 5-year melanoma-specific survival ran from 93% for stage IIIA to 32% for stage IIID.1

Questions to ask

  • Which sub-stage am I (IIIA, B, C, or D)?
  • Should treatment start before surgery in my case?
  • Has my tumor been tested for BRAF?
  • Which side effects should I call about the same day?
  • Is there a clinical trial I should consider?
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What usually happens next

  • When a node can be felt or seen on a scan, immunotherapy often starts before surgery, because trials show better results with that order.2
  • When the only finding is a positive sentinel node, most patients are followed with ultrasound instead of having all the nodes removed.4
  • After surgery, about a year of immunotherapy, or targeted therapy for tumors with a BRAF mutation, lowers the chance of recurrence.2
  • The tumor is tested for a BRAF mutation.

Read next

Immunotherapy before surgery→Lymph node surgery and lymphedema→Immunotherapy side effects→BRAF and MEK targeted therapy→
Stage IV

Melanoma that has spread to distant organs

Melanoma has traveled to distant skin, lymph nodes, or organs such as the lungs, liver, bones, or brain.1 Several drug classes can now control stage IV melanoma, and new ones continue to arrive.

Questions to ask

  • Which treatment do you recommend first, and what is the goal?
  • How and when will we know whether it is working?
  • Do I need a brain MRI?
  • Who do I call after hours?
  • Which clinical trials fit my situation?
Build a printable list

What usually happens next

  • Most people start with a checkpoint inhibitor, alone or in combination.2
  • Tumors with a BRAF mutation can also be treated with BRAF and MEK inhibitor pills, which often work fast.2
  • Surgery or focused radiation can treat a small number of metastases, including in the brain.2
  • Later options include TIL therapy (lifileucel), an injected virus therapy with nivolumab, and clinical trials.2
  • A palliative care team can manage symptoms alongside cancer treatment from the start.

Read next

Immunotherapy side effects→TIL therapy explained→Melanoma brain metastases→Clinical trials→Coping with a diagnosis→

References

  1. Gershenwald JE, Scolyer RA, Hess KR, and colleagues. Melanoma staging: evidence-based changes in the AJCC eighth edition cancer staging manual. CA: A Cancer Journal for Clinicians. 2017. https://doi.org/10.3322/caac.21409
  2. American Cancer Society. Treatment of melanoma skin cancer, by stage. Revised August 12, 2026. https://www.cancer.org/cancer/types/melanoma-skin-cancer/treating/by-stage.html
  3. National Cancer Institute, SEER Program. Cancer Stat Facts: melanoma of the skin. 2026. https://seer.cancer.gov/statfacts/html/melan.html
  4. Wong SL, Faries MB, Kennedy EB, and colleagues. Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: ASCO and SSO guideline update. Journal of Clinical Oncology. 2018. https://pubmed.ncbi.nlm.nih.gov/29232171/

Reviewed against these sources in September 2026. Figures change every year, and this page is updated when new estimates are released.

The information provided on this website is not intended to serve as a replacement for the advice, diagnosis, or treatment provided by a qualified medical professional. If you have any questions about a medical condition, you should never hesitate to consult with either your primary care physician or another qualified healthcare provider. You should never disregard the advice of a qualified medical professional or put off getting treatment because of something you have read on this website.
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