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  • Staging and prognosis of melanoma

    Contents

    Staging

    The test results will help your doctors assign a stage to describe the melanoma. You may also have some other diagnostic tests, including blood tests and imaging tests (ultrasound, CT scan or PET scan), to work out whether the melanoma has spread from the primary site to other parts of the body. Staging the melanoma helps your health care team recommend the most appropriate treatment for you.

    Gene mutation testing

    If the melanoma has spread (stage III or IV), further tests can help work out whether you have a particular gene change (mutation) that may be causing the cancer cells to multiply and grow. These genetic mutations are due to changes in cancer cells – they are not the same thing as genes passed through families.

    Approximately 40% of people with melanoma have a mutation in the BRAF gene and approximately 15% have a mutation in the NRAS gene. C-KIT is a rare mutation affecting less than 4% of people.

    Genetic tests can be done on the sample removed during surgery. The test results will help doctors decide whether you are offered immunotherapy or targeted therapy.

    Prognosis

    Prognosis means the predicted outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Instead, your doctor can discuss any concerns you have.

    Melanoma can be treated most effectively in its early stages when it is still confined to the top layer of the skin (epidermis). The deeper a melanoma penetrates into the lower layer of the skin (dermis), the greater the risk that it could spread to nearby lymph nodes or other organs. In recent years, clinical trials have led to new treatments that continue to improve the prognosis for people with melanoma that has spread from the primary site (advanced melanoma).

    Which health professionals will I see?

    Your GP will probably arrange the first tests to assess your symptoms. If these tests confirm melanoma, you will usually be referred to a specialist, such as a dermatologist or surgeon. The specialist will arrange further tests. If melanoma is diagnosed, the specialist will consider treatment options. These options may be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting.

    During and after treatment, you may also see a range of health professionals who specialise in different aspects of your care, especially if you have a melanoma with a Breslow thickness greater than 1 mm, or if the melanoma has spread.

    Melanoma units

    Some people, particularly if they have a deeper, invasive melanoma, are treated in specialist melanoma units located at hospitals in major cities around Australia.

    If you are referred to a multidisciplinary melanoma unit by your GP, you will be able to talk to one or more medical specialists who will answer your questions, and recommend the most suitable treatment. The best treatment pathway will depend on the test results.

    To find a specialist melanoma unit near you, ask your doctor, call Cancer Council 13 11 20 or visit Melanoma Patients Australia.

    This website page was last reviewed and updated November 2019.

    Information reviewed by: : A/Prof Victoria Atkinson, Senior Staff Specialist, Princess Alexandra Hospital, Visiting Medical Oncologist, Greenslopes Private Hospital, and The University of Queensland Clinical School of Medicine, QLD; Adjunct Prof John Kelly AM, Consultant Dermatologist, Victorian Melanoma Service, and Department of Medicine at Alfred Health, Monash University, VIC; Dr Alex Chamberlain, Dermatologist, Glenferrie Dermatology, Victorian Melanoma Service and Monash Univeristy, VIC; Alison Button-Sloan, Melanoma Patients Australia; Peter Cagney, Consumer; Prof Brendon J Coventry, Associate Professor of Surgery, The University of Adelaide, Surgical Oncologist, Royal Adelaide Hospital, and Research Director, Australian Melanoma Research Foundation, SA; Dr David Gyorki, Consultant Surgical Oncologist, Peter MacCallum Cancer Centre, VIC; Liz King, Skin Cancer Prevention Manager, Cancer Council NSW; Shannon Jones, SunSmart Health Professionals Coordinator, Cancer Council Victoria; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Richard Scolyer, Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Co-Medical Director, Melanoma Institute Australia and Clinical Professor, The University of Sydney, NSW; Heather Walker, Chair, Cancer Council National Skin Cancer Committee, Cancer Council Australia.

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