Melanoma Treatment by Stage: A Comprehensive Overview

Melanoma staging (0–IV) guides treatment decisions. Higher stages indicate deeper invasion and/or spread to lymph nodes or distant sites.

Stage-Based Treatment Overview

• Stage 0 (in situ): Confined to the epidermis. Treated with wide local excision (0.5–1 cm margins).
• Stage I: Invasive but ≤2 mm thick, no ulceration. Wide excision (1 cm margins); sentinel lymph node biopsy (SLNB) considered for tumors ≥0.8 mm or with ulceration.
• Stage II: >2 mm thick or ulcerated, no nodal spread. Wide excision (2 cm margins); SLNB recommended; adjuvant therapy considered for high-risk features.
• Stage III: Regional lymph node involvement. Complete lymph node dissection (or observation for micrometastases); adjuvant immunotherapy (checkpoint inhibitors) or targeted therapy (BRAF/MEK inhibitors if mutation-positive).
• Stage IV: Distant metastasis. Systemic therapy: immunotherapy, targeted therapy, clinical trials; surgery/radiation for oligometastatic disease or palliation.

Treatment Modalities

• Surgery: Primary for localized disease; palliative for metastatic.
• Radiation: Adjuvant for high-risk nodal disease; palliative for brain/bone metastases.
• Immunotherapy: Anti-PD-1 (pembrolizumab, nivolumab), anti-CTLA-4 (ipilimumab); first-line for advanced disease.
• Targeted Therapy: BRAF + MEK inhibitors for BRAF V600-mutant melanoma.
• Palliative Care: Symptom management and quality of life focus for advanced disease.

Multidisciplinary teams (dermatology, surgical oncology, medical oncology, radiation oncology) optimize care. Regular surveillance is critical for all stages.