Stage I melanoma is the thinnest form of the disease with no spread to other parts of the body including the lymph nodes. Stage I melanoma can be further subdivided into stage IA and stage IB.

Stage IA means all of the following:

  • the melanoma is less than 0.8mm thick
  • the covering layer of skin over the tumour is not broken (it is not ulcerated)

Stage IB can be categorised as either:

  • the melanoma is less than 0.8mm thick and the skin is broken (ulcerated)

Or

  • the melanoma is between 0.8mm and 2mm (without ulceration)

The diagnosis will be made following analysis of the original biopsy and therefore, although the doctor may suspect melanoma when the biopsy is performed, you won’t know for sure until the biopsy has been tested. This commonly takes two weeks. If the results confirm that it is melanoma, you will have a second operation to remove a wider area of skin (wide local excision). This will usually be between 1cm and 2cm around where the melanoma was situated.

Your case will be discussed by a Local Skin Cancer Multi-Disciplinary Team (MDT), which includes a dermatologist (skin doctor), a plastic surgeon, an oncologist (cancer doctor), a specialist nurse, a pathologist (who reviews the biopsy) and a radiologist (x-ray/scan doctor) and possibly some other types of support staff.

After the removal of a stage IA melanoma you should have an initial follow-up appointment, where you will be shown what to look out for in future and to address any questions or concerns that you may have. You will also have further appointments for the doctors to examine you.

If your doctor thinks you have a stage IB tumour, you may be offered a sentinel lymph node biopsy. If this is ‘negative’ your melanoma will be now be considered as stage IA which has a better prognosis.  If your sentinel lymph node biopsy is positive, your melanoma will be considered stage III and you would be eligible for adjuvant treatment. These treatments will be discussed with you by an oncologist.

If you don’t have a sentinel lymph node biopsy, your stage IB melanoma will usually be seen every three months for three years and then every six months for another five years.

Stage I melanoma treatment is straightforward and usually involves removal of the skin around the melanoma to fully remove it. The type of surgery is usually one involving a direct closure with a linear or straight line scar. At sensitive sites, such as the face or hands, different options for reconstruction would be explained to you in order to enable you to complete the required treatment that suits your individual needs. For example, a local flap (nearby spare skin in moved around) or skin graft (a shaving of skin or a piece of skin is used as a dressing) may be a better option in some sites.

If your melanoma was diagnosed at stage I you are unlikely to have further recurrence of your disease and almost everyone is cured by their surgery, provided you have had sufficient tissue from around the melanoma removed.

The following information should be used as part of a discussion with your medical team about the most appropriate treatment for your melanoma. Patients should also be aware that they may not be suitable for all the diagnostic interventions and treatments outlined below.

Values you may wish to consider during treatment

  • Are there any factors apart from curing your melanoma that you would like to take into account when receiving treatment?
  • Do you want the treatment that is most likely to leave your daily life unaffected?
  • How much do you want to avoid having a visible scar after treatment?
  • How important is it to you to maintain living an active lifestyle, taking into account your daily activities and hobbies?
  • Are there any aspects of the appearance of the scar or the function of that area that are very important to you or that will have a particular impact on you?
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