Staging is a critical element in treatment planning following surgical excision and should be clearly documented in the patient’s medical record.

Initial melanoma staging occurs with the complete excision of the primary lesion. Most melanomas (thickness < 0.8 mm with adequate margins) do not require further investigation.

Sentinel lymph node biopsy should be considered for patients with melanoma greater than 1 mm thickness and for patients with melanoma greater than 0.75 mm and other high-risk features such as ulceration, to provide optimal staging and prognostic information. If metastatic melanoma is detected, management of the regional lymph nodes region should be discussed. The options are observation with clinical and ultrasound review or completion lymph node dissection (CLND). CLND does not offer any survival benefit over close observation. A subset of patients who have metastatic melanoma detected in the sentinel nodes are likely to be referred to a medical oncologist to discuss the role of adjuvant systemic therapy. Sentinel node biopsy should be performed by a surgeon experienced in the procedure.

Node negative melanoma does not require imaging staging investigations.

If a patient has a positive sentinel lymph node biopsy or has had a primary melanoma and has palpable regional lymph nodes, further staging imaging and referral to a surgeon is required. Images are likely to be a CT scan or a PET-CT scan.

Evidence to suggest metastatic disease, where there has been a previous primary melanoma, or at the time of the diagnosis of a primary melanoma, specialist referral for further investigation may be required.

Visit the Cancer Institute New South Wales website for information about understanding the stages of cancer.