Skin Cancer Diagnosis and Staging

The types of biopsies offered at Scripps include:

Skin biopsy

A biopsy is the only way to confirm skin cancer. During a biopsy, the doctor removes a small tissue sample from the skin to be examined under a microscope. Scripps uses various types of skin biopsy procedures.

Shave (tangential) biopsy

The doctor shaves off the top layers of the skin with a small surgical blade.

Punch biopsy

A punch biopsy uses a tool to remove a deeper sample of tissue from the suspicious area.

Incisional or excisional biopsy

An incisional biopsy removes part of a tumor that may have grown into the deeper layers of the skin. An excisional biopsy removes the entire tumor.

Fine-needle aspiration (FNA) lymph node biopsy

Using a syringe with a thin, hollow needle, the doctor suctions (aspirates) very small pieces of the affected area.

Lymph node biopsy

If your doctor believes skin cancer has spread beyond the skin to the lymph nodes, a sample of the lymph nodes may be removed and examined for signs of cancer.

The doctor examines the skin through a magnified device.

Imaging tests may be done to determine if skin cancer has spread to other parts of the body, most commonly with thicker melanoma and unusual skin cancer categories. These tests can include computed tomography (CT) scan, magnetic resonance imaging (MRI) or positron emission tomography (PET) scan.

Basal cell and squamous cell cancers stages are partly determined by the presence of high-risk features, which include:

• Thicker than 2 mm
• Spread into the lower layers of the skin
• Spread into the tiny nerves in the skin
• Located on the ear or lip

Stage 0

Also called carcinoma in situ, stage 0 cancer is found only in the upper layer of the skin (epidermis) and has not spread deeper to the dermis.

Stage I

Stage I skin cancer is less than 2 cm across, has not spread to nearby lymph nodes or organs, and has one or fewer high-risk features.

Stage II

Stage II skin cancer is either of the following:

• Larger than 2 cm across, and has not spread to nearby organs or lymph nodes
• Any size with 2 or more high-risk features

Stage III

Stage III skin cancer has spread into facial bones or one nearby lymph node, but not to other organs.

Stage IV

Stage IV skin cancer can be any size and has spread to one or more lymph nodes that are larger than 3 cm, and may have spread to bones or other organs.

Melanoma skin cancer staging includes:

• The mitotic rate, which measures how fast cancer cells are dividing and growing
• Ulceration, which indicates if the layer of skin covering the tumor is broken (ulcerated)

Stage 0

Stage 0 melanoma is also known as melanoma in situ. This is when melanoma is only in the epidermis and has not spread to deeper skin layers.

Stage I

Stage I melanoma cancer has two substages:

Stage IA is when melanoma is less than 1.0 mm thick. It is not ulcerated and has a mitotic rate of less than 1/mm2. It has not been found in lymph nodes or distant organs.

Stage IB is when melanoma is either:

• Less than 1.0 mm thick and is ulcerated or has a mitotic rate of at least 1/mm2, or
• Between 1.01 and 2.0 mm and is not ulcerated, and has not been found in lymph nodes or distant organs

Stage II 

Stage II melanoma cancer has three substages:

Stage IIA is when melanoma has not been found in lymph nodes or distant organs, and is either:

• Between 1.01 mm and 2.0 mm thick and is ulcerated, or
• Between 2.01 and 4.0 mm thick and is not ulcerated

Stage IIB is when melanoma has not been found in lymph nodes or distant organs, and is either:

• Between 2.01 mm and 4.0 mm thick and is ulcerated, or
• Is thicker than 4.0 mm and is not ulcerated

Stage IIC: Melanoma has not been found in lymph nodes or distant organs, and is thicker than 4.0 mm

Stage III 

Stage III melanoma cancer has three substages:

Stage IIIA is when melanoma is any thickness, but is not ulcerated. It has spread to one to three lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when viewed under the microscope. There is no distant spread.

Stage IIIB is when melanoma has not spread to distant organs, and is one of the following:

• Any thickness and is ulcerated. It has spread to one to three lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when they are viewed under the microscope.
• Any thickness, but is not ulcerated. It has spread to one to three lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma.
• Any thickness, but is not ulcerated. It has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma.

Stage IIIC is when melanoma is any thickness, has not spread to distant organs, and is one of the following:

• Ulcerated and has spread to one to three lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma.
• Ulcerated and has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma.
• May or may not be ulcerated. It has spread to 4 or more nearby lymph nodes, or to nearby lymph nodes that are clumped together, or to nearby skin or lymphatic channels (around the original tumor) and to nearby lymph nodes. The nodes are enlarged because of the melanoma.

Stage IV

Melanoma has spread beyond the original area of skin and nearby lymph nodes to other organs, such as the lung, liver or brain, or to distant areas of the skin, subcutaneous tissue or distant lymph nodes.