Medium stage melanoma (Stage 2 and 3)

Stage 2 melanomas are thicker than 2mm or thicker than 1mm and ulcerated. Ulcerated means that the covering layer of skin is broken. Stage 2 melanomas are only in the skin and there is no sign that they have spread to nearby lymph nodes or any other part of the body.

Stage 3 melanoma means that the melanoma cells have spread into skin, lymph vessels, or lymph glands close to the melanoma.

Doctors describe stage 2 melanomas as having a 'moderate' or 'intermediate risk' of coming back or spreading after they have been removed. There is a possibility that your melanoma could come back in another part of your body. Stage 3 melanomas are described by doctors as having a higher risk of recurrence.

Stage 2 and 3 melanomas are more likely to spread to other parts of the body than stage 1 melanomas because the melanoma cells have grown deeper into the skin. So some melanoma cells may reach the blood vessels or lymph vessels just under the skin and may be carried to other parts of the body in the bloodstream or lymph fluid.

Your melanoma may also be at risk of coming back or spreading if you have

• A local recurrence of a primary melanoma - nodules of secondary melanoma have grown less than 5cm from your primary melanoma
• 'In transit' metastases - clusters of melanoma cells that have grown further than 5cm from the primary melanoma, but have not reached the nearest group of lymph nodes

Your first treatment is surgery to remove the melanoma. You may also need to have further surgery to remove more tissue if there are signs from the biopsy results that any melanoma cells could have been left behind.

This is a new technique being researched to help find out the stage of your melanoma. It is not a treatment, but is a type of test. The idea is to find out which is the first lymph node to drain tissue fluid from the area of the primary melanoma. This is the lymph node most likely to contain cancer cells from the primary melanoma, simply because they will reach that node first once they go into the lymphatic system.

Sentinel node biopsy is being tried because it may be a good way of finding out whether cancer cells have spread to lymph nodes close to the melanoma. In the past, surgeons sometimes removed all the lymph nodes close to the melanoma to see if they contained cancer cells but this can cause long term swelling (lymphoedema). With sentinel node biopsy, you won't need any further lymph node surgery if the sentinel node doesn't contain any cancer cells. If the node does contain cancer cells, you will have another operation to remove all the other nodes in the area in case they contain cancer cells too.

If any of your lymph nodes are found to contain melanoma cells, you have an operation to have them removed. This can be quite a big operation. The type of surgery you have will depend on where your primary melanoma was in your body. There are large groups of lymph nodes in the

• Neck
• Armpit
• Groin

So, for example, if you had a melanoma on your leg, the lymph nodes in the groin on the same side will be removed. If you had a melanoma on your scalp or head, the lymph nodes on the same side of your neck would be removed.

There are some side effects from this type of surgery. You are likely to be in some pain after the operation. This should get better as the area heals. But a few people (less than one in ten) have pain that continues after this time, particularly if the lymph nodes in the neck are removed.

Shoulder stiffness and pain are the most common problems after the lymph nodes under the arm have been taken out. You may find that you cannot move your arm as freely as you could before the surgery.

With lymph node dissection in the groin or armpit, swelling of the leg or arm on the same side is the most common problem after surgery. This is called lymphoedema. It can usually be controlled with a combination of exercise, massage, and wearing an elastic stocking on the affected arm or leg.

Treatment that is done after surgery for cancer to try to prevent it coming back is called adjuvant treatment. There is no strong research evidence at the moment to show that any adjuvant treatment helps to stop melanoma from coming back or spreading. For this reason, you should only be offered adjuvant treatment within a clinical trial. You may be asked to join a trial if your lymph nodes contained cancer cells.

As adjuvant treatment for melanoma, you may have

• Chemotherapy
• Biological therapy

There is information in CancerHelp UK about all these types of adjuvant treatment. Unfortunately, very little is known about which is the best adjuvant treatment for melanoma. Doctors do not yet really know whether the adjuvant treatment will help to prevent your melanoma from coming back. Clinical trials are going on all the time to try to find out the best treatment approach. We have included what is known about each type of adjuvant treatment in this section of CancerHelp UK.