Newly.diagnosed

It's never a good occasion to have to visit a 'newly diagnosed' page. But the shock of diagnosis can lead many patients scrambling to understand this disease. The links below contain information to help a newly diagnosed patient understand melanoma a little better, and hopefully give them material that they can discuss with their doctors.
Figure 1

Melanoma

Melanoma - A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites.


ArrowThere are 19 links on this page, so please scroll down.Arrow

newly.diagnosed

Common Areas.Of Confusion

Clark's Level and Stage - One of the most commonly confused concepts among the newly diagnosed

While learning as much as possible about your disease is important, it is also important not to confuse a pathologic descriptor of melanoma, "Clark's level," with "stage." Many patients will have a Clark level IV melanoma. This is not to be confused with stage IV, which has a poor prognosis and is defined by metastatic spread. In contrast, Clark level IV does not have any real bearing on stage at all, and is frequently present in even those lesions that are Stage I with excellent overall prognoses. (Emory Cancer Center). Clark's Level II / Stage II and Clark's Level III / Stage III are commonly confused as well.

What are the specific stages of melanoma?

Although the specific stage of melanoma will be discussed with each patient individually by his/her doctor, melanoma can be separated in simple terms by a few characteristics:

  • Most patients who have been diagnosed with melanoma from a biopsy of a mole or birthmark will have stage I or stage II disease
  • This is defined by melanoma that has not spread to the lymph nodes.
  • By definition, melanoma that has spread to the lymph nodes is at least stage III disease.
  • If melanoma has spread to internal organs or to other distant parts of the body it is classified as stage IV.

This is a simplification of the staging system for melanoma but is intended to provide patients with an overview of the way the doctors treating patients with melanoma break things down.



Clark's Level (NCCN website) Another system describes the thickness of a melanoma in relation to its penetration into the skin instead of actually measuring it. The Clark level of a melanoma uses a scale of I to V to describe thickness (with higher numbers indicating a deeper melanoma): (The Clark level Roman numerals should not be confused with the stage grouping Roman numerals.)

  • if the melanoma stays in the epidermis (Clark level I)
  • if the melanoma has begun to penetrate to the upper dermis (Clark level II)
  • if the melanoma involves most of the upper dermis (Clark level III)
  • if the melanoma has penetrated to the lower dermis (Clark level IV)
  • if the melanoma has penetrated very deeply, to the subcutis (Clark level V)

In the newest classification, the Breslow measurement of thickness has become more important than the Clark level of penetration as the first prognostic factor. This is because the thickness measurement is easier and depends less on the pathologist’s judgment. Sometimes, however, the Clark level tells us that a melanoma is more advanced than we may think it is from the Breslow measurement. Therefore, both systems are often used to help stage a melanoma. In either system, the melanoma has a worse prognosis if the pathologist says it is ulcerated (covering layer of epidermis is absent).