Skin Cancer Diagnosis and Staging

Expert diagnosis for skin cancer

A doctor closely examines an area of a patient's skin related to skin cancer diagnosis and staging at Scripps Cancer Center

Expert diagnosis for skin cancer

Most skin cancers begin as unusual spots or bumps that are visible to the naked eye. But the steps involved in diagnosing skin cancer vary. In some cases, a physician will remove suspicious areas without actually testing them for cancer, while other cases require further diagnostic testing and determining the type of skin cancer and how far it may have spread.


Scripps Cancer Center provides a full range of services to diagnose and prevent skin cancer.

How is skin cancer detected and diagnosed?

Skin cancer often has visible signs and symptoms in the early stages, such as new growths or spots on the skin, or changes in the appearance of a mole. To confirm the type of cancer, Scripps physicians may take a tissue sample for a biopsy.

Imaging and diagnostic testing

Should you or your doctor find an unusual growth or spot on your skin, Scripps physicians may use advanced imaging and lab tests to diagnose skin cancer. These may include a variety of biopsies, dermatoscopy and imaging tests.

Biopsy

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.

Dermatoscopy

The doctor examines the skin through a magnified device.

Imaging tests

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.

Skin cancer stages

Scripps oncologists use skin cancer stages to determine whether cancer has spread from the skin to other areas of the body. Staging may be important for developing a skin cancer prognosis and treatment plan.


Basal cell and squamous cell skin cancers are staged differently than melanomas. Because basal cell cancers are usually caught and treated early, staging may not be necessary.


Staging may be more important with squamous cell skin cancers, which may be more likely to spread, especially in people who have weakened immune systems.

Basal cell and squamous cell carcinoma stages

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 stages

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.

Understanding your diagnosis

After a skin cancer diagnosis, you may feel anxious, scared, depressed or overwhelmed. It can be helpful to learn as much as you can about your diagnosis and your options, so that you can make informed, confident decisions about the next steps to take.


Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:


  • Should I get a second opinion?
  • How do I find a specialist?
  • What is my cancer treatment plan?
  • Will I have to miss work/school?
  • What are the side effects of skin cancer treatment?
  • How successful is my treatment likely to be?
  • What costs will be covered by insurance?
  • Which costs will I be responsible for?


Your Scripps cancer team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.


Learn more about the many cancer patient resources available to you and your loved ones via Scripps.