This page is general information, not medical advice. Your own doctor or care team is the right source for questions about your skin, diagnosis or treatment.
A stage III diagnosis can involve different patterns of nearby spread. The label does not mean that every person has the same lymph node findings, the same operation or the same treatment afterward. Understanding the pattern described in the records is part of understanding the care discussion.
This page explains the treatment categories agencies describe and the question studied in a node-surgery trial. Your care team can explain which, if any, apply to you. It provides no survival figures or estimate of anyone's outcome.
What nearby spread means
The National Cancer Institute's melanoma patient summary describes stage III using information about the skin tumor, nearby lymph nodes and small deposits of melanoma in nearby skin or lymphatic vessels. Lymph nodes are small immune-system structures that filter lymph fluid. This differs from a stage describing spread to distant organs.
Small nearby skin deposits may be called satellite or microsatellite tumors. Deposits along skin lymphatic pathways may be called in-transit metastases. These terms describe where melanoma cells are found relative to the primary tumor, the original melanoma. They are tissue and staging descriptions, rather than symptoms everyone with this stage notices.
The NCI stage subdivisions use combinations of tumor thickness, ulceration, and the extent and pattern of nearby spread. Ulceration is breakdown of the surface over the melanoma. A stage letter supplies detail within the overall group; its meaning belongs with the complete record.
Some node involvement is found only when a sentinel node is examined under a microscope. Other node involvement is identified through examination or imaging and confirmed with tissue testing. The page on sentinel lymph node biopsy explains the first draining node and how its result contributes to staging.
Surgery and lymph node discussions
The American Cancer Society's stage-based treatment guide describes wide excision, removal of the skin melanoma with surrounding tissue, in stage III care. It also describes removal of nearby skin deposits when that is possible. Your care team can explain which, if any, surgical categories apply to you.
A lymph node dissection removes a group of nodes. The Society discusses different node approaches depending on how melanoma was identified in the nodes and other clinical features. These include dissection or close assessment with examinations and imaging, such as ultrasound, in some circumstances after a positive sentinel-node result. Your care team can explain which, if any, apply to you.
Close observation is a clinical monitoring plan. It involves defined assessments, rather than an absence of care. The terms biopsy, dissection and observation therefore refer to different parts of a node discussion. A sentinel biopsy examines selected draining nodes; completion dissection removes additional nodes in that region.
What completion-dissection research examined
A randomized trial reported in the New England Journal of Medicine studied people with melanoma in a sentinel node. It compared immediate completion node dissection with node observation that included ultrasound. Immediate dissection improved disease control in the regional nodes but did not increase melanoma-specific survival in the analyzed population.
The trial also reported more lymphedema, swelling caused by disrupted lymph drainage, in the dissection group. The report cautioned about interpreting some secondary outcomes. Its findings concern the participants and the monitoring used in the study. They are not a prediction for a particular person or a recommendation about further node surgery.
This research asked what to do after melanoma had been found in a sentinel node. It did not compare having a skin biopsy with avoiding one, and it did not answer every question about stage III treatment. Different research questions can concern diagnosis, staging, local disease control or treatment throughout the body.
Treatment before or after surgery
The NCI summary and American Cancer Society guide describe immunotherapy and targeted therapy in stage III care. Immunotherapy works through the immune system. Targeted therapy concerns specific features of cancer cells, including relevant gene changes. These are broad treatment categories, not interchangeable labels. Your care team can explain which, if any, apply to you.
The Society discusses immune checkpoint inhibitors as a type of immunotherapy. It also describes targeted therapy for melanoma with changes in the BRAF gene. The gene finding is part of the treatment discussion; the stage label alone does not establish that finding. The actual tissue or molecular testing supplies the relevant information.
Treatment before surgery is called neoadjuvant treatment. Treatment afterward is called adjuvant treatment. These words describe where treatment sits in the plan. They do not mean that every stage III melanoma has both parts. The agencies' descriptions depend on whether disease can be removed surgically and on other findings.
The Society also discusses radiation therapy for some people after node surgery. The NCI describes radiation as a category using high-energy radiation directed at cancer. Its purpose differs from treatment categories that circulate more widely in the body. Your care team can explain which, if any, apply to you.
Research, follow-up and statistics
The NCI summary describes clinical trials as research studies of treatment questions. The page on how clinical trials work explains research phases, consent and costs. A study's purpose and eligibility requirements are separate from whether participation is relevant to an individual situation.
The NCI also describes follow-up tests during and after treatment. They may assess response or look for a change in the condition. The page on follow-up care after melanoma treatment explains the general role of records, skin checks and appointments.
The National Cancer Institute's SEER melanoma statistics page presents population information. It explains that group statistics cannot predict an individual's outcome and that responses to treatment vary. Your care team can discuss questions about outlook in the context of your actual findings, rather than treating a stage label or a group statistic as a personal forecast.