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Patients in this stage have melanoma in situ or lentigo maligna; the melanoma cells have not penetrated beyond the epidermis (the first layer of the skin).
Patients with stage 0 melanoma have excellent prognosis. There is virtually zero risk for metastatic spread. Although the 8th edition of the AJCC system published in 2018 did not specifically list the overall survival rate for patient with stage 0 melanoma, the 5-year survival is almost 100%.
Adopted from NCCN Guideline 2022
The treatment plan is relatively straightforward: remove the melanoma with a standard surgical margin of 0.5-1cm.
“Standard surgical margin” refers to the amount of normal surrounding skin tissue that needs to be removed.
Routine imaging (e.g., X-ray or CT scan) or lab tests are not recommended.
There are also times when surgery is not a suitable option, specifically for a type of melanoma in situ known as the lentigo malign.
In some cases, lentigo maligna is too large to be completely removed. Also, in some cases, after the initial surgery, the pathology report shows that the tumor has not been completely removed. Lastly, there are clinical scenarios where the patients are not in good health to proceed with surgery.
In those cases, a topical drug, Imiquimod (Aldara), activates the body's immune system to attack the cancer cells. Although the drug is not approved by the FDA, studies have shown high rates of melanoma clearance and low recurrence rates.
Aside from Imiquimod, radiation treatment is another viable option.