Melanoma staging: Difference between revisions

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/* Clark Level{{cite journal| author=Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D et al.| title=Model predicting survival in stage I melanoma based on tumor progression. | journal=J Natl Cancer Inst | year= 1989 | volume= 81 | issue=...
 
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__NOTOC__
__NOTOC__
{{CMG}}
{{Melanoma}}
{{Melanoma}}
{{CMG}} {{AE}}{{Sab}}{{SSK}}; {{YD}}


==Overview==
==Overview==
Staging of melanoma is essential to determine the prognosis. Staging is based on the 2010 AJCC TNM Classification and is divided into stage 0 or melanoma in situ, stage 1 or invasive melanoma with good prognosis, stage 2 or high risk melanoma, stage 3 or melanoma with regional lymph node metastasis, and stage 4 or melanoma with distant metastasis.
[[Cancer staging|Staging]] of melanoma is essential to determine the [[prognosis]]. [[Cancer staging|Staging]] is based on the eight edition [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]] melanoma [[TNM]] Classification.  


==Staging==
==Staging==
===2010 American Joint Committee on Cancer (AJC) TNM Definitions for Melanoma===
===Eight Edition American Joint Committee on Cancer (AJCC) Melanoma TNM Staging System===
====Primary Tumor (T)<ref name="pmid19917835">{{cite journal| author=Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR et al.| title=Final version of 2009 AJCC melanoma staging and classification. | journal=J Clin Oncol | year= 2009 | volume= 27 | issue= 36 | pages= 6199-206 | pmid=19917835 | doi=10.1200/JCO.2009.23.4799 | pmc=PMC2793035 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19917835  }} </ref>====
====Primary Tumor (T) Classification<ref name="pmid24061524">{{cite journal |vauthors=Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NM, Ellis DW |title=Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR) |journal=Am. J. Surg. Pathol. |volume=37 |issue=12 |pages=1797–814 |date=December 2013 |pmid=24061524 |pmc=3864181 |doi=10.1097/PAS.0b013e31829d7f35 |url=}}</ref><ref name="pmid27075324">{{cite journal |vauthors=Ge L, Vilain RE, Lo S, Aivazian K, Scolyer RA, Thompson JF |title=Breslow Thickness Measurements of Melanomas Around American Joint Committee on Cancer Staging Cut-Off Points: Imprecision and Terminal Digit Bias Have Important Implications for Staging and Patient Management |journal=Ann. Surg. Oncol. |volume=23 |issue=8 |pages=2658–63 |date=August 2016 |pmid=27075324 |doi=10.1245/s10434-016-5196-1 |url=}}</ref><ref name="pmid17938027">{{cite journal |vauthors=Patrick RJ, Corey S, Glass LF |title=The use of sequential serial sectioning of thin melanomas in determining maximum Breslow depth |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 Suppl |pages=S127–8 |date=November 2007 |pmid=17938027 |doi=10.1016/j.jaad.2006.02.007 |url=}}</ref><ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Thickness'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Thickness'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Ulceration status/mitoses'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Ulceration status'''}}
|-
|-
| TX||Primary tumor cannot be assessed||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |TX: Primary tumor thickness cannot be assessed (eg, diagnosis by curettage)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
|-
| T0||No evidence of primary tumor||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T0: No evidence of primary tumor (eg, unknown primary or completely regressed melanoma)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
|-
| Tis|| Melanoma in situ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tis (Melanoma in situ)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
|-
| T1b||≤ 1.0 mm||Ulcerated or ≥1 mitosis/mm2
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T1|| style="padding: 5px 5px; background: #F5F5F5;" |≤ 1.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" Unknown |or unspecified
|-
|-
| T2a||1.01 - 2.0 mm||No ulceration
| style="padding: 5px 5px; background: #DCDCDC; " |T1a|| style="padding: 5px 5px; background: #F5F5F5;" |< 0.8 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
|-
| T2b||1.01 - 2.0 mm||Ulcerated
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC; " |T1b|| style="padding: 5px 5px; background: #F5F5F5;" |< 0.8 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present 
|-
|-
| T3a||2.01 - 4.0 mm||No ulceration
| style="padding: 5px 5px; background: #F5F5F5;" |0.8 – 1.0 mm
| style="padding: 5px 5px; background: #F5F5F5;" |With or without [[Ulcer|ulceration]]
|-
|-
| T3b||2.01 - 4.0 mm||Ulcerated
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T2|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
|-
| T4a||> 4.0 mm||No ulceration
| style="padding: 5px 5px; background: #DCDCDC; " |T2a|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T2b|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T3|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0 – 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T3a|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0–4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T3b|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0–4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T4|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T4a|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T4b|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
|-
| T4b||> 4.0 mm||Ulcerated
|}
|}


====Regional Lymph Nodes (N)<ref name="pmid19917835">{{cite journal| author=Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR et al.| title=Final version of 2009 AJCC melanoma staging and classification. | journal=J Clin Oncol | year= 2009 | volume= 27 | issue= 36 | pages= 6199-206 | pmid=19917835 | doi=10.1200/JCO.2009.23.4799 | pmc=PMC2793035 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19917835  }} </ref>====
====Regional Lymph Nodes (N) Classification<ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Number of Nodes'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Number of Nodes'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Nodal Mass'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Presence of In-Transit, Satelite, and/or microsatellite Metastases'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |NX|| style="padding: 5px 5px; background: #F5F5F5;" |Regional [[Lymph node|nodes]] not assessed (eg, [[Sentinel lymph node|sentinel lymph node [SLN]]] [[biopsy]] not performed, regional [[Lymph node|nodes]] previously removed for another reason); Exception: [[Pathology|pathological]] N category is not required for T1 melanomas, use clinical N information|| style="padding: 5px 5px; background: #F5F5F5;" align="center" | No
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N0|| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[Metastasis|metastases]] detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N1|| style="padding: 5px 5px; background: #F5F5F5;" |One [[tumor]]-involved [[Lymph node|node]] or any number of in-transit, satellite, and/or microsatellite [[Metastasis|metastases]] with no [[tumor]]-involved [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| NX||Lymph node metastasis cannot be assessed||
| style="padding: 5px 5px; background: #DCDCDC; " |N1a|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
|-
| N0||No lymph node metastasis||
| style="padding: 5px 5px; background: #DCDCDC; " |N1b|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
|-
| N1a||1 node||Micrometastasis
| style="padding: 5px 5px; background: #DCDCDC; " |N1c|| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|-
|-
| N1b||1 node||Macrometastasis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N2|| style="padding: 5px 5px; background: #F5F5F5;" |Two or 3 [[tumor]]-involved [[Lymph node|nodes]] or any number of in-transit, satellite, and/or micro- satellite [[Metastasis|metastases]] with one [[tumor]]-involved [[Lymph node|node]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| N2a||2 - 3 nodes||Micrometastasis
| style="padding: 5px 5px; background: #DCDCDC; " |N2a|| style="padding: 5px 5px; background: #F5F5F5;" |2 or 3 clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
|-
| N2b||2 - 3 nodes||Macrometastasis
| style="padding: 5px 5px; background: #DCDCDC; " |N2b|| style="padding: 5px 5px; background: #F5F5F5;" |2 or 3 [[Lymph node|nodes]], at least one of which was clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
|-
| N2c||2 - 3 nodes||In-transit metastasis/Satellites without metastatic nodes
| style="padding: 5px 5px; background: #DCDCDC; " |N2c|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically occult or clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|-
|-
| N3||≥ 4 nodes||Metastatic nodes, Matted nodes, In-transit metastasis/Satellites with metastatic nodes
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N3|| 4 or morstyle="padding: 5px 5px; background: #F5F5F5;" |4 or more [[tumor]]-involved [[Lymph node|nodes]] or any number of in-transit, satellite, and/or microsatellite [[Metastasis|metastases]] with 2 or more [[tumor]]-involved [[Lymph node|nodes]], or any number of matted [[Lymph node|nodes]] without or with in-transit, satellite, and/or microsatellite [[Metastasis|metastases]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3a|| style="padding: 5px 5px; background: #F5F5F5;" |4 or more clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3b|| style="padding: 5px 5px; background: #F5F5F5;" |4 or more, at least one of which was clinically detected, or the presence of any number of matted [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3c|| style="padding: 5px 5px; background: #F5F5F5;" |2 or more clinically occult or clinically detected and/or presence of any number of matted [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|}
|}


====Distant Metastasis (M)<ref name="pmid19917835">{{cite journal| author=Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR et al.| title=Final version of 2009 AJCC melanoma staging and classification. | journal=J Clin Oncol | year= 2009 | volume= 27 | issue= 36 | pages= 6199-206 | pmid=19917835 | doi=10.1200/JCO.2009.23.4799 | pmc=PMC2793035 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19917835  }} </ref>====
====Distant Metastasis (M)<ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''M Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''M Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Site'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Serum LDH'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M0|| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of distant [[metastasis]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1|| style="padding: 5px 5px; background: #F5F5F5;" |Evidence of distant [[metastasis]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1a|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[skin]], [[soft tissue]] including [[muscle]], and/or non-regional [[lymph node]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1a (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1a (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1b|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[lung]] with or without M1a sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1b (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1b (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1c|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to non-[[CNS]] [[Viscus|visceral]] sites with or without M1a or M1b sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M1c (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
|-
| M0||No evidence of distant metastasis
| style="padding: 5px 5px; background: #DCDCDC;" | M1c (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
|-
| M1a||Metastasis to skin, subcutaneous tissue, or distant lymph nodes
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1d|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[CNS]] with or without M1a, M1b, or M1c sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
|-
| M1b||Metasitasis to lung
| style="padding: 5px 5px; background: #DCDCDC;" | M1d (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
|-
| M1c||Metastasis to any other visceral site with elevated LDH
| style="padding: 5px 5px; background: #DCDCDC;" | M1d (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|}
|}


====Clark Level<ref name="pmid2593166">{{cite journal| author=Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D et al.| title=Model predicting survival in stage I melanoma based on tumor progression. | journal=J Natl Cancer Inst | year= 1989 | volume= 81 | issue= 24 | pages= 1893-904 | pmid=2593166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2593166  }} </ref>====
====Clark Level<ref name="pmid2593166">{{cite journal| author=Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D et al.| title=Model predicting survival in stage I melanoma based on tumor progression. | journal=J Natl Cancer Inst | year= 1989 | volume= 81 | issue= 24 | pages= 1893-904 | pmid=2593166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2593166  }} </ref>====
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Clark Level'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Clark Level'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
|-
|-
| Level I||Above the basement membrane
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level I||style="padding: 5px 5px; background: #F5F5F5;" |Above the basement membrane
|-
|-
| Level II||Infiltrating the papillary dermis
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level II||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating the papillary dermis
|-
|-
| Level III||Between papillary dermis and reticular dermis
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level III||style="padding: 5px 5px; background: #F5F5F5;" |Between papillary dermis and reticular dermis
|-
|-
| Level IV||Infiltrating the reticular dermis
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level IV||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating the reticular dermis
|-
|-
| Level V||Infiltrating subcutaneous tissue
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level V||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating subcutaneous tissue
|}
|}
Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.


===Staging of Melanoma===
===Staging of Melanoma===
Line 122: Line 164:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 16:03, 18 February 2019

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Risk calculators and risk factors for Melanoma staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Serge Korjian M.D.; Yazan Daaboul, M.D.

Overview

Staging of melanoma is essential to determine the prognosis. Staging is based on the eight edition American Joint Committee on Cancer (AJCC) melanoma TNM Classification.

Staging

Eight Edition American Joint Committee on Cancer (AJCC) Melanoma TNM Staging System

Primary Tumor (T) Classification[1][2][3][4]

T classification Thickness Ulceration status
TX: Primary tumor thickness cannot be assessed (eg, diagnosis by curettage) Not applicable Not applicable
T0: No evidence of primary tumor (eg, unknown primary or completely regressed melanoma) Not applicable Not applicable
Tis (Melanoma in situ) Not applicable Not applicable
T1 ≤ 1.0 mm or unspecified
T1a < 0.8 mm No ulceration
T1b < 0.8 mm Ulceration present
0.8 – 1.0 mm With or without ulceration
T2 > 1.0 – 2.0 mm Unknown or unspecified
T2a > 1.0 – 2.0 mm No ulceration
T2b > 1.0 – 2.0 mm Ulceration present
T3 > 2.0 – 4.0 mm Unknown or unspecified
T3a > 2.0–4.0 mm No ulceration
T3b > 2.0–4.0 mm Ulceration present
T4 > 4.0 mm Unknown or unspecified
T4a > 4.0 mm No ulceration
T4b > 4.0 mm Ulceration present

Regional Lymph Nodes (N) Classification[5]

N Classification Number of Nodes Presence of In-Transit, Satelite, and/or microsatellite Metastases
NX Regional nodes not assessed (eg, sentinel lymph node [SLN] biopsy not performed, regional nodes previously removed for another reason); Exception: pathological N category is not required for T1 melanomas, use clinical N information No
N0 No regional metastases detected No
N1 One tumor-involved node or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes
N1a One clinically occult (i.e., detected by SLN biopsy) No
N1b One clinically detected No
N1c No regional lymph node disease Yes
N2 Two or 3 tumor-involved nodes or any number of in-transit, satellite, and/or micro- satellite metastases with one tumor-involved node
N2a 2 or 3 clinically occult (i.e., detected by SLN biopsy) No
N2b 2 or 3 nodes, at least one of which was clinically detected No
N2c One clinically occult or clinically detected Yes
N3 4 or more tumor-involved nodes or any number of in-transit, satellite, and/or microsatellite metastases with 2 or more tumor-involved nodes, or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases
N3a 4 or more clinically occult (i.e., detected by SLN biopsy) No
N3b 4 or more, at least one of which was clinically detected, or the presence of any number of matted nodes No
N3c 2 or more clinically occult or clinically detected and/or presence of any number of matted nodes Yes

Distant Metastasis (M)[6]

M Classification Site Serum LDH
M0 No evidence of distant metastasis Not applicable
M1 Evidence of distant metastasis
M1a Distant metastasis to skin, soft tissue including muscle, and/or non-regional lymph node Not recorded or unspecified
M1a (0) Not elevated
M1a (1) Elevated
M1b Distant metastasis to lung with or without M1a sites of disease Not recorded or unspecified
M1b (0) Not elevated
M1b (1) Elevated
M1c Distant metastasis to non-CNS visceral sites with or without M1a or M1b sites of disease Not recorded or unspecified
M1c (0) Not elevated
M1c (1) Elevated
M1d Distant metastasis to CNS with or without M1a, M1b, or M1c sites of disease Not recorded or unspecified
M1d (0) Not elevated
M1d (1) Elevated

Clark Level[7]

Clark Level Definition
Level I Above the basement membrane
Level II Infiltrating the papillary dermis
Level III Between papillary dermis and reticular dermis
Level IV Infiltrating the reticular dermis
Level V Infiltrating subcutaneous tissue

Staging of Melanoma

Stage 0: Melanoma in Situ, 100% Survival

  • Tis (Clark Level I)

Stage I: Invasive Melanoma, 85-95% Survival

  • T1a (Clark Level II-III)
  • T1b (Clark Level IV-V)
  • T2a

Stage II: High Risk Melanoma, 40-85% Survival

  • T2b
  • T3a
  • T3b
  • T4a
  • T4b

Stage III: Regional Metastasis, 25-60% Survival

  • N1
  • N2
  • N3

Stage IV: Distant Metastasis, 9-15% Survival

  • M1a
  • M1b
  • M1c

References

  1. ↑ Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NM, Ellis DW (December 2013). "Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR)". Am. J. Surg. Pathol. 37 (12): 1797–814. doi:10.1097/PAS.0b013e31829d7f35. PMC 3864181. PMID 24061524.
  2. ↑ Ge L, Vilain RE, Lo S, Aivazian K, Scolyer RA, Thompson JF (August 2016). "Breslow Thickness Measurements of Melanomas Around American Joint Committee on Cancer Staging Cut-Off Points: Imprecision and Terminal Digit Bias Have Important Implications for Staging and Patient Management". Ann. Surg. Oncol. 23 (8): 2658–63. doi:10.1245/s10434-016-5196-1. PMID 27075324.
  3. ↑ Patrick RJ, Corey S, Glass LF (November 2007). "The use of sequential serial sectioning of thin melanomas in determining maximum Breslow depth". J. Am. Acad. Dermatol. 57 (5 Suppl): S127–8. doi:10.1016/j.jaad.2006.02.007. PMID 17938027.
  4. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  5. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  6. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  7. ↑ Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D; et al. (1989). "Model predicting survival in stage I melanoma based on tumor progression". J Natl Cancer Inst. 81 (24): 1893–904. PMID 2593166.
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