Melanoma staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Staging

2010 American Joint Committee on Cancer (AJC) TNM Definitions for Melanoma

Primary Tumor (T)

T Classification	Thickness	Ulceration status/mitoses
T1a	≤ 1.0 mm	No ulceration & <1 mitosis/mm2
T1b	≤ 1.0 mm	Ulcerated or ≥1 mitosis/mm2
T2a	1.01 - 2.0 mm	No ulceration
T2b	1.01 - 2.0 mm	Ulcerated
T3a	2.01 - 4.0 mm	No ulceration
T3b	2.01 - 4.0 mm	Ulcerated
T4a	> 4.0 mm	No ulceration
T4b	> 4.0 mm	Ulcerated

Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.

Staging of Melanoma

Stage 0: Melanoma in Situ (Clark Level I), 100% Survival

Stage I/II: Invasive Melanoma, 85-95% Survival

• T1a: Less than 1.00 mm primary, w/o Ulceration, Clark Level II-III
• T1b: Less than 1.00 mm primary, w/Ulceration or Clark Level IV-V
• T2a: 1.00-2.00 mm primary, w/o Ulceration

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

• T2b: 1.00-2.00 mm primary, w/ Ulceration
• T3a: 2.00-4.00 mm primary, w/o Ulceration
• T3b: 2.00-4.00 mm primary, w/ Ulceration
• T4a: 4.00 mm or greater primary w/o Ulceration
• T4b: 4.00 mm or greater primary w/ Ulceration

Stage III: Regional Metastasis, 25-60% Survival

• N1: Single Positive Lymph Node
• N2: 2-3 Positive Lymph Nodes OR Regional Skin/In-Transit Metastasis
• N3: 4 Positive Lymph Nodes OR Lymph Node and Regional Skin/In Transit Metastases

Stage IV: Distant Metastasis, 9-15% Survival

• M1a: Distant Skin Metastasis, Normal LDH
• M1b: Lung Metastasis, Normal LDH
• M1c: Other Distant Metastasis OR Any Distant Metastasis with Elevated LDH

Based Upon AJCC 5-Year Survival With Proper Treatment