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==Staging==
==Staging==
===2010 American Joint Committee on Cancer (AJC) TNM Definitions for Melanoma===
===Eight Edition American Joint Committee on Cancer (AJCC) Melanoma 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)<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>====
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
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! style="background: #4479BA;" | {{fontcolor|#FFF|'''Ulceration status'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Ulceration status'''}}
|-
|-
| TX: Primary tumor thickness cannot be assessed (eg, diagnosis by curettage)||Not applicable||Not applicable
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|Tis (Melanoma in situ)||Not applicable||Not applicable
|-
|-
| T1||≤ 1.0 mm||Unknown or unspecified
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T1||≤ 1.0 mm||Unknown or unspecified
|-
|-
| T1a||< 0.8 mm||Without ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T1a||< 0.8 mm||No ulceration
|-
|-
| rowspan="2" | T1b||< 0.8 mm<br>||With ulceration<br>  
| rowspan="2" |T1b||< 0.8 mm||Ulceration present  
|-
|-
|0.8 – 1.0 mm
|0.8 – 1.0 mm
|With or without ulceration
|With or without ulceration
|-
|-
| T2||> 1.0 – 2.0 mm||Unknown or unspecified
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T2||> 1.0 – 2.0 mm||Unknown or unspecified
|-
|-
| T2a||> 1.0 – 2.0 mm||Without ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T2a||> 1.0 – 2.0 mm||No ulceration
|-
|-
| T2b||> 1.0 – 2.0 mm||With ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T2b||> 1.0 – 2.0 mm||Ulceration present
|-
|-
| T3||> 2.0 – 4.0 mm||Unknown or unspecified
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T3||> 2.0 – 4.0 mm||Unknown or unspecified
|-
|-
| T3a||> 2.0–4.0 mm||Without ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T3a||> 2.0–4.0 mm||No ulceration
|-
|-
| T3b||> 2.0–4.0 mm||With ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T3b||> 2.0–4.0 mm||Ulceration present
|-
|-
| T4||> 4.0 mm||Unknown or unspecified
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T4||> 4.0 mm||Unknown or unspecified
|-
|-
| T4a||> 4.0 mm||Without ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T4a||> 4.0 mm||No ulceration
|-
|-
| T4b||> 4.0 mm||With ulceration
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|T4b||> 4.0 mm||Ulceration present
|-
|-
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Regional lymph nodes involvement'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Nodal metastatic burden'''}}
|}
|}


Revision as of 19:49, 13 February 2019

Melanoma Microchapters

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

Overview

Staging of melanoma is essential to determine the prognosis. Staging is based on the 2010 AJCC TNM Classification[1] and is divided into stage 0 or melanoma in situ, stage I or invasive melanoma with good prognosis, stage II or high-risk melanoma, stage III or melanoma with regional lymph node metastasis, and stage IV or melanoma with distant metastasis.

Staging

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

Primary Tumor (T)[1]

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 Unknown 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)[1]

N Classification Number of Nodes Nodal Mass
NX Lymph node metastasis cannot be assessed
N0 No lymph node metastasis
N1a 1 node Micrometastasis
N1b 1 node Macrometastasis
N2a 2 - 3 nodes Micrometastasis
N2b 2 - 3 nodes Macrometastasis
N2c 2 - 3 nodes In-transit metastasis/Satellites without metastatic nodes
N3 ≥ 4 nodes Metastatic nodes, Matted nodes, In-transit metastasis/Satellites with metastatic nodes

Distant Metastasis (M)[1]

M Classification Definition
M0 No evidence of distant metastasis
M1a Metastasis to skin, subcutaneous tissue, or distant lymph nodes
M1b Metasitasis to lung
M1c Metastasis to any other visceral site with elevated LDH

Clark Level[2]

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. ↑ 1.0 1.1 1.2 1.3 Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR; et al. (2009). "Final version of 2009 AJCC melanoma staging and classification". J Clin Oncol. 27 (36): 6199–206. doi:10.1200/JCO.2009.23.4799. PMC 2793035. PMID 19917835.
  2. ↑ 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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