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
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Melanoma in situ
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

Regional Lymph Nodes (N)

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)

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

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: 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

Based Upon AJCC 5-Year Survival With Proper Treatment