Melanoma staging: Difference between revisions
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! style="background: #4479BA;" | {{fontcolor|#FFF|'''Presence of In-Transit, Satelite, and/or microsatellite Metastases'''}} | ! style="background: #4479BA;" | {{fontcolor|#FFF|'''Presence of In-Transit, Satelite, and/or microsatellite Metastases'''}} | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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 | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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||align="center"| No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N0||No regional metastases detected||No | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N0||No regional metastases detected||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N1||One tumor-involved node or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N1||One tumor-involved node or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N1a||One clinically occult (i.e., detected by SLN biopsy)||No | | style="padding: 5px 5px; background: #DCDCDC; |N1a||One clinically occult (i.e., detected by SLN biopsy)||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N1b||One clinically detected||No | | style="padding: 5px 5px; background: #DCDCDC; |N1b||One clinically detected||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N1c||No regional lymph node disease||Yes | | style="padding: 5px 5px; background: #DCDCDC; |N1c||No regional lymph node disease||align="center"|Yes | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N2||Two or 3 tumor-involved nodes or any number of in-transit, satellite, and/or micro- satellite metastases with one tumor-involved node | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|N2||Two or 3 tumor-involved nodes or any number of in-transit, satellite, and/or micro- satellite metastases with one tumor-involved node | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N2a||2 or 3 clinically occult (i.e., detected by SLN biopsy)||No | | style="padding: 5px 5px; background: #DCDCDC; |N2a||2 or 3 clinically occult (i.e., detected by SLN biopsy)||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N2b||2 or 3 nodes, at least one of which was clinically detected||No | | style="padding: 5px 5px; background: #DCDCDC; |N2b||2 or 3 nodes, at least one of which was clinically detected||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N2c||One clinically occult or clinically detected||Yes | | style="padding: 5px 5px; background: #DCDCDC; |N2c||One clinically occult or clinically detected||align="center"|Yes | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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 | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold"|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 | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N3a||4 or more clinically occult (i.e., detected by SLN biopsy)||No | | style="padding: 5px 5px; background: #DCDCDC; |N3a||4 or more clinically occult (i.e., detected by SLN biopsy)||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N3b||4 or more, at least one of which was clinically detected, or the presence of any number of matted nodes||No | | style="padding: 5px 5px; background: #DCDCDC; |N3b||4 or more, at least one of which was clinically detected, or the presence of any number of matted nodes||align="center"|No | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; |N3c||2 or more clinically occult or clinically detected and/or presence of any number of matted nodes||Yes | | style="padding: 5px 5px; background: #DCDCDC; |N3c||2 or more clinically occult or clinically detected and/or presence of any number of matted nodes||align="center"|Yes | ||
|} | |} | ||
Revision as of 21:16, 13 February 2019
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Melanoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Melanoma staging On the Web |
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American Roentgen Ray Society Images of Melanoma staging |
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 TNM Staging System
Primary Tumor (T) Classification[2][3][4][5]
| 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[6]
| 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)[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[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
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
- ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
- ↑ 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.