Melanoma staging
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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
2010 American Joint Committee on Cancer (AJC) TNM Definitions for Melanoma
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 | Without ulceration |
| T1b | < 0.8 mm 0.8 – 1.0 mm |
With ulceration With or without ulceration |
| T2 | > 1.0 – 2.0 mm | Unknown or unspecified |
| T2a | > 1.0 – 2.0 mm | Without ulceration |
| T2b | > 1.0 – 2.0 mm | With ulceration |
| T3 | > 2.0 – 4.0 mm | Unknown or unspecified |
| T3a | > 2.0–4.0 mm | Without ulceration |
| T3b | > 2.0–4.0 mm | With ulceration |
| T4 | > 4.0 mm | Unknown or unspecified |
| T4a | > 4.0 mm | Without ulceration |
| T4b | > 4.0 mm | With ulceration |
| N classification | Regional lymph nodes involvement | Nodal metastatic burden |
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
- ↑ 1.0 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.
- ↑ 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.