Melanoma staging
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Staging of melanoma is essential to determine the prognosis. Staging is based on the 2010 AJCC TNM Classification and is divided into stage 0 or melanoma in situ, stage 1 or invasive melanoma with good prognosis, stage 2 or high risk melanoma, stage 3 or melanoma with regional lymph node metastasis, and stage 4 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/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)[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 |
Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.[2]
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 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.
- ↑ Malignant melanoma: staging at Collaborative Hypertext of Radiology