Melanoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Serge Korjian M.D.; Yazan Daaboul, M.D.

## Overview[edit | edit source]

Staging of melanoma is essential to determine the prognosis. Staging is based on the eight edition American Joint Committee on Cancer (AJCC) melanoma TNM Classification.

## Staging[edit | edit source]

### Eight Edition American Joint Committee on Cancer (AJCC) Melanoma TNM Staging System[edit | edit source]

#### Primary Tumor (T) Classification[1][2][3][4][edit | edit source]

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[5][edit | edit source]

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)[6][edit | edit source]

M Classification | Site | Serum LDH

|
|

M0 | No evidence of distant metastasis | Not applicable
M1 | Evidence of distant metastasis |
M1a | Distant metastasis to skin, soft tissue including muscle, and/or non-regional lymph node | Not recorded or unspecified
M1a (0) |  | Not elevated
M1a (1) |  | Elevated
M1b | Distant metastasis to lung with or without M1a sites of disease | Not recorded or unspecified
M1b (0) |  | Not elevated
M1b (1) |  | Elevated
M1c | Distant metastasis to non-CNS visceral sites with or without M1a or M1b sites of disease | Not recorded or unspecified
M1c (0) |  | Not elevated
M1c (1) |  | Elevated
M1d | Distant metastasis to CNS with or without M1a, M1b, or M1c sites of disease | Not recorded or unspecified
M1d (0) |  | Not elevated
M1d (1) |  | Elevated

#### Clark Level[7][edit | edit source]

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[edit | edit source]

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[edit | edit source]

1. ↑ 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.
2. ↑ 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.
3. ↑ 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.
4. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
5. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
6. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
7. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)