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Cancer Staging Systems

Staging of Malignant Melanoma

Last Update: Sunday January 4th, 2004 7:15 PM GMT

Clark?s classification (level of invasion)

  • Level I: Lesions involving only the epidermis (in situ melanoma); not an invasive lesion.
  • Level II: Invasion of the papillary dermis, but does not reach the papillary-reticular dermal interface.
  • Level III: Invasion fills and expands the papillary dermis, but does not penetrate the reticular dermis.
  • Level IV: Invasion into the reticular dermis but not into the subcutaneous tissue.
  • Level V: Invasion through the reticular dermis into the subcutaneous tissue.

TNM Definition

Primary tumor (T)

  • TX: Primary tumor cannot be assessed (e.g., shave biopsy or regressed melanoma)
  • T0: No evidence of primary tumor
  • Tis: Melanoma in situ
  • T1: Tumor 1.0 mm or less in thickness with or without ulceration
    • T1a: Tumor 1.0 mm or less in thickness and Clark?s level II or III, no ulceration
    • T1b: Tumor 1.0 mm or less in thickness and Clark?s level IV or V or with ulceration
  • T2: Tumor more than 1.0 mm but not more than 2.0 mm in thickness with or without ulceration
    • T2a: Tumor more than 1.0 mm but not more than 2.0 mm in thickness, no ulceration
    • T2b: Tumor more than 1.0 mm but not more than 2.0 mm in thickness, with ulceration
  • T3: Tumor more than 2.0 mm but not more than 4 mm in thickness with or without ulceration
    • T3a: Tumor more than 2.0 mm but not more than 4 mm in thickness, no ulceration
    • T3b: Tumor more than 2.0 mm but not more than 4 mm in thickness, with ulceration
  • T4: Tumor more than 4.0 mm in thickness with or without ulceration
    • T4a: Tumor more than 4.0 mm in thickness, no ulceration
    • T4b: Tumor more than 4.0 mm in thickness, with ulceration

Regional lymph nodes (N)

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis to 1 lymph node
    • N1a: Clinically occult (microscopic) metastasis
    • N1b: Clinically apparent (macroscopic) metastasis
  • N2: Metastasis to 2 or 3 regional nodes or intralymphatic regional metastasis without nodal metastases
    • N2a: Clinically occult (microscopic) metastasis
    • N2b: Clinically apparent (macroscopic) metastasis
    • N2c: Satellite or in-transit metastasis without nodal metastasis
  • N3: Metastasis in 4 or more regional nodes, or matted lymph nodes, or in-transit metastasis or satellite(s) with metastatic regional node(s)

Distant Metastasis (M)

  • MX: Distant metastasis cannot be assessed
  • M0: No distant metastasis
  • M1: Distant metastasis
    • M1a: Metastasis to skin, subcutaneous tissues, or distant lymph nodes
    • M1b: Metastasis to lung
    • M1c: Metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactic dehydrogenase (LDH)

Stage grouping

Stage 0

  • Tis, N0, M0

Stage IA

  • T1a, N0, M0

Stage IB

  • T1b, N0, M0
  • T2a, N0, M0

Stage IIA

  • T2b, N0, M0
  • T3a, N0, M0

Stage IIB

  • T3b, N0, M0
  • T4a, N0, M0

Stage IIC

  • T4b, N0, M0

Stage III

  • Any T, N1, M0
  • Any T, N2, M0
  • Any T, N3, M0

Stage IV

  • Any T, any N, M1

References

  1. Melanoma of the skin. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 209-220.

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