Headlines:

Back to cancer staging index

Cancer Staging Systems

Staging of Malignant Melanoma

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)

		Are you a doctor or a nurse? Do you want to join the Doctors Lounge online medical community? Participate in editorial activities (publish, peer review, edit) and give a helping hand to the largest online community of patients. Click on the link below to see the requirements: Doctors Lounge Membership Application

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.

send to a friend printer friendly version

The Main Discussion Board     Breast Cancer Topics       Colon and Rectal Cancers Topics       Lung Cancer Topics The Oncology Articles