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Skin-Melanocytic Tumors

Staging of melanomas

 

Last major update: November 2008 - next update November 2009

Revised: 11 July 2009

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

Staging

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● Primary difference between clinical and pathologic stage grouping is whether regional lymph nodes are staged clinically (including radiologic exam) or pathologically (after excision)

Clinical staging: perform after complete excision of tumor, microstaging (pathologic exam to determine Breslow thickness and Clark level of invasion) and assessment of metastases

Note: significant survival differences are noted based on clinical versus pathologic staging

Pathologic staging: uses clinical staging information plus pathologic examination of regional lymph nodes and pathologic confirmation of metastases

 

Primary tumor (T)

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TX: primary tumor cannot be assessed (e.g. shave biopsy or regressed melanoma)

T0: no evidence of primary tumor

Tis: melanoma in situ

T1: melanoma 1.0 mm or less in thickness with or without ulceration

T1a: melanoma 1.0 mm or less in thickness and level II or III, no ulceration

T1b: melanoma 1.0 mm or less in thickness and level IV or V or with ulceration

T2: melanoma 1.01 - 2.0 mm in thickness with or without ulceration

T2a: melanoma 1.01 - 2.0 mm in thickness, no ulceration

T2b: melanoma 1.01 - 2.0 mm in thickness, with ulceration

T3: melanoma 2.01 - 4.0 mm in thickness with or without ulceration

T3a: melanoma 2.01 - 4.0 mm in thickness, no ulceration

T3b: melanoma 2.01 - 4.0 mm in thickness, with ulceration

T4: melanoma greater than 4.0 mm in thickness with or without ulceration

T4a: melanoma greater than 4.0 mm in thickness, no ulceration

T4b: melanoma greater than 4.0 mm in thickness, with ulceration

 

Notes: ulceration means absence of intact epidermis overlying the primary melanoma, as assessed by histologic examination

 

Regional lymph nodes (N)

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NX: regional lymph nodes cannot be assessed

N0: no regional lymph node metastasis

N1: metastasis in one lymph node

N1a: clinically occult (microscopic) metastasis

N1b: clinically apparent (macroscopic) metastasis

N2: metastasis in 2-3 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 four or more regional nodes, or matted metastatic nodes, or in-transit metastasis or satellite(s) with metastasis in regional node(s)

 

Satellite metastases: defined arbitrarily as intralymphatic metastases occurring within 2 cm of the primary melanoma

In-transit metastases: defined arbitrarily as intralymphatic metastases occurring more than 2 cm from the primary melanoma but before the first echelon of regional lymph nodes

Regional nodal metastases: disease confined to one nodal basin or two contiguous nodal basins

 

Note: HMB45 or MelanA positive isolated cells in sentinel nodes appear to have no prognostic significance, at least short term (AJSP 2007;31:1175)

 

Distant Metastases (M)

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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)

 

Clinical stage grouping

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0      : Tis N0 M0

IA     : T1a N0 M0 ()

IB     : T1b N0 M0 or T2a N0 M0

IIA    : T2b N0 M0 or T3a N0 M0

IIB    : T3b N0 M0 or T4a N0 M0

IIC    : T4b N0 M0

III     : Any T, N1-N3, M0

IV     : Any T, any N, M1

 

● Note: clinical staging includes microstaging of the primary melanoma and clinical/radiologic examination for metastases, but no pathologic examination of lymph nodes

 

Stages I/II: no evidence of metastases; stage I are considered low risk for metastases / mortality, and stage II are considered intermediate risk

Stage III: regional metastases to lymph nodes, satellite metastases or in-transit metastases; no substaging is done

Stage IV: distant metastases

 

Pathologic stage grouping and 5 year survival

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0      : Tis N0 M0

IA     : T1a N0 M0 (95%)

IB     : T1b N0 M0 or T2a N0 M0 (89-91%)

IIA    : T2b N0 M0 or T3a N0 M0 (77-79%)

IIB    : T3b N0 M0 or T4a N0 M0 (63-67%)

IIC    : T4b N0 M0 (45%)

IIIA   : T1-T4a, N1a or N2a, M0 (67%)

IIIB   : T1-T4b, N1a or N2a, M0 or T1-T4a, N1b or N2b, M0 or T1-T4b, N2c, M0 (52-54%)

IIIC   : T1-T4b, N1b or N2b, M0 or any T, N3 M0 (24-28%)

IV     : Any T, any N, M1

 

Stages I/II: no evidence of metastases (regional or distant); stage I are considered low risk for metastases / mortality, and stage II are considered intermediate risk

Stage III: regional metastases to lymph nodes, satellite metastases or in-transit metastases; stage IIIA are considered to have intermediate risk for distant metastases / survival, stage IIIB to have high risk and stage IIIC to have very high risk

Stage IV: distant metastases

 

Tables

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TNM classification    

 

Notes

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● Increased complexity of AJCC 2002 system did not improve its predictive ability over the simpler AJCC 1997 (Cancer 2006;106:163)

 

Additional references

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CA Cancer J Clin 2004;54:131, Cancer Control 2002;9:9, Staging Tool

 

End of Skin-Melanocytic Tumors > Staging of melanomas

 

 

 

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