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Skin-Melanocytic Tumors
Last major update: January 2010
Revised: 28 January 2010
Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.
Copyright: (c) 2002-2010, 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)
● Based on AJCC Cancer Staging Manual (7th ed)
Primary tumor (T)
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● TX: Primary tumor cannot be assessed (e.g. curettaged or regressed melanoma)
● T0: No evidence of primary tumor
● Tis: Melanoma in situ
● T1: Melanoma 1.0 mm or less in thickness
● T1a: Melanoma 1.0 mm or less in thickness, without ulceration and mitosis < 1/mm2
● T1b: Melanoma 1.0 mm or less in thickness, with ulceration or mitosis >= 1/mm2
● T2: Melanoma 1.01 - 2.0 mm in thickness
● T2a: Melanoma 1.01 - 2.0 mm in thickness, without ulceration
● T2b: Melanoma 1.01 - 2.0 mm in thickness, with ulceration
● T3: Melanoma 2.01 - 4.0 mm in thickness
● T3a: Melanoma 2.01 - 4.0 mm in thickness, without ulceration
● T3b: Melanoma 2.01 - 4.0 mm in thickness, with ulceration
● T4: Melanoma greater than 4.0 mm in thickness
● T4a: Melanoma greater than 4.0 mm in thickness, without 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 (e.g. previously removed for another reason)
● N0: No regional lymph node metastasis
● N1: Metastasis in one lymph node
● N1a: Micrometastasis
● N1b: Macrometastasis
● N2: Metastasis in 2-3 regional nodes
● N2a: Micrometastasis
● N2b: Macrometastasis
● 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)
● Micrometastases are diagnosed after sentinel lymph node biopsy and completion lymphadenectomy (if performed)
● Macrometastases are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or when nodal metastasis exhibits gross extracapsular extension.
● 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
● 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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● M0: No detectable evidence of distant metastases
● M1a: Metastases to skin, subcutaneous or distant lymph nodes
● M1b: Metastases to lung
● M1c: Metastases to all other visceral sites or distant metastases to 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 / T2a N0 M0
● IIA : T2b / T3a N0 M0
● IIB : T3b / T4a N0 M0
● IIC : T4b N0 M0
● III : any T N1-3 M0
● IV : any T any N M1
● Clinical staging includes microstaging of the primary melanoma and clinical/radiologic examination for metastases. By convention, it should be used after complete excision of the primary melanoma with clinical assessment for regional and distant metastases.
Pathologic stage grouping
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● 0 : Tis N0 M0
● IA : T1a N0 M0
● IB : T1b/T2a N0 M0
● IIA : T2b /T3a N0 M0
● IIB : T3b/T4a N0 M0
● IIC : T4b N0 M0
● IIIA : T1-4a N1a/N2a M0
● IIIB : T1-4b N1a/N2a M0 or T1-4a N1b/N2b/N2c M0
● IIIC : T1-4b N1b/N2b/N2c M0 or any T N3 M0
● IV : Any T any N M1
● Pathologic staging includes microstaging of the primary melanoma and pathologic information about the regional lymph nodes after partial or complete lymphadenectomy. Pathologic Stage 0 or Stage IA patients are the exception; they do not require pathologic evaluation of their lymph nodes.
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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