Editing Melanoma (section)

== '''Staging''' ==

* Prior to pathological lymph node assessment:
** T1a cN0: WLE without SLNB and no staging imaging
** T4b cN0: CT CAP prior to WLE + SLNB
** cN1: USS +/- FNA
*** If confirmed regional melanoma, PET/CT and MRI brain
*** If negative FNA, stage nodes with SLNB according to guidelines below
** In-transit/satellite metastases: PET/CT and MRI brain
* After pathological assessment of lymph nodes:
** IIB or IIIA: CT CAP
** IIC or IIIB: CT CAP and PET. MRIB for symptoms.
** IIIC or IIID; CT CAP, PET and MRIB
** IV: CT CAP, PET, MRIB, LDH
* Calculators such as www.melanomaprognosis.org and www.melanomacalculator.com can provide additional prognostic information



'''AJCC 8th edition melanoma TNM definitions'''
{| class="wikitable"
|'''Primary tumor (T)'''
|
|
|-
|'''T category'''
|'''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
|Unknown or unspecified
|-
|T1a
|<0.8 mm
|Without ulceration
|-
|T1b
|<0.8 mm
|With ulceration
|-
|
|0.8 to 1 mm
|With or without ulceration
|-
|T2
|>1 to 2 mm
|Unknown or unspecified
|-
|T2a
|>1 to 2 mm
|Without ulceration
|-
|T2b
|>1 to 2 mm
|With ulceration
|-
|T3
|>2 to 4 mm
|Unknown or unspecified
|-
|T3a
|>2 to 4 mm
|Without ulceration
|-
|T3b
|>2 to 4 mm
|With ulceration
|-
|T4
|>4 mm
|Unknown or unspecified
|-
|T4a
|>4 mm
|Without ulceration
|-
|T4b
|>4 mm
|With ulceration
|-
|'''Regional lymph nodes (N)'''
|
|
|-
|'''N category'''
|'''Extent of regional lymph node and/or lymphatic metastasis'''
|
|-
|
|'''Number of tumor-involved regional lymph nodes'''
|'''Presence of in-transit, satellite, and/or microsatellite metastases'''
|-
|NX
|Regional nodes not assessed (eg, SLN biopsy not performed, regional nodes previously removed for another reason).

'''Exception:''' Pathological N category is not required for T1 melanomas, use cN.
|No
|-
|N0
|No regional metastases detected
|No
|-
|N1
|One tumor-involved node or in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes
|
|-
|N1a
|One clinically occult (ie, detected by SLN biopsy)
|No
|-
|N1b
|One clinically detected
|No
|-
|N1c
|No regional lymph node disease
|Yes'
|-
|N2
|Two or three tumor-involved nodes or in-transit, satellite, and/or microsatellite metastases with one tumor-involved node
|
|-
|N2a
|Two or three clinically occult (ie, detected by SLN biopsy)
|No
|-
|N2b
|Two or three, at least one of which was clinically detected
|No
|-
|N2c
|One clinically occult or clinically detected
|Yes
|-
|N3
|Four or more tumor-involved nodes or in-transit, satellite, and/or microsatellite metastases with two or more tumor-involved nodes, or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases
|
|-
|N3a
|Four or more clinically occult (ie, detected by SLN biopsy)
|No
|-
|N3b
|Four or more, at least one of which was clinically detected, or presence of any number of matted nodes
|No
|-
|N3c
|Two or more clinically occult or clinically detected and/or presence of any number of matted nodes
|Yes
|-
|'''Distant metastasis (M)'''
|
|
|-
|'''M category'''
|'''M criteria'''
|
|-
|
|'''Anatomic site'''
|'''LDH level'''
|-
|M0
|No evidence of distant metastasis
|Not applicable
|-
|M1
|Evidence of distant metastasis
|See below
|-
|M1a
|Distant metastasis to skin, soft tissue including muscle, and/or nonregional 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)
|
|Normal
|-
|M1d(1)
|
|Elevated
|}
Suffixes for M category: (0) LDH not elevated, (1) LDH elevated. No suffix is used if LDH is not recorded or is unspecified.


{| class="wikitable"
|'''Clinical (cTNM)'''
|
|
|
|-
|Clinical staging includes microstaging of the primary melanoma and clinical/radiologic/biopsy evaluation for metastases. By convention, clinical staging should be used after biopsy of the primary melanoma, with clinical assessment for regional and distant metastases. Note that pathological assessment of the primary melanoma is used for both clinical and pathological classification. Diagnostic biopsies to evaluate possible regional and/or distant metastasis also are included. Note there is only one stage group for clinical Stage III melanoma.
|
|
|
|-
|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''Then the clinical stage group is...'''
|-
|Tis
|N0
|M0
|0
|-
|T1a
|N0
|M0
|IA
|-
|T1b
|N0
|M0
|IB
|-
|T2a
|N0
|M0
|IB
|-
|T2b
|N0
|M0
|IIA
|-
|T3a
|N0
|M0
|IIA
|-
|T3b
|N0
|M0
|IIB
|-
|T4a
|N0
|M0
|IIB
|-
|T4b
|N0
|M0
|IIC
|-
|Any T, Tis
|≥N1
|M0
|III
|-
|Any T
|Any N
|M1
|IV
|-
|'''Pathological (pTNM)'''
|
|
|
|-
|Pathological staging includes microstaging of the primary melanoma, including any additional staging information from the wide-excision (surgical) specimen that constitutes primary tumor surgical treatment and pathological information about the regional lymph nodes after SLN biopsy or therapeutic lymph node dissection for clinically evident regional lymph node disease.
|
|
|
|-
|'''When T is...'''
|'''And N is...'''
|'''And M is...'''
|'''Then the pathological stage group is...'''
|-
|Tis
|N0
|M0
|0
|-
|T1a
|N0
|M0
|IA
|-
|T1b
|N0
|M0
|IA
|-
|T2a
|N0
|M0
|IB
|-
|T2b
|N0
|M0
|IIA
|-
|T3a
|N0
|M0
|IIA
|-
|T3b
|N0
|M0
|IIB
|-
|T4a
|N0
|M0
|IIB
|-
|T4b
|N0
|M0
|IIC
|-
|T0
|N1b, N1c
|M0
|IIIB
|-
|T0
|N2b, N2c, N3b, or N3c
|M0
|IIIC
|-
|T1a/b-T2a
|N1a or N2a
|M0
|IIIA
|-
|T1a/b-T2a
|N1b/c or N2b
|M0
|IIIB
|-
|T2b/T3a
|N1a-N2b
|M0
|IIIB
|-
|T1a-T3a
|N2c or N3a/b/c
|M0
|IIIC
|-
|T3b/T4a
|Any N ≥N1
|M0
|IIIC
|-
|T4b
|N1a-N2c
|M0
|IIIC
|-
|T4b
|N3a/b/c
|M0
|IIID
|-
|Any T, Tis
|Any N
|M1
|IV
|}