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(/* Clark Level{{cite journal| author=Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D et al.| title=Model predicting survival in stage I melanoma based on tumor progression. | journal=J Natl Cancer Inst | year= 1989 | volume= 81 | issue=...)
 
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{{Melanoma}}
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==Overview==
==Overview==
[[Cancer staging|Staging]] of melanoma is essential to determine the [[prognosis]]. [[Cancer staging|Staging]] is based on the eight edition [[American Joint Committee on Cancer|American Joint Committee on Cancer (AJCC)]] melanoma [[TNM]] Classification.


==Staging==
==Staging==
''Further context on [[cancer staging]] is available at [[TNM]].''
===Eight Edition American Joint Committee on Cancer (AJCC) Melanoma TNM Staging System===
====Primary Tumor (T) Classification<ref name="pmid24061524">{{cite journal |vauthors=Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NM, Ellis DW |title=Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR) |journal=Am. J. Surg. Pathol. |volume=37 |issue=12 |pages=1797–814 |date=December 2013 |pmid=24061524 |pmc=3864181 |doi=10.1097/PAS.0b013e31829d7f35 |url=}}</ref><ref name="pmid27075324">{{cite journal |vauthors=Ge L, Vilain RE, Lo S, Aivazian K, Scolyer RA, Thompson JF |title=Breslow Thickness Measurements of Melanomas Around American Joint Committee on Cancer Staging Cut-Off Points: Imprecision and Terminal Digit Bias Have Important Implications for Staging and Patient Management |journal=Ann. Surg. Oncol. |volume=23 |issue=8 |pages=2658–63 |date=August 2016 |pmid=27075324 |doi=10.1245/s10434-016-5196-1 |url=}}</ref><ref name="pmid17938027">{{cite journal |vauthors=Patrick RJ, Corey S, Glass LF |title=The use of sequential serial sectioning of thin melanomas in determining maximum Breslow depth |journal=J. Am. Acad. Dermatol. |volume=57 |issue=5 Suppl |pages=S127–8 |date=November 2007 |pmid=17938027 |doi=10.1016/j.jaad.2006.02.007 |url=}}</ref><ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Thickness'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Ulceration status'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |TX: Primary tumor thickness cannot be assessed (eg, diagnosis by curettage)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T0: No evidence of primary tumor (eg, unknown primary or completely regressed melanoma)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Tis (Melanoma in situ)|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T1|| style="padding: 5px 5px; background: #F5F5F5;" |≤ 1.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" Unknown |or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T1a|| style="padding: 5px 5px; background: #F5F5F5;" |< 0.8 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC; " |T1b|| style="padding: 5px 5px; background: #F5F5F5;" |< 0.8 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present 
|-
| style="padding: 5px 5px; background: #F5F5F5;" |0.8 – 1.0 mm
| style="padding: 5px 5px; background: #F5F5F5;" |With or without [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T2|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T2a|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T2b|| style="padding: 5px 5px; background: #F5F5F5;" |> 1.0 – 2.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T3|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0 – 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T3a|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0–4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T3b|| style="padding: 5px 5px; background: #F5F5F5;" |> 2.0–4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |T4|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |Unknown or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T4a|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |No [[Ulcer|ulceration]]
|-
| style="padding: 5px 5px; background: #DCDCDC; " |T4b|| style="padding: 5px 5px; background: #F5F5F5;" |> 4.0 mm|| style="padding: 5px 5px; background: #F5F5F5;" |[[Ulcer|Ulceration]] present
|-
|}


Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.<ref> [http://chorus.rad.mcw.edu/doc/00955.html Malignant melanoma: staging] at Collaborative Hypertext of Radiology</ref>
====Regional Lymph Nodes (N) Classification<ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Number of Nodes'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Presence of In-Transit, Satelite, and/or microsatellite Metastases'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |NX|| style="padding: 5px 5px; background: #F5F5F5;" |Regional [[Lymph node|nodes]] not assessed (eg, [[Sentinel lymph node|sentinel lymph node [SLN]]] [[biopsy]] not performed, regional [[Lymph node|nodes]] previously removed for another reason); Exception: [[Pathology|pathological]] N category is not required for T1 melanomas, use clinical N information|| style="padding: 5px 5px; background: #F5F5F5;" align="center" | No
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N0|| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[Metastasis|metastases]] detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N1|| style="padding: 5px 5px; background: #F5F5F5;" |One [[tumor]]-involved [[Lymph node|node]] or any number of in-transit, satellite, and/or microsatellite [[Metastasis|metastases]] with no [[tumor]]-involved [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N1a|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N1b|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N1c|| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N2|| style="padding: 5px 5px; background: #F5F5F5;" |Two or 3 [[tumor]]-involved [[Lymph node|nodes]] or any number of in-transit, satellite, and/or micro- satellite [[Metastasis|metastases]] with one [[tumor]]-involved [[Lymph node|node]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N2a|| style="padding: 5px 5px; background: #F5F5F5;" |2 or 3 clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N2b|| style="padding: 5px 5px; background: #F5F5F5;" |2 or 3 [[Lymph node|nodes]], at least one of which was clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N2c|| style="padding: 5px 5px; background: #F5F5F5;" |One clinically occult or clinically detected|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |N3|| 4 or morstyle="padding: 5px 5px; background: #F5F5F5;" |4 or more [[tumor]]-involved [[Lymph node|nodes]] or any number of in-transit, satellite, and/or microsatellite [[Metastasis|metastases]] with 2 or more [[tumor]]-involved [[Lymph node|nodes]], or any number of matted [[Lymph node|nodes]] without or with in-transit, satellite, and/or microsatellite [[Metastasis|metastases]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3a|| style="padding: 5px 5px; background: #F5F5F5;" |4 or more clinically occult (i.e., detected by [[Sentinel lymph node|SLN]] [[biopsy]])|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3b|| style="padding: 5px 5px; background: #F5F5F5;" |4 or more, at least one of which was clinically detected, or the presence of any number of matted [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |No
|-
| style="padding: 5px 5px; background: #DCDCDC; " |N3c|| style="padding: 5px 5px; background: #F5F5F5;" |2 or more clinically occult or clinically detected and/or presence of any number of matted [[Lymph node|nodes]]|| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Yes
|}


Melanoma stages:<ref name=AJCC />
====Distant Metastasis (M)<ref>{{cite book | last = Amin | first = Mahul | title = AJCC cancer staging manual | publisher = Springer | location = Switzerland | year = 2017 | isbn = 9783319406176 }}</ref>====
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''M Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Site'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Serum LDH'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M0|| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of distant [[metastasis]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not applicable
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1|| style="padding: 5px 5px; background: #F5F5F5;" |Evidence of distant [[metastasis]]|| style="padding: 5px 5px; background: #F5F5F5;" |
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1a|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[skin]], [[soft tissue]] including [[muscle]], and/or non-regional [[lymph node]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1a (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1a (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1b|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[lung]] with or without M1a sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1b (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1b (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1c|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to non-[[CNS]] [[Viscus|visceral]] sites with or without M1a or M1b sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" |M1c (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1c (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | M1d|| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis]] to [[CNS]] with or without M1a, M1b, or M1c sites of [[disease]]|| style="padding: 5px 5px; background: #F5F5F5;" |Not recorded or unspecified
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1d (0)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Not elevated
|-
| style="padding: 5px 5px; background: #DCDCDC;" | M1d (1)|| style="padding: 5px 5px; background: #F5F5F5;" | || style="padding: 5px 5px; background: #F5F5F5;" |Elevated
|}


'''Stage 0''': Melanoma in Situ (Clark Level I), 100% Survival
====Clark Level<ref name="pmid2593166">{{cite journal| author=Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D et al.| title=Model predicting survival in stage I melanoma based on tumor progression. | journal=J Natl Cancer Inst | year= 1989 | volume= 81 | issue= 24 | pages= 1893-904 | pmid=2593166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2593166  }} </ref>====
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Clark Level'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level I||style="padding: 5px 5px; background: #F5F5F5;" |Above the basement membrane
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level II||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating the papillary dermis
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level III||style="padding: 5px 5px; background: #F5F5F5;" |Between papillary dermis and reticular dermis
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level IV||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating the reticular dermis
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Level V||style="padding: 5px 5px; background: #F5F5F5;" |Infiltrating subcutaneous tissue
|}


'''Stage I/II''': Invasive Melanoma, 85-95% Survival
===Staging of Melanoma===
*T1a: Less than 1.00&nbsp;mm primary, w/o Ulceration, Clark Level II-III
 
*T1b: Less than 1.00&nbsp;mm primary, w/Ulceration or Clark Level IV-V
'''Stage 0''': Melanoma in Situ, 100% Survival
*T2a: 1.00-2.00&nbsp;mm primary, w/o Ulceration
*Tis (Clark Level I)
 
'''Stage I''': Invasive Melanoma, 85-95% Survival
*T1a (Clark Level II-III)
*T1b (Clark Level IV-V)
*T2a


'''Stage II''': High Risk Melanoma, 40-85% Survival
'''Stage II''': High Risk Melanoma, 40-85% Survival
*T2b: 1.00-2.00&nbsp;mm primary, w/ Ulceration
*T2b
*T3a: 2.00-4.00&nbsp;mm primary, w/o Ulceration
*T3a
*T3b: 2.00-4.00&nbsp;mm primary, w/ Ulceration
*T3b
*T4a: 4.00&nbsp;mm or greater primary w/o Ulceration
*T4a
*T4b: 4.00&nbsp;mm or greater primary w/ Ulceration
*T4b


'''Stage III''': Regional Metastasis, 25-60% Survival
'''Stage III''': Regional Metastasis, 25-60% Survival
*N1: Single Positive Lymph Node
*N1
*N2: 2-3 Positive Lymph Nodes OR Regional Skin/In-Transit Metastasis
*N2
*N3: 4 Positive Lymph Nodes OR Lymph Node and Regional Skin/In Transit Metastases
*N3


'''Stage IV''': Distant Metastasis, 9-15% Survival
'''Stage IV''': Distant Metastasis, 9-15% Survival
*M1a: Distant Skin Metastasis, Normal LDH
*M1a
*M1b: Lung Metastasis, Normal LDH
*M1b
*M1c: Other Distant Metastasis OR Any Distant Metastasis with Elevated LDH
*M1c
 
''Based Upon AJCC 5-Year Survival With Proper Treatment''


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 16:03, 18 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Serge Korjian M.D.; Yazan Daaboul, M.D.

Overview

Staging of melanoma is essential to determine the prognosis. Staging is based on the eight edition American Joint Committee on Cancer (AJCC) melanoma TNM Classification.

Staging

Eight Edition American Joint Committee on Cancer (AJCC) Melanoma TNM Staging System

Primary Tumor (T) Classification[1][2][3][4]

T classification 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 or unspecified
T1a < 0.8 mm No ulceration
T1b < 0.8 mm Ulceration present
0.8 – 1.0 mm With or without ulceration
T2 > 1.0 – 2.0 mm Unknown or unspecified
T2a > 1.0 – 2.0 mm No ulceration
T2b > 1.0 – 2.0 mm Ulceration present
T3 > 2.0 – 4.0 mm Unknown or unspecified
T3a > 2.0–4.0 mm No ulceration
T3b > 2.0–4.0 mm Ulceration present
T4 > 4.0 mm Unknown or unspecified
T4a > 4.0 mm No ulceration
T4b > 4.0 mm Ulceration present

Regional Lymph Nodes (N) Classification[5]

N Classification Number of Nodes Presence of In-Transit, Satelite, and/or microsatellite Metastases
NX Regional nodes not assessed (eg, sentinel lymph node [SLN] biopsy not performed, regional nodes previously removed for another reason); Exception: pathological N category is not required for T1 melanomas, use clinical N information No
N0 No regional metastases detected No
N1 One tumor-involved node or any number of in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes
N1a One clinically occult (i.e., detected by SLN biopsy) No
N1b One clinically detected No
N1c No regional lymph node disease Yes
N2 Two or 3 tumor-involved nodes or any number of in-transit, satellite, and/or micro- satellite metastases with one tumor-involved node
N2a 2 or 3 clinically occult (i.e., detected by SLN biopsy) No
N2b 2 or 3 nodes, at least one of which was clinically detected No
N2c One clinically occult or clinically detected Yes
N3 4 or more tumor-involved nodes or any number of in-transit, satellite, and/or microsatellite metastases with 2 or more tumor-involved nodes, or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases
N3a 4 or more clinically occult (i.e., detected by SLN biopsy) No
N3b 4 or more, at least one of which was clinically detected, or the presence of any number of matted nodes No
N3c 2 or more clinically occult or clinically detected and/or presence of any number of matted nodes Yes

Distant Metastasis (M)[6]

M Classification Site Serum LDH
M0 No evidence of distant metastasis Not applicable
M1 Evidence of distant metastasis
M1a Distant metastasis to skin, soft tissue including muscle, and/or non-regional 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) Not elevated
M1d (1) Elevated

Clark Level[7]

Clark Level Definition
Level I Above the basement membrane
Level II Infiltrating the papillary dermis
Level III Between papillary dermis and reticular dermis
Level IV Infiltrating the reticular dermis
Level V Infiltrating subcutaneous tissue

Staging of Melanoma

Stage 0: Melanoma in Situ, 100% Survival

  • Tis (Clark Level I)

Stage I: Invasive Melanoma, 85-95% Survival

  • T1a (Clark Level II-III)
  • T1b (Clark Level IV-V)
  • T2a

Stage II: High Risk Melanoma, 40-85% Survival

  • T2b
  • T3a
  • T3b
  • T4a
  • T4b

Stage III: Regional Metastasis, 25-60% Survival

  • N1
  • N2
  • N3

Stage IV: Distant Metastasis, 9-15% Survival

  • M1a
  • M1b
  • M1c

References

  1. ↑ Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NM, Ellis DW (December 2013). "Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR)". Am. J. Surg. Pathol. 37 (12): 1797–814. doi:10.1097/PAS.0b013e31829d7f35. PMC 3864181. PMID 24061524.
  2. ↑ Ge L, Vilain RE, Lo S, Aivazian K, Scolyer RA, Thompson JF (August 2016). "Breslow Thickness Measurements of Melanomas Around American Joint Committee on Cancer Staging Cut-Off Points: Imprecision and Terminal Digit Bias Have Important Implications for Staging and Patient Management". Ann. Surg. Oncol. 23 (8): 2658–63. doi:10.1245/s10434-016-5196-1. PMID 27075324.
  3. ↑ Patrick RJ, Corey S, Glass LF (November 2007). "The use of sequential serial sectioning of thin melanomas in determining maximum Breslow depth". J. Am. Acad. Dermatol. 57 (5 Suppl): S127–8. doi:10.1016/j.jaad.2006.02.007. PMID 17938027.
  4. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  5. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  6. ↑ Amin, Mahul (2017). AJCC cancer staging manual. Switzerland: Springer. ISBN 9783319406176.
  7. ↑ Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Schultz D; et al. (1989). "Model predicting survival in stage I melanoma based on tumor progression". J Natl Cancer Inst. 81 (24): 1893–904. PMID 2593166.
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