Topic Overview
The American Joint Committee on
Cancer has developed a system for classifying cancers according to the extent
of the cancer. Complete excision of the melanoma is followed by assessment of
lymph nodes and other parts of the body to determine whether the cancer has
spread. The staging system looks at other factors that have been found to
affect survival, such as tumor thickness (Breslow level), depth of invasion
(Clark level), and
ulceration.1
Two systems are used for staging melanoma.
- The clinical staging system uses information gained from the removal of the melanoma and from
blood tests and X-rays for any spread of the cancer.
- The
pathologic staging system uses information gained from
the removal of the melanoma and from pathological exam after
lymph nodes are removed (lymphadenectomy).
The clinical staging system uses the letter T to describe
primary tumors, the letter N to describe lymph node involvement, and the letter
M for metastases (spread). Numbers after each of these letters show the
seriousness of the disease.
Clinical staging system for melanoma| Category | Description |
|---|
Tumor (describes the primary
tumor) | - TX: Primary tumor cannot be
assessed.
- T0: No evidence of primary tumor
- Tis: Melanoma that
invades only the outer layer of skin (melanoma in situ)
- T1:
Melanomas 1.0 mm or less in thickness, with possible
ulceration
- T2: Melanomas 1.01–2.0 mm, with possible ulceration
- T3: Melanomas 2.01–4.0 mm, with possible ulceration
- T4: Melanomas more than 4.0 mm, with possible ulceration
|
Nodes (describes whether cancer has
spread into the lymph nodes) | - NX: Lymph nodes cannot be
examined.
- N0: No metastasis found in lymph nodes.
- N1:
Metastases based on number of metastatic nodes and is present in one lymph node.
- N2: Metastasis present in
2 or 3 lymph nodes.
- N3: Metastasis is present in four or more lymph
nodes.
|
Metastasis (describes the extent of
cancer spread outside primary melanoma site) | - M0: No evidence of melanoma cells elsewhere in the
body
- 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 combined with an elevated serum LDH
|
The pathologic staging system uses all the above information
and adds the pathologic evaluation of the lymph nodes and the examination of
any evidence of melanoma spread.
Pathologic staging system for melanoma| Pathologic stage | Description |
|---|
Stage 0 | Tis, N0, M0 |
Stage 1A | T1a, N0, M0 |
Stage 1B | 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 IIIA | T1–4a, N1a, M0 T1–4a, N2a, M0 |
Stage IIIB | T1–4b, N1a, M0 T1–4b, N2a, M0 T1–4a, N1b, M0 T1–4a, N2b, M0 T1–4a, N2c, M0 |
Stage IIIC | T1–4b, N1b, M0 T1–4b, N2b, M0 T1–4b, N2c, M0 Any T, N3, M0 |
Stage IV | Any T, Any N, M1 |
References
Citations
- American Joint Committee on Cancer (2010). Melanoma of the skin. In AJCC Cancer Staging Manual, 7th ed., pp. 325–344. New York: Springer.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Alexander H. Murray, MD, FRCPC - Dermatology |
|---|
| Last Revised | December 17, 2010 |
|---|
Last Revised:
December 17, 2010
American Joint Committee on Cancer (2010). Melanoma of the skin. In AJCC Cancer Staging Manual, 7th ed., pp. 325–344. New York: Springer.