The Revised AJCC TNM Staging System for Cutaneous Malignant Melanoma

Description

The American Joint Committee on Cancer (AJCC) has revised its staging classification for cutaneous malignant melanoma. This incorporates factors useful for predicting risk of metastasis and prognosis. It was developed by Melanoma Staging Committee with members from 15 institutions from 4 continents.

Parameters:

(1) thickness in mm

(2) Clark's level

(3) cutaneous ulceration

(4) lymph node involvement

(5) metastases

Group	Parameter	Additional Parameter	Code
T	thickness <= 1.0 mm	without ulceration AND Clark level II or III	T1a
	thickness <= 1.0 mm	with ulceration, OR Clark level IV or V	T1b
	thickness 1.01 – 2.0 mm	without ulceration	T2a
	thickness 1.01 – 2.0 mm	with ulceration	T2b
	thickness 2.01 – 4.0 mm	without ulceration	T3a
	thickness 2.01 – 4.0 mm	with ulceration	T3b
	thickness > 4.0 mm	without ulceration	T4a
	thickness > 4.0 mm	with ulceration	T4b
N	1 node	micrometastasis (diagnosed on histology)	N1a
	1 node	macrometastasis (clinically detectable nodal metastasis OR gross extracapsular extension)	N1b
	2 or 3 nodes	micrometastasis	N2a
	2 or 3 nodes	macrometastasis	N2b
		in transit metastasis or satellite lesions without metastasis to nodes	N2c
	4 or more nodes, OR matted nodes, OR in transit metastasis/satellite lesions with metatastic nodes		N3
M	distant skin, subcutaneous tissue or nodal metastasis	normal LDH	M1a
	lung metastasis	normal LDH	M1b
	all other visceral metastasis	normal LDH	M1c
	all distant metastasis	elevated LDH	M1c

where:

• The level of invasion is not as accurate, reproducible or quantitative as thickness and ulceration. However, for T1 lesions it still is associated with prognosis. (I am not sure if I have ever seen a level IV or V tumor that is <= 1 mm thick.)

• My reading of N2c is that it consists of transit metastasis or satellite lesions but is not associated with nodal involvement.

T Code	N Code	M Code	Clinical Stage
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	N1, N2 or N3	M0	III
any T	any N	any M	IV

The Pathologic Stage is the same as the Clinical Stage except that it recognizes 3 subgroups to Stage III.

T Code	N Code	M Code	Clinical Stage
T(1 to 4)a	N1a or N2a	M0	IIIA
T(1 to 4)a	N1b, N2b, or N2c	M0	IIIB
T(1 to 4)b	N1a or N2a	M0	IIIB
T(1 to 4)b	N1b, N2b, or N2c	M0	IIIC
any T	N3	M0	IIIC

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The Revised AJCC TNM Staging System for Cutaneous Malignant Melanoma

Description

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