Staging system for melanoma
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 indicate the
seriousness of the disease.
Clinical staging system for melanoma| Category | Description |
|---|
Tumor (describes the primary
tumor) | - TX: Primary tumor cannot be
assessed.
- TO: No evidence of tumor
- Tis: Melanoma that
invades only the outer layer of skin (melanoma in situ)
- T1:
Melanoma is no more than 1.0 mm thick, with possible
ulceration.
- T2: Melanoma is no more than 2.0 mm thick, with
possible ulceration.
- T3: Melanoma is no more than 4.0 mm thick,
with possible ulceration.
- T4: Melanoma is greater than 4.0 mm
thick, 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:
Metastasis 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) | - MX: Spread of cancer to other organs cannot
be evaluated.
- M0: No evidence of melanoma cells elsewhere in the
body
- M1: Melanoma cells found somewhere else in the body
|
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 | Melanoma that invades only the outer layer of skin (melanoma in
situ) |
Stage 1A and 1B | Early-stage melanoma with low risk for spread of melanoma
cells. |
Stage IIA, IIB, and IIC | Melanoma is thicker than Stage 1, but no lymph node
involvement. Intermediate risk for spread of melanoma cells. |
Stage IIIA, IIIB, and IIIC | Lymph node involvement, ranging from intermediate risk to very
high risk for spread of melanoma cells |
Stage IV | Melanoma cells found in other parts of the body |
Citations
- American Joint Committee on Cancer (2002). Melanoma of the skin. In AJCC Cancer Staging Manual, 6th ed., pp. 209–220. New York: Springer-Verlag.
Last Updated:December 5, 2008
American Joint Committee on Cancer (2002). Melanoma of the skin. In AJCC Cancer Staging Manual, 6th ed., pp. 209–220. New York: Springer-Verlag.