Cancer and its management (7th edition) J Tobias and D Hochhauser Blackwell, 2015. AJCC 7th Edition Melanoma Staging Postneoadjuvant therapy staging Clinical trials with chemotherapy and immunotherapy2018. This webinar is sponsored by The Centers for Disease Control and Prevention.
Some stages are split further, using capital letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread. PURPOSE To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging.The earliest stage melanomas are stage 0 (melanoma in situ), and then range from stages I (1) through IV (4). The Eighth Edition of the AJCC Cancer Staging. •Introduction and Overarching Vision of AJCC Staging. Non Melanoma Skin Cancer Pathogenesis Overview D
Tumor thickness: The thickness of the melanoma is called the Breslow measurement. How is the stage determined?The staging system most often used for melanoma is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:The extent of the main (primary) tumor (T): How deep has the cancer grown into the skin? Is the cancer ulcerated? Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way. And within a stage, an earlier letter means a lower stage.
Melanomas that are ulcerated tend to have a worse outlook.The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?The spread ( metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs ? (Melanoma can spread almost anywhere in the body, but the most common sites of spread are the lungs, liver, brain, bones, and the skin or lymph nodes in other parts of the body.)Numbers or letters after T, N, and M provide more details about each of these factors. Ulceration: Ulceration is a breakdown of the skin over the melanoma. As the melanoma becomes thicker, it has a greater chance of spreading.
This is determined by examining tissue removed during an operation. The staging system in the table below uses the pathologic stage (also called the surgical stage). For more information, see Cancer Staging. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.
If your cancer has been clinically staged, it is best to talk to your doctor about your specific stage.The table below is a simplified version of the most recent TNM system, effective as of 2018.Melanoma staging can be very complex, so if you have any questions about the stage of your cancer or what it means, ask your doctor to explain it to you in a way you understand.The cancer is confined to the epidermis, the outermost skin layer (Tis). Sometimes, though, the cancer has spread farther than the clinical stage estimates, so it may not predict a person’s outlook as accurately as a pathologic stage. The clinical stage will be used to help plan treatment. This is based on the results of physical exams, biopsies, and imaging tests (as described in Tests for Melanoma Skin Cancer).
The cancer has spread to 1 to 3 nearby lymph nodes, but it is so small that it is only seen under the microscope (N1a or N2a). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).The tumor is no more than 2 mm thick and might or might not be ulcerated (T1 or T2a). It might or might not be ulcerated. The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0)The tumor is more than 1 mm thick (T2b or T3) and may be thicker than 4 mm (T4).
It has spread to 2 or 3 nearby lymph nodes (N2a or N2b) It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (without reaching the nearby lymph nodes) (N1c) OR The cancer has spread to only one nearby lymph node (N1a or N1b) OR It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (without reaching the nearby lymph nodes) (N1c)It has not spread to distant parts of the body (M0).The tumor is no more than 4 mm thick and might or might not be ulcerated (T1, T2, or T3a) AND: The cancer has spread to only one nearby lymph node (N1b) OR
It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it might (N2c) or might not (N1c) have reached 1 nearby lymph node) The cancer has spread to 1 to 3 nearby lymph nodes, which are not clumped together (N1a/b or N2a/b) OR The cancer has spread to 4 or more nearby lymph nodes (N3a or N3b), or it has spread to nearby lymph nodes that are clumped together (N3b or N3c)The tumor is more than 2 mm but no more than 4 mm thick and is ulcerated (T3b) OR it is thicker than 4 mm but is not ulcerated (T4a).The cancer has spread to one or more nearby lymph nodes AND/OR it has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (N1 or higher).It has not spread to distant parts of the body.The tumor is thicker than 4 mm and is ulcerated (T4b) AND: The cancer has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it has reached nearby lymph nodes (N2c or N3c) OR It has spread to nearby lymph nodes that are clumped together (N3b or N3c)The tumor is no more than 4 mm thick, and might or might not be ulcerated (T1, T2, or T3a) AND : It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it has reached the nearby lymph nodes (N2c or N3c) OR
It has spread to distant lymph nodes or to organs such as the lungs, liver or brain (M1). The cancer might or might not have spread to nearby lymph nodes (any N). It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, AND it has spread to at least 2 nearby lymph nodes, or to lymph nodes that are clumped together (N3c) ORThe tumor can be any thickness and might or might not be ulcerated (any T). It has spread to nearby lymph nodes that are clumped together (N3b)
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