Staging system for melanoma

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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

References

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.

Credits

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Denele Ivins
Associate Editor	Pat Truman
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Randall D. Burr, MD - Dermatology
Last Updated	January 11, 2007

Last updated:	January 11, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Kathleen Romito, MD - Family Medicine, Randall D. Burr, MD - Dermatology
Editors:	Kathleen M. Ariss, MS, Pat Truman

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