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Melanoma/Skin Cancer Health Center

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Melanoma/Skin Cancer Health Center

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Melanoma - 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

WebMD Medical Reference from Healthwise

Last Updated: December 17, 2010

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.