Part of Cancer staging guidance sheets

Malignant melanoma of skin (ICD10 C43, C51.0, C60.9, C63.2)

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Introduction

This is the data sheet for TNM 8th edition staging of the malignant melanoma of skin (ICD10 C43, C51.0, C60.9, C63.2)

For more detailed information regarding TNM staging, please see pages 142-146 of the UICC TNM 8 book or visit the Wiley and UICC website.

Stage groupings

Clinical stage

Stage Group	T stage	N stage	M stage
Stage 0	pTis	N0	M0
Stage IA	pT1a	N0	M0
Stage IB	pT1b	N0	M0
	pT2a	N0	M0
Stage IIA	pT2b	N0	M0
	pT3a	N0	M0
Stage IIB	pT3b	N0	M0
	pT4a	N0	M0
Stage IIC	pT4b	N0	M0
Stage III	Any pT	N1, N2, N3	M0
Stage IV	Any pT	Any N	M1

Pathological stage*

Stage Group	T stage	N stage	M stage
Stage 0	pTis	N0	M0
Stage I	pT1	N0	M0
Stage IA	pT1a	N0	M0
	pT1b	N0	M0
Stage IB	pT2a	N0	M0
Stage IIA	pT2b	N0	M0
	pT3a	N0	M0
Stage IIB	pT3b	N0	M0
	pT4a	N0	M0
Stage IIC	pT4b	N0	M0
Stage III	Any pT	N1, N2, N3	M0
Stage IIIA	pT1a, T1b, T2a	N1a, N2a	M0
Stage IIIB	pT1a, T1b, T2a	N1b, N1c, N2b	M0
	pT2b-T3a	N1, N2a, N2b	M0
Stage IIIC	pT1a, T1b, T2a, T2b, T3a	N2c, N3	M0
	pT3b, T4a	N1, N2, N3	M0
	pT4b	N1, N2	M0
Stage IIID	pT4b	N3	M0
Stage IV	Any pT	Any N	M1

Note: * If lymph node(s) are identified with no apparent primary the stage is as below

Stage IIIB	T0	N1b, N1c	M0
Stage IIIC	T0	N2b, N2c, N3b, N3c	M0

TNM clinical classification

T - primary tumour

The extent of the tumour is classified after excision, see pT.

N - regional lymph nodes

N value	Description
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in one regional lymph node or intralymphatic regional metastasis without nodal metastases N1a - Only microscopic metastasis (clinically occult) N1b - Macroscopic metastasis (clinically apparent) N1c - Satellite or in‐transit metastasis without regional nodal metastasis
N2	Metastasis in two or three regional lymph nodes or intralymphatic regional metastasis with lymph node metastases N2a - Only microscopic nodal metastasis N2b - Macroscopic nodal metastasis N2c - Satellite or in‐transit metastasis with only one regional nodal metastasis
N3	Metastasis in four or more regional lymph nodes, or matted metastatic regional lymph nodes, or satellite(s) or in‐transit metastasis with metastasis in two or more regional lymph node(s) N3a - Only microscopic nodal metastasis N3b - Macroscopic nodal metastasis N3c - Satellite(s) or in‐transit metastasis with two or more regional nodal metastasis

Notes: Satellites are tumour nests or nodules (macro‐ or microscopic) within 2 cm of the primary tumour. In‐transit metastasis involves skin or subcutaneous tissue more than 2 cm from the primary tumour but not beyond the regional lymph nodes.

M - distant metastasis

M value	Description
M0	No distant metastasis
M1	Distant metastasis* M1a - Skin, subcutaneous tissue or lymph node(s) beyond the regional lymph nodes M1b - Lung M1c - Other non‐central nervous system sites M1d - Central nervous system

M value

Description

No distant metastasis

Distant metastasis*

M1a - Skin, subcutaneous tissue or lymph node(s) beyond the regional lymph nodes

M1b - Lung

M1c - Other non‐central nervous system sites

M1d - Central nervous system

Note:

* Suffixes for M category: (0) lactic dehydrogenase (LDH) – not elevated (1) LDH – elevated so that M1a(1) is metastasis in skin, subcutaneous tissue, or lymph node(s) beyond the regional lymph nodes with elevated LDH.

No suffix is used if LDH is not recorded or unspecified.

TNM pathological classification

pT - primary tumour

pT value	Description
pTX	Primary tumour cannot be assessed*
pT0	No evidence of primary tumour
pTis	Melanoma in situ (Clark level I) (atypical melanocytic hyperplasia, severe melanocytic dysplasia, not an invasive malignant lesion)
pT1	Tumour 1 mm or less in thickness pT1a – less than 0.8 mm in thickness without ulceration pT1b – less than 0.8 mm in thickness with ulceration or 0.8 mm or more but no more than 1mm in thickness, with or without ulceration
pT2	Tumour more than 1 mm but not more than 2 mm in thickness pT2a - without ulceration pT2b - with ulceration
pT3	Tumour more than 2 mm but not more than 4 mm in thickness pT3a - without ulceration pT3b - with ulceration
pT4	Tumour more than 4 mm in thickness pT4a - without ulceration pT4b - with ulceration

* pTX includes shave biopsies and regressed melanomas

pN - regional lymph nodes

The pN categories correspond to the N categories

pN value	Description
pN0	Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. Classification based solely on sentinel node biopsy without subsequent axillary lymph node dissection is designated (sn) for sentinel node, e.g., (p)N1(sn).