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Clinical and Pathologic AJCC Stages/Prognostic Groups

Clinical Stage¹

Clinical T

Clinical N

Clinical M

Pathologic Stage²

Pathologic T

Pathologic N

Pathologic M

0

Tis

N0

M0

0

Tis

N0

M0

IA

T1a

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

IB

T1b

N0

M0

 

T2a

N0

M0

 

T2a

N0

M0

IIA

T2b

N0

M0

IIA

T2b

N0

M0

 

T3a

N0

M0

 

T3a

N0

M0

IIB

T3b

N0

M0

IIB

T3b

N0

M0

 

T4a

N0

M0

 

T4a

N0

M0

IIC

T4b

N0

M0

IIC

T4b

N0

M0

III

Any T

≥ N1

M0

IIIA

T1-4a

N1a

M0

 

 

 

 

 

T1-4a

N2a

M0

 

 

 

 

IIIB

T1-4b

N1a

M0

 

 

 

 

 

T1-4b

N2a

M0

 

 

 

 

 

T1-4a

N1b

M0

 

 

 

 

 

T1-4a

N2b

M0

 

 

 

 

 

T1-4a

N2c

M0

 

 

 

 

IIIC

T1-4b

N1b

M0

 

 

 

 

 

T1-4b

N2b

M0

 

 

 

 

 

T1-4b

N2c

M0

 

 

 

 

 

Any T

N3

M0

IV

Any T

Any N

M1

IV

Any T

Any N

M1

¹Clinical staging includes microstaging of the primary melanoma and clinical/radiologic evaluation for metastases. By convention, it should be used after complete excision of the primary melanoma with clinical assessment for regional and distant metastases. 
²Pathologic staging includes microstaging of the primary melanoma and pathologic information about the regional lymph nodes after partial or complete lymphadenectomy. Pathologic stage 0 or stage IA patients are the exception; they do not require pathologic evaluation of their lymph nodes.

(T) Primary Tumor

TNM

Definitions

TX

Primary tumor cannot be assessed (e.g., curettaged or severely regressed melanoma)

T0

No evidence of primary tumor

Tis

Melanoma in situ

T1

Melanomas ≤ 1.0 mm in thickness

T1a

Melanomas ≤ 1.0 mm in thickness without ulceration and mitosis < 1/mm²

T1b

Melanomas ≤ 1.0 mm in thickness with ulceration or mitoses ≥ 1/mm²

T2

Melanomas 1.01-2.0 mm

T2a

Melanomas 1.01-2.0 mm without ulceration

T2b

Melanomas 1.01-2.0 mm with ulceration

T3

Melanomas 2.01-4.0 mm

T3a

Melanomas 2.01-4.0 mm without ulceration

T3b

Melanomas 2.01-4.0 mm with ulceration

T4

Melanomas > 4.0 mm

T4a

Melanomas > 4.0 mm without ulceration

T4b

Melanomas > 4.0 mm with ulceration

¹Micrometastases are diagnosed after sentinel lymph node biopsy and completion lymphadenectomy (if performed). ²Macrometastases are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or when nodal metastasis exhibits gross extracapsular extension.

(N) Regional Lymph Nodes

NX

Patients in whom regional nodes cannot be assessed (e.g., previously removed for another reason)

N0

No regional metastases detected

N1

1 metastatic node

N1a

1 metastatic node and micrometastasis¹

N1b

1 metastatic node and macrometastasis²

N2

2-3 metastatic nodes

N2a

2-3 metastatic nodes and micrometastasis¹

N2b

2-3 metastatic nodes and macrometastasis²

N2c

2-3 metastatic nodes and in transit met(s)/satellite(s) without metastatic nodes

N3

≥ 4 metastatic nodes, or matted nodes, or in transit met(s)/satellite(s) with metastatic node(s)

(M) Distant Metastasis

M0

No detectable evidence of distant metastases

M1a

Metastases to skin, subcutaneous tissues, or distant lymph nodes

M1b

Metastases to lung

M1c

Metastases to all other visceral sites or distant metastases to any site associated with an elevated serum LDH

Χαρακτηριστικά Επέκτασης
  • Growth patterns
    • Some melanomas exhibit in situ growth phase (radial growth) before potential dermal invasion (vertical growth)
      • e.g., superficial spreading, lentigo maligna, and acral lentiginous melanoma
  • Nodular melanoma exhibits vertical growth phase from onset
  • Accounts for its aggressiveness
  • Direct extension
  • Spread through lymphatic system to lymph nodes (regional or distant)
    • Autopsy series showed nodal metastasis in nearly 3/4 of patients
  • Hematogenous spread
  • Melanoma spread can occur by 3 primary routes from primary lesion
  • Skin
  • Subcutaneous soft tissues
  • Lung
  • Brain
  • Most common sites of metastases are regional lymph nodes
  • Distant metastases

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Melanocytic tumors (WHO classification)

  • Malignant melanoma
    • Superficial spreading melanoma
    • Nodular melanoma
    • Lentigo maligna
    • Acral lentiginous melanoma
    • Desmoplastic melanoma
    • Melanoma arising from blue nevus
    • Melanoma arising in giant congenital nevus
    • Melanoma of childhood
    • Nevoid melanoma
    • Persistent melanoma

Major melanoma subtypes (organized by histological characteristics)

  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma