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Staging

Revised June 8, 2016


1. Classification Criteria Used for Melanoma Staging

Please refer to the2010 edition of the AJCC staging system and see references.

Primary Tumour

T Classification

Thickness (mm)

Ulceration Status/Mitotic Rate

T1

≤ 1.0

a: without ulceration and <1 mitosis/mm2
b: with ulceration or ≥ 1 mitosis/mm2

T2

1.01 - 2.0

a: without ulceration
b: with ulceration

T3

2.01 – 4.0

a: without ulceration
b: with ulceration

T4

>4.0

a: without ulceration
b: with ulceration

TX primary tumour cannot be assessed; T0 no evidence of primary tumour; 
Tis melanoma in situ

Regional Lymph Nodes

N Classification

Number of Metastatic Nodes

Nodal Metastatic Mass

N1

1 node

a: micrometastasis
b: macrometastasis

N2

2-3 nodes

a: micrometastasis
b: macrometastasis
c: in transit met(s)/satellite(s) without metastatic nodes

N3

4 or more nodes, or matted nodes, or in transit met(s) with metastatic nodes

 

 

Distant Metastasis

M Classification

Site

Serum LDH

M1a

Distant skin, subcutaneous or nodal metastases

Normal

M1b

Lung metastases

Normal

M1c

All other visceral metastases
Any distant metastasis

Elevated

 

Clinical Staging

Stage 0

Tis

N0

M0

Stage IA

T1a

N0

M0

Stage IB

T1b
T2a

N0
N0

M0
M0

Stage IIA

T2b
T3a

N0
N0

M0
M0

Stage IIB

T3b
T4a

N0
N0

M0
M0

Stage IIC

T4b

N0

M0

Stage III

Any T

≥N1

M0

Stage IV

Any T

Any N

M1


2 Investigations for Staging

The initial staging work-up should include a thorough history and physical examination, with special attention to the skin and lymph nodes. Any abnormal finding should direct the need for further studies to detect regional and distant metastases. In asymptomatic patients with localized melanoma of any thickness, routine blood tests and imaging studies are not recommended. LDH is an insensitive marker for metastatic disease and is not clinically useful. Routine surveillance chest x-ray, computed tomography (CT) and positron emission tomography (PET) are limited by a low yield for the detection of metastases and a relatively high false-positive rate. Imaging studies should be performed only as clinically indicated for the investigation of suspicious signs or symptoms which may alter clinical management.

Sentinel lymph node biopsy (SLNB) is a staging procedure for melanoma that is optional. For a discussion of its role in melanoma staging, see section 6.2

Referen​​​​ces:

  1. NCCN Clinical Practice Guidelines in Oncology: Melanoma. V.3. 2011.
  2. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. Melanoma of the skin. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer-Verlag; 2010.

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