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.

References:

NCCN Clinical Practice Guidelines in Oncology: Melanoma. V.3. 2011.
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.