Staging and prognosis

Staging is the process of determining how much cancer is present and where it is located. It then describes the severity of a malignancy based on the extent of the malignancy and whether it has spread to lymph nodes or other organs.

Staging is the process of determining how much cancer is present and where it is located. It then describes the severity of a malignancy based on the extent of the malignancy and whether it has spread to lymph nodes or other organs.

Melanoma
Melanoma

Recognizing the state of the disease allows the doctor to formulate a prognosis and to implement the most effective therapy based on the stage of the tumor

The American Joint Committee on Cancer (AJCC) TNM System

T (describes the tumor, its size and its extension within the skin):

  • TX: the tumor cannot be studied
  • T0: no evidence of the primary tumor
  • T1s: Melanoma in situ (Clark level I)
  • T1a: thickness less than or equal to 1 mm without ulceration and with Clark level II or III
  • T1b: thickness less than or equal to 1 mm without ulceration and with Clark level IV or V or with ulceration
  • T2a: thickness between 1.01 and 2.0 mm without ulceration
  • T2b: thickness between 1.01 and 2.0 mm with ulceration
  • T3a: thickness between 2.01 and 4.0 mm without ulceration
  • T3b: thickness between 2.01 and 4.0 mm with ulceration
  • T4a: thickness greater than 4 mm without ulceration
  • T4b: thickness greater than 4 mm with ulceration

N (refers to regional lymph nodes and depends on whether the sentinel node was removed):

  • NX: lymph nodes not investigated
  • N0: no lymph node dissemination
  • N1a: occult dissemination to 1 satellite lymph node
  • N1b: dissemination to a clinically apparent lymph node
  • N2a: dissemination to 2 or 3 satellite lymph nodes, or regional intralymphatic metastases without clinically occult nodal metastasis
  • N2b: dissemination to 2 or 3 satellite lymph nodes, or regional intralymphatic metastases without clinically apparent nodal metastases
  • N2c: satellitosis or metastasis in transit without lymph node location
  • N3: dissemination to 4 or more regional lymph nodes, or metastasis in transit or satellitosis associated with lymph node metastases

Category M (refers to distant metastases).

  • MX: distant metastases cannot be evaluated
  • M0: no distant metastases
  • M1a: distant metastases to the skin or subcutis or distant lymph nodes
  • M1b: metastasis to lung
  • M1c: metastasis to other organs  or associated with high levels of LDH

Staging (SR – survival rate):

  • Stage 0: Tis, N0, M0: melanoma in situ
  • Stage IA: T1a, N0, M0: (SR: 99 %)
  • Stage IB: T1b or T2a, N0, M0: (SR: 92 %)
  • Stage IIA: T2b or T3a, N0, M0: (SR: 78 %)
  • Stage IIB: T3b or T4a, N0, M0: (SR: 68%)
  • Stage IIC: T4b, N0, M0: (SR: 56 %)
  • Stage IIIA: T1a-4a, N1a or N2a, M0: (SR: not available)
  • Stage IIIB: T1b-4b, N1a or N2a, M0 or T1a-4a, N1b or N2b, M0 or T1a/b-4a/b, N2c, M0: (SR: 50 %)
  • Stage IIIC: T1b-4b, N1b or N2b, M0 or any T, N3, M0: (SR: 27 %)
  • Stage IV: any T, any N, M1: (SR: 18 %)

Download the PDF of the “Melanoma staging poster”