Malignant melanoma
Staging is the process that determines how much cancer is present and where it is located. It describes the severity of a tumor according to the extension of the tumor and possible spread to lymphnodes or other organs. Recognizing the status of the disease allows the physician to formulate a prognosis and to implement the most effective therapy according to the stage of disease
The American Joint Committee on Cancer (AJCC) TNM System
T (describe the tumor, its size and its extension into the skin)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Melanoma in situ
T1 Melanoma < 1.0 mm in thickness with or without ulceration
T1a Melanoma < 1.0 mm in thickness and level II or III, no ulceration
T1b Melanoma < 1.0 mm in thickness and level IV or V or with ulceration
T2 Melanoma 1.01-2 mm in thickness with or without ulceration
T2a Melanoma 1.01-2.0 mm in thickness, no ulceration
T2b Melanoma 1.01-2.0 mm in thickness, with ulceration
T3 Melanoma 2.01-4 mm in thickness with or without ulceration
T3a Melanoma 2.01-4.0 mm in thickness, no ulceration
T3b Melanoma 2.01-4.0 mm in thickness, with ulceration
T4 Melanoma greater than 4.0 mm in thickness with or without ulceration
T4a Melanoma > 4.0 mm in thickness, no ulceration
T4b Melanoma > 4.0 mm in thickness, with ulceration
N (regional lymph nodes)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in one lymph node
N1a Clinically occult (microscopic) metastasis
N1b Clinically apparent (macroscopic) metastasis
N2 Metastasis in two to three regional nodes or intralymphatic regional metastasis without nodal metastases
N2a Clinically occult (microscopic) metastasis
N2b Clinically apparent (macroscopic) metastasis
N2c Satelliteor in-transit metastasis without nodal metastasis
N3 Metastasis in four or more regional nodes, or matted metastatic nodes, or in-transit metastasis or satellite(s) with metastasis in regional node(s)
M (distant metastasis)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Metastasis to skin, subcutaneous tissues or distant lymph nodes
M1b Metastasis to lung
M1c Metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactic dehydrogenase
Staging (SR – survival rate):
Stage 0: Tis, N0, M0: melanoma in situ
Stage IA: T1a, N0, M0: (SR: 99 %)
Stage IB: T1b o T2a, N0, M0: (SR: 92 %)
Stage IIA: T2b o T3a, N0, M0: (SR: 78 %)
Stage IIB: T3b o T4a, N0, M0: (SR: 68%)
Stage IIC: T4b, N0, M0: (SR: 56 %)
Stage IIIA: T1a-4a, N1a o N2a, M0: (SR: not avaible )
Stage IIIb: T1b-4b, N1a o N2a, M0 or T1a-4a, N1b o N2b, M0 or T1a/b-4a/b, N2c, M0: (SR: 50 %)
Stage IIIC: T1b-4b, N1b o N2b, M0 or anyT, N3, M0: (SR: 27 %)
Stage IV: any T, any N, M1: (SR: 18 %)