MELANOMA OF SKIN (ICD‐O‐3 C44, C51.0, C60.9, C63.2)


MALIGNANT MELANOMA OF SKIN (ICD‐O‐3 C44, C51.0, C60.9, C63.2)


Rules for Classification


There should be histological confirmation of the disease.


Regional Lymph Nodes


The regional lymph nodes are those appropriate to the site of the primary tumour. See Regional Lymph Nodes under Skin Tumours.


TNM Clinical Classification


T – Primary Tumour


The extent of the tumour is classified after excision, see pT, page 000.


N – Regional Lymph Nodes




































NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in one regional lymph node or intralymphatic regional metastasis without nodal metastasis
N1a Only microscopic metastasis (clinically occult) (Fig. 357)
N1b Macroscopic metastasis (clinically apparent) (Fig. 358)
N1c  Satellite or in‐transit metastasis without regional nodal metastasis (Figs. 359, 360)
N2 Metastasis in two or three regional lymph nodes or intralymphatic regional metastasis with regional metastasis
N2a Only microscopic nodal metastasis (Fig. 361)
N2b Macroscopic nodal metastasis (Fig. 362)
N2c Satellite or in‐transit metastasis with only one regional nodal metastasis (Fig. 363)
N3 Metastasis in four or more regional lymph nodes (Fig. 364), or matted metastatic regional lymph nodes (Fig. 365), or satellite(s) or in‐transit metastasis with metastasis in regional lymph node(s) (Figs. 366, 367)

Note
Satellites are tumour nests or nodules (macro‐ or microscopic) within 2 cm of the primary tumour. In‐transit metastasis involves skin or subcutaneous tissue more than 2 cm from the primary tumour but not beyond the regional lymph nodes.

Schematic illustration of Only microscopic metastasis.

Fig. 357

Schematic illustration of Macroscopic metastasis.

Fig. 358

Schematic illustration of Satellite or in-transit metastasis without regional nodal metastasis.

Fig. 359

Schematic illustration of Satellite or in-transit metastasis without regional nodal metastasis.

Fig. 360

Schematic illustration of Only microscopic nodal metastasis.

Fig. 361

Schematic illustration of Macroscopic nodal metastasis.

Fig. 362

Schematic illustration of Satellite or in-transit metastasis with only one regional nodal metastasis.

Fig. 363

Schematic illustration of Metastasis in four or more regional lymph nodes.

Fig. 364

Schematic illustration of matted metastatic regional lymph nodes.

Fig. 365

Schematic illustration of satellite(s) or in-transit metastasis with metastasis in regional lymph node.

Fig. 366

Schematic illustration of satellite(s) or in-transit metastasis with metastasis in regional lymph node(s).

Fig. 367


M – Distant Metastasis


















M0 No distant metastasis
M1 Distant metastasis
M1a Skin, subcutaneous tissue or lymph node(s) beyond the regional lymph nodes (Figs. 324, 325, 326, 327)
M1b Lung
M1c Other sites, or any site with elevated serum lactate dehydrogenase (LDH)

pTNM Pathological Classification


pT – Primary Tumour


The pT classification of malignant melanoma considers the following histological criteria:



  1. Tumour thickness (Breslow) according to the largest vertical diameter of the tumour in millimetre (Fig. 368)
  2. Absence or presence of ulceration of the primary tumour
Schematic illustration of tumour thickness (Breslow) according to the largest vertical diameter of the tumour in millimetre.

Fig. 368












pTX Primary tumour cannot be assessed*
pT0 No evidence of primary tumour
pTis Melanoma in situ (Clark level I)

Note * pTX includes shave biopsies and curettage that do not fully assess the thickness of the primary.







































pT1 Tumour 1 mm or less in thickness
pT1a Less than 0.8 mm thickness without ulceration (Fig. 369)
pT1b Less than 0.8 mm in thickness with ulceration or 0.8 mm or more but no more than 1 mm in thickness, with or without ulceration (Fig. 370)
pT2 Tumour more than 1 mm but not more than 2 mm in thickness (Fig. 371)
pT2a without ulceration
pT2b with ulceration
pT3 Tumour more than 2 mm but not more than 4 mm in thickness (Fig. 372)
pT3a without ulceration
pT3b with ulceration
pT4 Tumour more than 4 mm in thickness (Fig. 373)
pT4a without ulceration
pT4b with ulceration
Schematic illustration of Less than 0.8 mm thickness without ulceration.

Fig. 369

Schematic illustration of Less than 0.8 mm in thickness with ulceration or 0.8 mm or more but no more than 1 mm in thickness, with or without ulceration.

Fig. 370

Schematic illustration of tumour more than 1 mm but not more than 2 mm in thickness.

Fig. 371

Schematic illustration of tumour more than 2 mm but not more than 4 mm in thickness.

Fig. 372

Schematic illustration of tumour more than 4 mm in thickness.

Fig. 373


pN – Regional Lymph Nodes


The pN categories correspond to the N categories. (Figs. 357, 358, 359, 360, 361, 362, 364, 365, 366, 367).






pN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. Classification based solely on sentinel node biopsy without subsequent axillary lymph node dissection is designated (sn) for sentinel node, e.g., pN1(sn). (See Introduction.)

pM – Distant Metastasis






pM1 Distant metastasis microscopically confirmed

Note
pM0 and pMX are not valid categories.


Summary

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Dec 15, 2022 | Posted by in ONCOLOGY | Comments Off on MELANOMA OF SKIN (ICD‐O‐3 C44, C51.0, C60.9, C63.2)
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