User:Dawnarmstrong4/sandbox

Staging[edit]
Further context on cancer staging is available at TNM.

Melanoma staging guidelines as per AJCC Cancer Staging Manual 8thedition (in effect as of 2018)

Stage 0:  Melanoma in-situ

Stage I : thin melanoma, 98–94% 10-year survival


 * T1a: tumour thickness < 0.8 mm without ulceration
 * T1b: tumour thickness 0.8 to 1.0 mm; or tumour thickness ≤ 1.0 mm with ulceration
 * T2a: tumour thickness >1.0–2.0 mm, without ulceration

Stage II: thick melanoma, 88–75% 10-year survival


 * T2b: tumour thickness >1.0–2.0 mm, with ulceration
 * T3a: tumour thickness >2.0–4.0 mm, without ulceration
 * T3b: tumour thickness >2.0–4.0 mm, with ulceration
 * T4a: tumour thickness >4.0 mm, without ulceration
 * T4b: tumour thickness >4.0 mm, with ulceration

Stage III: Regional metastasis, 88-24% 10 year survival


 * N1: Single positive lymph node or in-transit, satellite, and/or microsatellite metastases with no tumour-involved nodes
 * N2: Two to three positive lymph nodes or in-transit, satellite, and/or microsatellite metastases with one tumour-involved node
 * N3: Four positive lymph nodes or in-transit, satellite, and/or microsatellite metastases with two or more tumour-involved nodes, or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases

Stage IV: Distant metastasis, survival data not available (see note)


 * M1a: Distant metastasis to skin, soft tissue including muscle, and/or non-regional lymph node
 * M1b: Lung metastasis
 * M1c: non-central nervous system visceral metastasis
 * M1d: central nevous system metastasis

Note:


 * 1) In recent years, targeted therapies and immunotherapies used in the setting of metastatic melanoma have significant improved survival of stage IV melanoma patients. New therapies are still evolving, thus survival data for the metastatic melanoma group is not available. In the 7thAJCC melanoma staging, which is before the advent of these new therapies, Stage IV 5 year survival is 7-19%.
 * 2) LDH level plays a role in subdividing the M categories.

3.     1 - Gershenwald, J. E., & Scolyer, R. A. (2018). Melanoma Staging: American Joint Committee on Cancer (AJCC) and Beyond. Annals of surgical oncology, 1-6.

4.     2 - Edge, S. B., & American Joint Committee on Cancer. (2010). AJCC cancer staging handbook: from the AJCC cancer staging manual(Vol. 2010, p. 718). New York: Springer.