AJCC Staging Moments AJCC TNM Staging 7th Edition Melanoma Case #1 Contributors: Jeffrey E....
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Transcript of AJCC Staging Moments AJCC TNM Staging 7th Edition Melanoma Case #1 Contributors: Jeffrey E....
AJCC Staging Moments
AJCC TNM Staging 7th Edition
Melanoma Case #1
Contributors: Jeffrey E. Gershenwald, MD University of Texas MD Anderson Cancer Center, Houston, Texas Daniel G. Coit, MD Memorial Sloan-Kettering Cancer Center, New York, New York Charles M. Balch, MD Johns Hopkins Medical Center, Baltimore, Maryland David R. Byrd, MD University of Washington Medical Center, Seattle, Washington
Melanoma Case # 1Presentation of New Case
• Newly diagnosed melanoma patient
• Presentation at Cancer Conference for treatment recommendations and clinical staging
Melanoma Case # 1History & Physical
• 83 yr old female who presented with a 2cm maximal diameter brown lesion right cheek over the right malar eminence, no ulceration, no cervical lymphadenopathy
• No family hx
Used with permission. Marghoob A, Halpern A. Atlas of Cancer. Edited by Maurie Markman, Ashfaq A. Marghoob. ©2002 Current Medicine, Inc.
Melanoma Case # 1Imaging Results
• No imaging
Melanoma Case # 1Diagnostic Procedure
• Procedure– Excision skin lesion rt cheek
• Pathology Report– Melanoma in situ– Lentigo maligna type– Radial margin involved
Melanoma Case # 1Clinical Staging
• Clinical staging – Uses information from the physical exam, imaging,
and diagnostic biopsy
• Purpose– Select appropriate treatment– Estimate prognosis
Melanoma Case # 1Clinical Staging
• Synopsis- elderly patient with 2cm maximal diameter melanoma in situ lesion with margins involved, no lymphadenopathy
• What is the clinical stage?– T____– N____– M____– Stage Group______
Melanoma Case # 1Clinical Staging
• Clinical Stage correct answer– pTis– cN0– cM0– Stage Group 0
• Based on stage, treatment is selected
• Review NCCN treatment guidelines for this stage
Melanoma Case # 1Clinical Staging
• Rationale for staging choices– Tis for carcinoma in situ
– N0 because nodes were clinically negative on physical exam *
– M0 because there was nothing to suggest distant metastases *
* if there was, appropriate tests would be performed before developing a treatment plan
Prognostic FactorsClinically Significant
• Applicable to this case– Ulceration: no
Melanoma Case # 1Surgery & Findings
• Procedure– Re-excision skin lesion with 5mm margin
• Operative findings– No additional information
Melanoma Case # 1Pathology Results
• Residual melanoma in situ
• Lentigo maligna type
• Clark’s Level I
• Extends close to radial margins
Melanoma Case # 1Pathologic Staging
• Pathologic staging – Uses information from the clinical staging
supplemented or modified by information from surgery and the pathology report
• Purpose– Additional precise data for estimating prognosis– Calculating end results (survival data)
Melanoma Case # 1Pathologic Staging
• Synopsis- patient with melanoma in situ, Clark’s level I lesion, no nodes removed, clinically nodes negative
• What is the pathologic stage?(remember, clinical M may be used in pathologic staging)
– T____– N____– M____– Stage Group______
Melanoma Case # 1Pathologic Staging
• Pathologic Stage correct answer– pTis– cN0– cM0– Stage Group 0
• Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is selected
Melanoma Case # 1Pathologic Staging
• Rationale for staging choices– pTis for carcinoma in situ
– cN0 because there is an exception for pathologic Stage 0 and Stage IA, they do not require pathologic evaluation of nodes
– cM0 – use clinical M with pathologic staging unless there is pathologic confirmation of distant metastases
Prognostic FactorsClinically Significant
• Applicable to this case– Ulceration: no
• There are no prognostic factors required for staging
AJCC Cancer Staging AtlasTis is melanoma in situ
Melanoma Case # 1Recap of Staging
• Summary of correct answers– Clinical stage pTis cN0 cM0 Stage Group 0– Pathologic stage pTis cN0 cM0 Stage Group 0
• The staging classifications have a different purpose and therefore can be different. Do not go back and change the clinical staging based on pathologic staging information.
Staging Moments Summary
• Review site-specific information if needed
• Clinical Staging– Based on information before treatment– Used to select treatment options
• Pathologic Staging– Based on clinical data PLUS surgery and pathology
report information– Used to evaluate end-results (survival)