Summary Stage 2018: Melanoma Skin
Summary Stage 2018
Notes
**Melanoma Skin**
8720-8790 (C000-C002, C006, C440-C449, C500, C510-C512, C518-C519, C600-C602, C608-C609, C632)
**Note 1:** The following sources were used in the development of this chapter
* SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998) (https://seer.cancer.gov/archive/manuals/EOD10Dig.3rd.pdf)
* SEER Summary Staging Manual-2000: Codes and Coding Instructions (https://seer.cancer.gov/tools/ssm/ssm2000/)
* Collaborative Stage Data Collection System, version 02.05: https://cancerstaging.org/cstage/Pages/default.aspx
* Chapter 47 *Melanoma of the Skin*, in the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Used with permission of the American College of Surgeons, Chicago, Illinois.
**Note 2:** For melanoma of sites other than those above
* C003-C005, C008-C069, C090-C148, C300-C329: See Melanoma Head and Neck
* C690: See Melanoma Conjunctiva
* C693, C694: See Melanoma Uvea
* For all other sites, use the appropriate site-specific schema
**Note 3:** If there is a discrepancy between the Clark level and the pathological description of extent (invasion into the layers of the dermis), use the higher (more extensive) code.
**Note 4:** Code the greatest extent of invasion from any procedure performed on the lesion, whether it is described as a biopsy or an excision. For example, if a punch biopsy with involvement of Clark level IV is followed by a re-excision with residual tumor involving Clark level II, code 2 (Clark level IV).
**Note 5:** If a Breslow’s depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (***Note:** If a physician documents a different Clark's Level then provided by these guidelines, go with the physician's Clark Level*)
+ In situ: Level 1
+ Localized
- Level II (< 0.75 mm Breslow’s Depth)
- Level III (0.76 mm to 1.50 mm Breslow’s Depth)
- Level IV (> 1.50 mm Breslow’s Depth)
+ Regional
- Level V: Through entire dermis
**Note 6:** Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction).
* Lymph nodes with isolated tumor cells (ITCs) are counted as positive lymph nodes
**Note 7:** In-transit, satellite, and/or microsatellite metastasis are metastasis that have occurred via lymphatic or angiolymphatic spread. Satellite nodules are subcutaneous metastasis that occur within 2 cm of the primary tumor. Microsatellite metastasis are microscopic cutaneous metastasis found adjacent or deep to a primary melanoma tumor.
* In-transit, satellite, and/or microsatellite metastasis are counted as positive nodes
**Note 8:** Bilateral or contralateral nodes are classified as regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy.
* Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed
**Note 9:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins and are coded as regional nodes.
| SS2018 |
Description |
| 0 |
In situ, intraepithelial, noninvasive
- Basement membrane of the epidermis is intact
- In situ, intraepidermal, intraepithelial, noninvasive
+ Clark level I |
| 1 |
Localized only (localized, NOS)
- Papillary dermis invaded
+ Clark level II
- Papillary-reticular dermal interface invaded
+ Clark level III
- Reticular dermis invaded
+ Clark level IV
- Skin/dermis, NOS |
| 2 |
Regional by direct extension only
- Subcutaneous tissue (through entire dermis)
+ Clark level V |
| 3 |
Regional lymph node(s) involved only
- All sites (Single, Multiple, Ipsilateral) (See Code 7 for contralateral or bilateral nodes (except for head and neck skin primaries))
+ Isolated tumor cells (ITCs) WITH or WITHOUT regional lymph node involvement
+ In-transit, satellite, and/or microsatellite metastasis WITH or WITHOUT regional lymph node involvement
+ Regional lymph node(s), NOS
* Lymph node(s), NOS
- Head and Neck skin primaries only (C000-C002, C006, C440, C442-C444) (includes contralateral and bilateral nodes)
+ Levels I-VII
+ Axillary (neck only, C444)
+ Cervical, NOS
+ Deep cervical, NOS
+ Facial (buccinator, buccal, nasolabial)
+ Internal jugular, NOS
+ Parapharyngeal
+ Parotid (infraauricular, intraparotid, periparotid, preauricular)
+ Retroauricular (mastoid)
+ Retropharyngeal
+ Suboccipital
- Skin of trunk (C445)
+ Upper trunk
* Axillary
* Cervical
* Internal mammary
* Supraclavicular
+ Lower trunk
* Superficial inguinal (femoral)
- Skin of upper limb and shoulder (C446)
+ Axillary
+ Cervical
+ Epitrochlear for hand/forearm
+ Internal mammary (parasternal)
+ Spinal accessory for shoulder
+ Supraclavicular (transverse cervical)
- Skin of lower limb and hip (C447)
+ Femoral (superficial inguinal)
+ Inguinal
+ Popliteal for heel and calf
- Vulva (C510-C512, C518-C519)
+ Deep inguinal, NOS
+ Femoral
+ Inguinal, NOS
+ Inguinofemoral (groin)
+ Node of Cloquet or Rosenmuller (highest deep inguinal)
+ Superficial inguinal (femoral)
- Penis (C600-C602, C608-C609)
+ Iliac, NOS
* External
* Internal (hypogastric, obturator)
+ Inguinal, NOS
* Node of Cloquet or Rosenmuller (highest deep inguinal)
* Superficial [femoral]
+ Pelvic, NOS
- Scrotum (C632)
+ Iliac, NOS
* External
* Internal (hypogastric), NOS
- Obturator
+ Inguinal, NOS
* Deep inguinal, NOS
- Node of Cloquet or Rosenmuller (highest deep inguinal)
* Superficial inguinal (femoral) |
| 4 |
Regional by BOTH direct extension AND regional lymph node(s) involved
- Codes (2) + (3) |
| 7 |
Distant site(s)/lymph node(s) involved
- Distant site(s) (including further contiguous extension)
+ Bone
+ Central nervous system (CNS)
+ Lung
+ Skeletal muscle (including direct extension)
+ Skin or subcutaneous tissue beyond regional lymph nodes
+ Underlying cartilage
+ Visceral metastasis, NOS
- Distant lymph node(s), NOS
+ Axillary (lower trunk)
+ Femoral (cephalad/caudal) (upper trunk)
+ Iliac (leg/hip)
- Distant metastasis, NOS
+ Carcinomatosis
+ Distant metastasis WITH or WITHOUT distant lymph node(s) |
| 9 |
Unknown if extension or metastasis |
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998
(2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001.
(3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05**. American Joint Committee on Cancer (Chicago, IL)
(4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
(5) Gershenwald, J.E., Scolyer, R.A., et al. **Melanoma of the Skin**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
