Summary Stage 2018: Merkel Cell Skin
Summary Stage 2018
Notes
**Merkel Cell Skin** 8041, 8190, 8247 (C000-C006, C008-C009, C440-C449, C510-C512, C518-C519, C600-C602, C608-C609, C632) 8190, 8247 (C809) **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 46 *Merkel Cell Carcinoma*, 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:** Merkel cell carcinoma presenting in nodal or visceral site with primary site unknown is coded to C449, Skin, NOS. **Note 3:** 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 4:** In transit metastasis is defined as a tumor distinct from the primary lesion and located either between the primary lesion and the draining regional lymph node(s) or distal to the primary lesion. In transit metastasis with positive lymph node(s) are coded under regional lymph nodes. * In-transit metastasis are counted as positive nodes **Note 5:** 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 6:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins and are coded as regional nodes.NAACCR Item
NAACCR #764| SS2018 | Description |
|---|---|
| 0 | In situ, intraepidermal, intraepithelial, noninvasive |
| 1 | Localized only (localized, NOS) - Confined to site of origin - Lesion(s) confined to dermis - Subcutaneous tissue (through entire dermis) |
| 2 | Regional by direct extension only - Bone - Cartilage - Fascia - Skeletal muscle |
| 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 mets 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 + Cartilage + Fascia + Lung + Other visceral sites + Skeletal muscle (excluding direct extension) + Skin or subcutaneous tissue beyond regional lymph nodes + Underlying cartilage - Distant lymph node(s), NOS + Axillary (lower trunk) + Femoral (cephalad/caudal) (upper trunk) + Iliac (leg/hip) + Supraclavicular (head and neck, arm/shoulder) - Distant metastasis, NOS + Carcinomatosis + Distant metastasis WITH or WITHOUT distant lymph node(s) |
| 9 | Unknown if extension or metastasis |