NCCN Guidelines for Patients® | Melanoma - page 29

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NCCN Guidelines for Patients
®
: Melanoma
Version 1.2013
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Part 3: Melanoma staging
Definitions:
Epidermis:
The outer layer
of skin
Lymph node:
Groups of
special disease-fighting
cells throughout the body
Lymph vessels:
Tubes
that carry lymph—a clear
fluid containing white blood
cells—throughout the body
Metastases:
Tumors
formed by cancer cells that
spread from the first tumor
to other parts of the body
Mitotic rate:
A measure of
how many cancer cells are
growing and dividing
Pathologist:
Doctor who’s
an expert in testing cells
and tissue to find disease
Ulceration:
The tumor’s
top skin layer is broken or
missing
!
See page 16 for
test details and
definitions.
N = Nodes
The N category reflects how far the melanoma has spread within nearby
(regional) lymph nodes. The main factor for the N score is the number of
lymph nodes to which cancer cells have spread. For N1 and N2 melanomas,
subcategories are given based on how the lymph node metastases were found
and whether cancer cells have spread to nearby skin or lymph vessels.
• N0
means there is no cancer in nearby lymph nodes.
• N1
means that cancer cells have spread to only 1 lymph node.
o
N1a
means that lymph node metastases were found only by the
pathologist because they were very small.
o
N1b
means that the lymph node metastases were found during a
physical exam or by imaging tests and then were confirmed by the
pathologist.
• N2
means that cancer cells have spread to 2 to 3 lymph nodes, the lymph
vessels, or nearby skin.
o
N2a
means that lymph node metastases were found only by the
pathologist because they were very small.
o
N2b
means that the lymph node metastases were found during a
physical exam or by imaging tests and then were confirmed by the
pathologist.
o
N2c
means that cancer cells have spread to small areas of nearby skin
(called satellite disease) or to nearby lymph vessels (called in-transit
disease) but not to the lymph nodes.
• N3
means that cancer cells have spread to ≥4 lymph nodes; the nodes
stick together; or cancer cells have spread to lymph nodes and to lymph
vessels or nearby skin.
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