NCCN Guidelines for Patients® | Melanoma - page 30

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
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N = Node
The N category reflects how far the melanoma has
spread within nearby (regional) lymph nodes. Lymph
nodes are small groups of special disease-fighting
cells located throughout the body. 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 the 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 a
satellite metastasis) or to nearby lymph
vessels (called an in-transit metastasis) 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.
M = Metastasis
The M category tells you if cancer cells have spread
to distant sites—called metastasis. Melanoma
usually spreads to distant skin and lymph nodes first.
Next, it often spreads to the lungs, then to the liver,
brain, bone, and/or intestines. Different patterns of
melanoma spread are also possible. For metastases,
subcategories are given based on where the cancer
has spread and whether LDH levels are normal or high.
M0
means the melanoma hasn’t spread to
distant sites.
M1
means the melanoma has spread to
distant organs.
o
M1a
means the cancer has spread to
distant skin sites, areas under the skin,
or distant lymph nodes, with normal LDH
levels.
o
M1b
means the cancer has spread to the
lungs, with normal LDH levels.
o
M1c
means cancer has spread to internal
organs with normal LDH levels or it has
spread to any site with high LDH levels.
Stages of melanoma
The TNM scores are combined to assign the cancer a
stage.
Chart 1
shows the melanoma stage groupings.
The stages are labeled by Roman numerals 0 to IV.
In general, melanomas of the same stage will have
a similar prognosis and thus are treated in a similar
way. Most melanomas—about 85 out of 100—are
found early, before they have spread beyond the
primary tumor. Most melanomas that are found and
removed early have a good prognosis and a low
chance of recurrence. However, for melanomas that
are thicker, are ulcerated, and/or have lymph node
spread, the risk of recurrence after surgery goes up.
3
Melanoma staging
Stages of melanoma
1...,20,21,22,23,24,25,26,27,28,29 31,32,33,34,35,36,37,38,39,40,...108
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