NCCN Guidelines for Patients® | Melanoma

31 NCCN Guidelines for Patients ® : Melanoma, 2018 3  Melanoma staging TNM scores 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, N2, and N3 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. † † NX means regional (nearby) lymph nodes have not been assessed. † † N0 means there is no cancer in nearby lymph nodes. † † N1 means that cancer cells have spread to only 1 lymph node or cancer cells are in the lymph vessels or nearby skin. • N1a means that 1 lymph node was found only by the pathologist. • N1b means that 1 lymph node was found during a physical exam or by imaging tests. • N1c means no regional lymph node disease. † † N2 means that cancer cells have spread to 2 to 3 lymph nodes or cancer cells are in the lymph vessels, or nearby skin along with 1 lymph node. • N2a means that the lymph node metastases were found only by the pathologist. • N2b means that the lymph node metastases were found and at least 1 was found during a physical exam or by imaging tests. • N2c means that cancer cells have spread to 1 known lymph node found by a pathologist or 1 lymph node was found during a physical exam or imaging test. † † N3 means that cancer cells have spread to ≥4 lymph nodes; the nodes stick together; or cancer cells have spread to both lymph nodes and to lymph vessels or nearby skin along with 2 or more lymph nodes. • N3a means that the lymph node metastases were found only by the pathologist. • N3b means that 4 or more lymph nodes were found and at least 1 was found during a physical exam or by imaging tests, or any number of nodes stick together. • N3c means that 2 or more lymph nodes were found by the pathologist or during a physical exam or imaging test, and/or any number of nodes stick together. 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. The next pattern of spread is generally 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 those sub-categories also include whether LDH levels are normal or high (elevated). † † M0 means the melanoma hasn’t spread to distant sites. † † M1 means the melanoma has spread to distant organs. • M1a means the cancer has spread to distant skin sites, areas under the skin, or distant lymph nodes. • M1a(0) LDH not elevated • M1a(1) LDH elevated

RkJQdWJsaXNoZXIy MTE3MTE1