33 NCCN Guidelines for Patients ® : Melanoma, 2018 3 Melanoma staging Stages of melanoma Guide 1. Melanoma stages Clinical staging* Pathologic staging** Stage 0 Tis N0 M0 Stage 0 Tis N0 M0 Stage IA T1a N0 M0 Stage IA T1a N0 M0 T1b N0 M0 T2a N0 M0 Stage IB T2a N0 M0 Stage IIA T2b N0 M0 Stage IIA T2b N0 M0 T3a N0 M0 T3a N0 M0 Stage IIB T3b N0 M0 Stage IIB T3b N0 M0 T4a N0 M0 T4a N0 M0 Stage IIC T4b N0 M0 Stage IIC T4b N0 M0 Stage III Any T, Tis ≥N1 M0 Stage IIIA T1a/b, T2a N1a, N2a M0 Stage IIIB T0 N1b, N1c M0 T1a/b, T2a N1b/c, N2b M0 T2b, T3a N1a/b/c, N2a/b M0 Stage IIIC T0 N2b/c, N3b/c M0 T1a/b, T2a/b, T3a N2c, N3a/b/c M0 T3b, T4a Any N ≥N1 M0 T4b N1a/b/c, N2a/b/c M0 Stage IIID T4b N3a/b/c M0 Stage IV Any T Any N M1 Stage IV Any T Any N M1 Clinical staging includes microstaging of the primary melanoma and clinical/radiologic/ biopsy evaluation for metastases. By convention, clinical staging should be used after biopsy of the primary melanoma, with clinical assessment for regional and distant metastases. Note that pathological assessment of the primary melanoma is used for both clinical and pathological classification. Diagnostic biopsies to evaluate possible regional and/or distant metastasis also are included. Note there is only one stage group for clinical Stage III melanoma *Pathological staging includes microstaging of the primary melanoma, including any additional staging information from the wide-excision (surgical) specimen that constitutes primary tumor surgical treatment and pathological information about the regional lymph nodes after SLN biopsy or therapeutic lymph node dissection for clinically evident regional lymph node disease. * Pathological Stage 0 (melanoma in situ) and T1 do not require pathological evaluation of lymph nodes to complete pathological staging; use cN information to assign their pathological stage Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2016) published by Springer Science+Business Media. (For complete information and data supporting the staging tables, visit www.springer.com. ) Any citation or quotation of this material must be credited to the AJCC as its primary source. The inclusion of this information herein does not authorize any reuse or further distribution without the expressed, written permission of Springer SBM, on behalf of the AJCC.