04 Malignant Skin Lesions

04 Malignant Skin Lesions

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Unformatted text preview: t majority of melanoma patients have a clinically localized form of the disease (i.e., stage I or II). Several clinical factors have been identified and employed for risk stratification and prognosis in this heterogeneous group. The most important prognostic factors in early-stage melanoma are tumor thickness (T1 through T4) and the presence or absence of ulceration: 5-year survival in patients with stage I and II melanomas falls significantly as tumor thickness increases and is substantially reduced (from 80% to 55%) in the presence of ulceration.30 In the past few years, the mitotic rate in the primary tumor has also been identified as an important prognostic factor, one that may eventually prove more important than the presence or absence of ulceration in this population.35 Accordingly, it is likely that tumor mitotic rate will be incorporated into the next iteration of the AJCC’s melanoma staging system. Study of thin (< 1 mm) melanomas, in particular, has led to further refinement of risk stratification.The Clark level has prognostic implications for these lesions, in that tumors extending to Clark level IV are considered T1b regardless of their actual thickness and are associated with a worse prognosis. A 2004 report from the University of Pennsylvania described a prognostic model that made use of a V Figure 4 The Clark system classifies skin tumors according to the level of invasion, determined by the presence or absence of malignant melanocytes in the epidermis, papillary dermis, reticular dermis, and subcutaneous fat. © 2006 WebMD, Inc. All rights reserved. ACS Surgery: Principles and Practice 3 BREAST, SKIN, AND SOFT TISSUE Table 3—American Joint Committee on Cancer TNM Clinical Classification of Melanoma85 Primary tumor (T) TX Primary tumor cannot be assessed (e.g., shave biopsy or regressed melanoma) Tis Melanoma in situ T0 No evidence of primary tumor T1 Lesion thickness ≤ 1.0 mm T1a: ulceration absent and Clark level II or III T1b: ulceration present or Clark level IV or V T2 Lesion thickness 1.01–2.0 mm T2a: ulceration absent T2b: ulceration present T3 Lesion thickness 2.01–4.0 mm T3a: ulceration absent T3b: ulceration present T4 Lesion thickness > 4.0 mm T4a: ulceration absent T4b: ulceration present Regional lymph nodes (N) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 1 metastatic lymph node N1a: micrometastases present N1b: macrometastases present N2 2 or 3 metastatic lymph nodes N2a: micrometastases present N2b: macrometastases present N2c: in-transit metastases or satellite metastases present without metastatic lymph nodes N3 ≥ 4 metastatic lymph nodes; matted lymph nodes; or combinations of in-transit metastases, satellite metastases, or ulcerated melanoma and metastatic lymph nodes Distant metastases (M) MX Distant metastases cannot be assessed M0 No distant metastasis M1 Distant metastases M1a: metastases to skin, subcutaneous tissues, or distant lymph nodes M1b: metastases to lung M1c: metastases to all other visceral sites or distant metasta...
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This note was uploaded on 03/21/2011 for the course ONC 01 taught by Professor Dzodic during the Spring '11 term at Multimedia University, Cyberjaya.

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