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Published on : Feb 24, 2014
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Slide 1 - AJCC Staging Moments AJCC TNM Staging 7th Edition Melanoma Case #1 Contributors: Jeffrey E. Gershenwald, MD University of Texas MD Anderson Cancer Center, Houston, Texas Daniel G. Coit, MD Memorial Sloan-Kettering Cancer Center, New York, New York Charles M. Balch, MD Johns Hopkins Medical Center, Baltimore, Maryland David R. Byrd, MD University of Washington Medical Center, Seattle, Washington
Slide 2 - Melanoma Case # 1 Presentation of New Case Newly diagnosed melanoma patient Presentation at Cancer Conference for treatment recommendations and clinical staging
Slide 3 - Melanoma Case # 1 History & Physical 83 yr old female who presented with a 2cm maximal diameter brown lesion right cheek over the right malar eminence, no ulceration, no cervical lymphadenopathy No family hx Used with permission. Marghoob A, Halpern A. Atlas of Cancer. Edited by Maurie Markman, Ashfaq A. Marghoob. ©2002 Current Medicine, Inc.
Slide 4 - Melanoma Case # 1 Imaging Results No imaging
Slide 5 - Melanoma Case # 1 Diagnostic Procedure Procedure Excision skin lesion rt cheek Pathology Report Melanoma in situ Lentigo maligna type Radial margin involved
Slide 6 - Melanoma Case # 1 Clinical Staging Clinical staging Uses information from the physical exam, imaging, and diagnostic biopsy Purpose Select appropriate treatment Estimate prognosis
Slide 7 - Melanoma Case # 1 Clinical Staging Synopsis- elderly patient with 2cm maximal diameter melanoma in situ lesion with margins involved, no lymphadenopathy What is the clinical stage? T____ N____ M____ Stage Group______
Slide 8 - Melanoma Case # 1 Clinical Staging Clinical Stage correct answer pTis cN0 cM0 Stage Group 0 Based on stage, treatment is selected Review NCCN treatment guidelines for this stage
Slide 9 - Melanoma Case # 1 Clinical Staging Rationale for staging choices Tis for carcinoma in situ N0 because nodes were clinically negative on physical exam * M0 because there was nothing to suggest distant metastases * * if there was, appropriate tests would be performed before developing a treatment plan
Slide 10 - Prognostic Factors Clinically Significant Applicable to this case Ulceration: no
Slide 11 - ppt slide no 11 content not found
Slide 12 - Melanoma Case # 1 Surgery & Findings Procedure Re-excision skin lesion with 5mm margin Operative findings No additional information
Slide 13 - Melanoma Case # 1 Pathology Results Residual melanoma in situ Lentigo maligna type Clark’s Level I Extends close to radial margins
Slide 14 - Melanoma Case # 1 Pathologic Staging Pathologic staging Uses information from the clinical staging supplemented or modified by information from surgery and the pathology report Purpose Additional precise data for estimating prognosis Calculating end results (survival data)
Slide 15 - Melanoma Case # 1 Pathologic Staging Synopsis- patient with melanoma in situ, Clark’s level I lesion, no nodes removed, clinically nodes negative What is the pathologic stage? (remember, clinical M may be used in pathologic staging) T____ N____ M____ Stage Group______
Slide 16 - Melanoma Case # 1 Pathologic Staging Pathologic Stage correct answer pTis cN0 cM0 Stage Group 0 Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is selected
Slide 17 - Melanoma Case # 1 Pathologic Staging Rationale for staging choices pTis for carcinoma in situ cN0 because there is an exception for pathologic Stage 0 and Stage IA, they do not require pathologic evaluation of nodes cM0 – use clinical M with pathologic staging unless there is pathologic confirmation of distant metastases
Slide 18 - Prognostic Factors Clinically Significant Applicable to this case Ulceration: no There are no prognostic factors required for staging
Slide 19 - AJCC Cancer Staging Atlas Tis is melanoma in situ
Slide 20 - Melanoma Case # 1 Recap of Staging Summary of correct answers Clinical stage pTis cN0 cM0 Stage Group 0 Pathologic stage pTis cN0 cM0 Stage Group 0 The staging classifications have a different purpose and therefore can be different. Do not go back and change the clinical staging based on pathologic staging information.
Slide 21 - Staging Moments Summary Review site-specific information if needed Clinical Staging Based on information before treatment Used to select treatment options Pathologic Staging Based on clinical data PLUS surgery and pathology report information Used to evaluate end-results (survival)