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Staging Moments Melanoma Case 2 Presentation Transcript

Slide 1 - AJCC Staging Moments AJCC TNM Staging 7th Edition Melanoma Case #2 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 # 2 Presentation of New Case Newly diagnosed melanoma patient Presentation at Cancer Conference for treatment recommendations and clinical staging
Slide 3 - Melanoma Case # 2 History & Physical 60 yr old female who presented with a 1x0.5cm skin lesion left calf of leg, no palpable inguinal or popliteal adenopathy 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 # 2 Imaging Results No imaging
Slide 5 - Melanoma Case # 2 Diagnostic Procedure Procedure Excision skin lesion left leg Pathology Report Superficial spreading melanoma Clark’s Level III Breslow 0.65mm tumor thickness No ulceration Mitosis <1/mm2 Extends to margin
Slide 6 - Melanoma Case # 2 Clinical Staging Clinical staging Uses information from the physical exam, imaging, and diagnostic biopsy Purpose Select appropriate treatment Estimate prognosis
Slide 7 - Melanoma Case # 2 Clinical Staging Synopsis- patient with 1cm melanoma skin left leg, Breslow tumor thickness 0.65mm, Clark’s level III, no ulceration, mitosis <1/mm2, nodes clinically negative What is the clinical stage? T____ N____ M____ Stage Group______
Slide 8 - Melanoma Case # 2 Clinical Staging Clinical Stage correct answer T1a N0 M0 Stage Group IA Based on stage, treatment is selected Review NCCN treatment guidelines for this stage
Slide 9 - Melanoma Case # 2 Clinical Staging Rationale for staging choices T1a for <1.0mm in thickness, no ulceration, mitosis <1/mm2 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 Measured tumor thickness: 0.65mm Ulceration: no Mitotic Rate: <1/mm2
Slide 11 - ppt slide no 11 content not found
Slide 12 - Melanoma Case # 2 Surgery & Findings Procedure Wide re-excision skin leg 1cm margin Operative findings No additional information
Slide 13 - Melanoma Case # 2 Pathology Results Residual melanoma in situ Margin negative
Slide 14 - Melanoma Case # 2 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 # 2 Pathologic Staging Synopsis- patient with original 0.65mm in tumor thickness lesion and residual melanoma in situ What is the pathologic stage? (remember, clinical M may be used in pathologic staging) T____ N____ M____ Stage Group______
Slide 16 - Melanoma Case # 2 Pathologic Staging Pathologic Stage correct answer pT1a cN0 cM0 Stage Group IA Based on pathologic stage, there is more information to estimate prognosis and adjuvant treatment is selected
Slide 17 - Melanoma Case # 2 Pathologic Staging Rationale for staging choices pT1a for <1.0mm in thickness, no ulceration, mitosis <1/mm2 cN0 because nodes were clinically negative and Stage IA patients do not require pathologic evaluation of their lymph 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 Measured tumor thickness: 0.65mm Ulceration: no Mitotic Rate: <1/mm2
Slide 19 - AJCC Cancer Staging Atlas T1a is <1.0mm in thickness, with ulceration or mitosis >1/mm2
Slide 20 - Melanoma Case # 2 Recap of Staging Summary of correct answers Clinical stage T1a N0 M0 Stage Group IA Pathologic stage T1a cN0 cM0 Stage Group IA 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)
 

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