In English | En español
Questions About Cancer? 1-800-4-CANCER

Melanoma Treatment (PDQ®)

  • Updated: 09/19/2014

Table 7. TNM Definitions for Stage IV Melanoma

Stage TNM Description Image 
Clinicala Pathologicalb
Enlarge
Stage IV melanoma; drawing shows that the primary tumor has spread to other parts of the body, such as the brain, lung, liver, lymph nodes, small intestine, or bone. The pullout shows cancer in the lymph nodes, lymph vessels, and blood vessel.
Stage IV melanoma.
IVIVAny TTX = Primary tumor cannot be assessed (e.g., curettaged or severely regressed melanoma)
T0 = No evidence of primary tumor
Tis = Melanoma in situ
T1a = Melanomas ≤1.0 mm in thickness without ulceration; mitosis <1/mm2
T1b = Melanomas ≤1.0 mm in thickness with ulceration or mitoses ≥1/mm2
T2a = Melanomas 1.01–2.0 mm in thickness without ulceration
T2b = Melanomas 1.01–2.0 mm in thickness with ulceration
T3a = Melanomas 2.01–4.0 mm in thickness without ulceration
T3b = Melanomas 2.01–4.0 mm in thickness with ulceration
T4a = Melanomas >4.0 mm in thickness without ulceration
T4b = Melanomas >4.0 mm in thickness with ulceration
Any NNX = Regional lymph nodes cannot be assessed (e.g., previously removed for another reason)
N1a = 1 regional lymph node metastasis with micrometastasisc
N1b = 1 regional lymph node metastasis with macrometastasisd
N2a = 2–3 regional lymph node metastases with micrometastasisc
N2b = 2–3 regional lymph node metastases with macrometastasisd
N2c = In transit met(s)/satellite(s) without metastatic lymph nodes
N3 = ≥4 regional lymph node metastases; or matted nodes; or in transit met(s)/satellite(s) with metastatic lymph node(s)
M1M1a = Metastases to skin, subcutaneous, or distant lymph nodes and normal serum LDH
M1b = Metastases to lung and normal serum LDH
M1c = Metastases to all other visceral sites and normal serum LDH; or distant metastases to any site and elevated serum LDH
LDH = Lactate dehydrogenase; T = primary tumor; N = regional lymph nodes; M = distant metastasis.
Adapted with permission from AJCC: Melanoma of the skin. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 325-44.
aClinical staging includes microstaging of the primary melanoma and clinical and/or radiologic evaluation for metastases. By convention, it should be used after complete excision of the primary melanoma with clinical assessment for regional and distant metastases.
bPathologic staging includes microstaging of the primary melanoma and pathologic information about the regional lymph nodes after partial or complete lymphadenectomy. Pathologic stage 0 or stage IA patients are the exception; they do not require pathologic evaluation of their lymph nodes.
cMicrometastases are diagnosed after sentinel lymph node biopsy and complete lymphadenectomy (if performed).
dMacrometastases are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or when nodal metastasis exhibits gross extracapsular extension.