Skin Cancer Anatomic Diagnosis Checklist
Part I. Malignant Melanoma
I. Primary Tumor Diagnosis
Skin, Site, Operation —Final Tumor Diagnosis
(including type of melanoma and pTN stage)
Lymph Node, Site, Operation —Final Diagnosis
II. Gross Examination:
Specimen type:
Site of specimen:
Size of tumor:
Description:
Sections taken and labeled:
III. Microscopic Examination:
A. Type of melanoma:
Acral lentiginous melanoma
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Other:_______________________
B. Measured (Breslow) Thickness: ______ mm.
(From epidermal granular layer/ulcer base to the deepest point of tumor invasion)
Comment: ________________________
(Exact depth of invasion difficult to assess due to tumor extension to the biopsy base /
Epidermal ulceration / previous biopsy site changes)
C. Level of Invasion (Clark Level): ______________
I
Confined to the epidermis (in situ), with all tumor cells
above the basement membrane.
II Tumor cells extending into the papillary dermis, or
adventitial dermis around skin appendages.
III Tumor cells filling the papillary dermis and accumulating
at the papillary-reticular dermal interface, compressing
the underlying collagen bundles of the reticular dermis.
IV Tumor cells extending into and penetrating between the
bundles of collagen in the reticular dermis.
V Tumor cells invading the subcutaneous adipose tissue
Note: Use only with thickness < 1.0 mm (otherwise omit)
D. Epidermal Ulceration:
E. Mitotic count:
Present;
Absent
/ 5 hpf (mm2) _
F. Additional Tumor Features:
1. Lymphovascular Invasion:
Present
Absent
2. Desmoplasia:
Present
Absent
3. Neurotropism:
Present
Absent
4. Tumor Regression:
Present (complete/partial) Absent
5. Intraepidermal Pattern: Lentiginous/Pagetoid/Nested/Absent
6. Cell Type:
Epitheloid/Spindle/Mixed epitheloid and spindle/Small
7. Associated Nevus:
Compound Nevus, Atypical Nevus,
Congenital Nevus, Not Identified.
8. Lymphocytic infiltrate:
Brisk
Non-brisk
G. Margins of Biopsy/Excision:
Margins of excision are free of tumor
Tumor extends to the peripheral margin of excision at ___________________ (specify location)
Tumor extends to the deep margin of excision
H. In-Transit Metastases/Satellite Metastases:
Present
Absent,
Not able to assess
Note:
1. Satellite metastasis is defined arbitrarily as grossly visible cutaneous/subcutaneous metastases
within 2 cm of the primary melanoma.
2. In-transit metastasis is defined as metastatic tumor ( > 2 cm from the primary melanoma)
between the primary site and the regional lymph nodes.
I. Lymph Node: _________________ (Site) ___________________(Operation)
A. Number examined:
B. Number positive:
C. Type of metastasis: Micrometastasis / Marcrometastasis
D. Comment:
Note: Those patients without clinical or radiologic evidence of lymph node metastases, but who have
pathologically documented nodal metastases, are defined by convention as exhibiting microscopic
metastases. In contrast, melanoma patients with both clinical evidence of nodal metastases and pathologic
examination documenting the number of nodal metastases (after therapeutic lymphadenectomy) are defined
as macroscopic nodal metastases.
J. Additional Findings and Comments:
IV. pTN Stage：
附件:
Melanoma of the Skin
TNM Classification
(excluding eyelid)
Primary Tumor (T)
依據 2009 年 AJCC 第七 版本修訂。
Stage Grouping
Clinical
Stage 0
Stage IA
Stage IB
Stage IIC
Tis
T1a
T1b
T2a
T2b
T3a
T3b
T4a
T4b
Stage III
Any T
Stage IV
Any T
Stage IIA
Stage IIB
N0
N0
N0
N0
N0
N0
N0
N0
N0
more
than N1
AnyN
Pathologic
Stage 0 Tis
Stage IA T1a
Stage IB T1b
T2a
Stage IIA T2b
T3a
Stage IIB T3b
T4a
Stage IIC T4b
Stage IIIA T1-4a
T1-4a
Stage IIIB T1-4b
T1-4b
T1-4a
T1-4a
T1-4a
Stage IIICT1-4b
T1-4b
T1-4b
Any T
Stage IV Any T
N0
N0
N0
N0
N0
N0
N0
N0
N0
N1a
N2a
N1a
N2a
N1b
N2b
N2c
N1b
N2b
N2c
N3
Any N
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M1
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M1
TX
T0
Tis
T1
T1a
T1b
T2
T2a
T2b
T3
T3a
T3b
T4
T4a
T4b
Primary tumor cannot be assessed (e.g., shave biopsy or
regressed melanoma)
No evidence of primary tumor
Melanoma in situ
Melanomas <=1.0 mm in thickness
without ulceration and mitosis <1/mm2
with ulceration or mitoses >= 1/mm2
Melanomas 1.01 – 2.0 mm
without ulceration
with ulceration
Melanomas 2.01-4.0 mm
without ulceration
with ulceration
Melanomas >4.0 mm
without ulceration
with ulceration
Regional Lymph Nodes (N)
NX
N0
N1
N1a
N1b
N2
N2a
N2b
N2c
N3
Regional lymph nodes cannot be assessed
No regional lymph node metastasis
1 node
micrometastasis*
macrometastasis**
2-3 nodes
micrometastasis*
macrometastasis**
in transit met(s)/satellite(s) without metastatic
nodes
Clinical: more than 1 node with in transit
met(s)/ satellite(s); pathologic: 4 or more
metastatic
nodes, or matted nodes, or in transit met(s)/
satellite(s) with metastatic node(s)
Distant Metastasis (M)
No distant metastasis (no pathologic M0; use
clinical M to complete stage group)
Metastases to skin, subcutaneous tissues, or
M1a
distant lymph nodes
M1b Metastases to lung
Metastases to all other visceral sites or distant
M1c metastases to any site combined
with an elevated serum LDH
M0
Skin Cancer Anatomic Diagnosis Checklist
Part II. Squamous Cell Carcinoma
( Including Variants)
I. Primary Tumor Diagnosis
Skin, Site, Operation — Final Tumor Diagnosis ( Including Variants)
(including pTN stage)
Lymph Node, Site, Operation —Final Diagnosis
II. Gross Examination:
Specimen type:
Site of specimen:
Size of tumor:
Description:
Sections taken and labeled:
III. Microscopic Examination:
A. Histologic Type:
1. Squamous cell carcinoma
2. Acantholytic squamous cell carcinoma
3. Spindle cell squamous cell carcinoma
4. Verrucous carcinoma
5. Adenosquamous carcinoma
6. Other:________________
B. Tumor Grade:
I (well differentiated) II (moderately differentiated) III (poorly differentiated)
IV (undifferentiated)
C. Size of Tumor: ____ x _____ x _______
cm.
Tumor size cannot be determined in this curettage/punch biopsy/ shave biopsy specimen
Comment:____________________________________________________
D. Tumor thickness: ______ mm.
E. Depth of invasion:
Tumor is confined to the epidermis
Tumor invades the dermis
Tumor invades the subcutis
F. Margins of Excision:
Peripheral/Deep/Peripheral and deep margins of excision are free of tumor
Tumor involves the peripheral margin of excision at
(specify location)
Tumor involves the deep margin of excision
G. Additional Tumor Features:
A. Lymphovascular Invasion:
Present
Absent
B. Perineural Invasion:
Present
Absent
C. Necrosis:
Present
Absent
D. Mitotic count / 5 hpf : __________________________
H. Lymph Node: _________________ (Site) __________________ (Operation)
A. Number examined:
B. Number positive:
C. Maximum size of metastasis:
D. Comment:________________________________________
Notes:
1. Micrometastasis is defined as a metastasis >or = 0.2mm but <2 mm.
2. Isolated tumor cells (ITC) are defined as single tumor cells or small clusters not greater than 0.2 mm,
usually detected only by immunohistochemical or molecular methods but which may be verified on
H&E stains. ITCs do not usually show evidence of metastatic activity (e.g., proliferation or stromal
reaction.). They are not considered metastases and are staged as pN0. Their presence should be noted
in the comment section under the lymph node section(s) above.
3. If particular protocols are being employed for the evaluation of sentinel lymph nodes (for example,
multiple H&E slides with intervening antikeratin immunohistochemistry), note this in the comment
section
I. Additional Findings and Comments:
附件:
Carcinoma of the Skin (excluding
eyelid, vulva and penis)
TNM Classification
Primary Tumor (T)
依據 2009 年 AJCC 版本修訂。
Stage Grouping
Stage 0Tis
Stage I T1
Stage IIT2
Stage
T3
III
T1
T2
T3
Stage
T1
IV
T2
T3
T Any
T4
T Any
N0
N0
N0
M0
M0
M0
N0
M0
N1
N1
N1
M0
M0
M0
N2
M0
N2
N2
N3
N Any
N Any
M0
M0
M0
M0
M1
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
Tumor 2 cm or less in greatest dimension with less than
T1
two high risk features**
Tumor greater than 2 cm in greatest dimension or Tumor
T2
any size with two or more high risk features*
T3 Tumor with invasion of maxilla, orbit, or temporal bone
Tumor with invasion of skeleton (axial or appendicular) or
T4
perineural invasion of skull base
* Excludes cSCC of the eyelid – See Chapter 48.
**High Risk Features for the Primary Tumor (T) Staging : Depth/Invasion:
>2 mm thickness, Clark level IV(invasion into reticular dermis), Perineural
invasion Anatomic Location: Primary site ear, Primary site hair-bearing lip
Differentiation: Poorly differentiated
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
Metastasis in a single ipsilateral lymph node, 3 cm or less
N1
in greatest dimension
Metastasis in a single ipsilateral lymph node, more than 3 cm
but not more than 6 cm in greatest dimension; or in multiple
N2 ipsilateral lymph nodes, none more than 6 cm in greatest
dimension; or in bilateral or contralateral lymph nodes, none
more than 6 cm in greatest dimension
Metastasis in a single ipsilateral lymph node, more than 3 cm
N2a
but not more than 6 cm in greatest dimension
Metastasis in multiple ipsilateral lymph nodes, none more than 6
N2b
cm in greatest dimension
Metastasis in bilateral or contralateral lymph nodes, none more
N2C
than 6 cm in greatest dimension
Metastasis in a lymph node, more than 6 cm in greatest
N3
dimension
Distant Metastasis (M)
No distant metastasis (no pathologic M0; use
clinical M to complete stage group)
M1 Distant metastasis
M0