Protocol for Specimens of Malignant Melanoma of the Skin



Protocol for Specimens of Malignant Melanoma of the Skin


David Cassarino, MD, PhD


























































































































































































































































































































































































































































































































































Melanoma of the Skin



Biopsy, Excision, Reexcision


Procedure (select all that apply)


____ Biopsy, shave


____ Biopsy, punch


____ Biopsy, incisional


____ Excision


____ Reexcision


____ Lymphadenectomy, sentinel node(s)


____ Lymphadenectomy, regional nodes (specify): ______________________________


____ Other (specify): ______________________________


____ Not specified


Specimen Laterality


____ Right


____ Left


____ Midline


____ Not specified


Tumor Site



Specify, if known: ______________________________


____ Not specified


Tumor Size (required only if tumor is grossly present)



Greatest dimension: __________ cm



*Additional dimensions: __________ x __________ cm


____ Indeterminate


Macroscopic Satellite Nodule(s) (required for excision specimens only)


____ Not identified


____ Present


____ Indeterminate


*Macroscopic Pigmentation


*____ Not identified


*____ Present, diffuse


*____ Present, patchy/focal


*____ Indeterminate


Histologic Type



Malignant melanoma



____ Melanoma, not otherwise specified



____ Superficial spreading melanoma



____ Nodular melanoma



____ Lentigo maligna melanoma



____ Acral-lentiginous melanoma



____ Desmoplastic &/or desmoplastic neurotropic melanoma



____ Melanoma arising from blue nevus



____ Melanoma arising in a giant congenital nevus



____ Melanoma of childhood



____ Nevoid melanoma



____ Persistent melanoma



____ Other (specify): ______________________________


Maximum Tumor Thickness



Specify: ___________ mm



At least __________ mm


____ Indeterminate


*Clark (Anatomic) Level


*____ I (melanoma in situ)


*____ II (melanoma present in, but does not fill and expand, papillary dermis)


*____ III (melanoma fills and expands papillary dermis)


*____ IV (melanoma invades reticular dermis)


*____ V (melanoma invades subcutaneum)


Ulceration


____ Present


____ Not identified


____ Indeterminate


Margins (select all that apply)



Peripheral margins



____ Cannot be assessed



____ Uninvolved by invasive melanoma





Distance of invasive melanoma from closest peripheral margin: ___________ mm (required for excisions only)




Specify location(s), if possible: ______________________________



____ Involved by invasive melanoma




Specify location(s), if possible: ______________________________



____ Uninvolved by melanoma in situ





Distance of melanoma in situ from closest margin: __________ mm (required for excisions only)





Specify location(s), if possible: ______________________________



____ Involved by melanoma in situ




Specify location(s), if possible: ______________________________



Deep margin



____ Cannot be assessed



____ Uninvolved by invasive melanoma





Distance of invasive melanoma from margin: __________ mm (required for excisions only)





Specify location(s), if possible: ______________________________



____ Involved by invasive melanoma





Specify location(s), if possible: ______________________________


Mitotic Index


____ < 1/mm2



Specify number/mm2: __________


Microsatellitosis


____ Not identified


____ Present


____ Indeterminate


Lymph-Vascular Invasion


____ Not identified


____ Present


____ Indeterminate


*Perineural Invasion


*____ Not identified


*____ Present


*____ Indeterminate


*Tumor-infiltrating Lymphocytes


*____ Not identified


*____ Present, nonbrisk


*____ Present, brisk


*Tumor Regression


*____ Not identified


*____ Present, involving < 75% of lesion


*____ Present, involving ≥ 75% of lesion


*____ Indeterminate


*Growth Phase (select all that apply)


*____ Radial


*____ Vertical


*____ Indeterminate


Lymph Nodes (required only if lymph nodes are present in the specimen) (select all that apply)



Number of sentinel nodes examined: __________



Total number of nodes examined (sentinel and nonsentinel): __________



Number of lymph nodes with metastases: __________



*Extranodal tumor extension




*____ Present




*____ Not identified




*____ Indeterminate



*Size of largest metastatic focus: __________ (mm) (for sentinel node)



*Location of metastatic tumor (for sentinel node)




*____ Subcapsular




*____ Intramedullary




*____ Subcapsular and intramedullary


Pathologic Staging (pTNM)



TNM descriptors (required only if applicable) (select all that apply)




____ m (multiple




____ r (recurrent)




____ y (post treatment)



Primary tumor (pT)




____ pTX: Primary tumor cannot be assessed (e.g., shave biopsy or regressed melanoma)




____ pT0: No evidence of primary tumor




____ pTis: Melanoma in situ (i.e., not an invasive tumor: Anatomic level 1)





pT1: Melanoma ≤ 1 mm in thickness, ± ulceration






____ pT1a: Melanoma ≤ 1.0 mm in thickness, no ulceration, < 1 mitosis/mm2






____ pT1b: Melanoma ≤ 1.0 mm in thickness with ulceration &/or ≥ 1 mitosis/mm2





pT2: Melanoma 1.01-2.0 mm in thickness, ± ulceration






____ pT2a: Melanoma 1.01-2.0 mm in thickness, no ulceration






____ pT2b: Melanoma 1.01-2.0 mm in thickness, with ulceration





pT3: Melanoma 2.01-4.0 mm in thickness, ± ulceration






____ pT3a: Melanoma 2.01-4.0 mm in thickness, no ulceration






____ pT3b: Melanoma 2.01-4.0 mm in thickness, with ulceration





pT4: Melanoma > 4.0 mm in thickness, ± ulceration






____ pT4a: Melanoma > 4.0 mm in thickness, no ulceration






____ pT4b: Melanoma > 4.0 mm in thickness, with ulceration



Regional lymph nodes (pN)




____ pNX: Regional lymph nodes cannot be assessed




____ pN0: No regional lymph node metastasis




pN1: Metastasis in 1 regional lymph node





____ pN1a: Clinically occult (microscopic) metastasis





____ pN1b: Clinically apparent (macroscopic metastasis




pN2: Metastasis in 2-3 regional lymph nodes or in intralymphatic regional metastasis without nodal metastasis





____ pN2a: Clinically occult (microscopic) metastasis





____ pN2b: Clinically apparent (macroscopic) metastasis





____ pN2c: Satellite or in-transit metastasis without nodal metastasis




____ pN3: Metastasis in ≥ 4 regional lymph nodes, or matted metastatic nodes, or in-transit metastasis or satellite(s) with metastasis in regional node(s)




____ No nodes submitted or found




Number of lymph nodes identified: ___________




Number containing metastasis identified macroscopically: __________




Number containing metastases identified microscopically: __________




Matted nodes





____ Present





____ Not identified



Distant metastasis (pM)




____ Not applicable




____ pM1: Distant metastasis (documented in this specimen)




*____ pM1a: Metastasis in skin, subcutaneous tissues, or distant lymph nodes




*____ pM1b: Metastasis to lung




*____ pM1c: Metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactic dehydrogenase (LDH)





*Specify site, if known: ______________________________


*Additional Pathologic Findings (select all that apply)


*____ Nevus remnant


*____ Other (specify): ______________________________


Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Melanoma of the Skin.” Posting date: November 2011, www.cap.org. *Data elements with asterisks are not required. These elements may be clinically important but are not yet validated or regularly used in patient management.

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Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Protocol for Specimens of Malignant Melanoma of the Skin
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