Merkel Cell Carcinoma of the Skin

Incisional Biopsy, Excision, Reexcision, Lymphadenectomy

Procedure

____ Biopsy, incisional

____ Excision

____ Reexcision

____ Lymphadenectomy, sentinel node(s)

____ Lymphadenectomy, regional nodes (specify):______________________________

____ Other (specify): ______________________________

____ Not specified

Macroscopic Tumor

____ Present

____ Not identified

Tumor Site

Specify (if known): ______________________________

____ Not specified

Tumor Size

Greatest dimension: __________ cm

^*Additional dimensions: __________ x __________ cm

____ Indeterminate

^*Tumor Thickness

^*Thickness: __________ mm

^*Thickness: ≥ __________ mm

Margins

Peripheral margins

____ Cannot be assessed

____ Uninvolved by carcinoma

Distance of carcinoma from closest margin: __________ mm

Specify location(s), if possible: ______________________________

____ Involved by carcinoma

Specify location(s), if possible: ______________________________

Deep margin

____ Cannot be assessed

____ Uninvolved by carcinoma

Distance of carcinoma from closest margin: __________ mm

Specify location(s), if possible: ______________________________

____ Involved by carcinoma

Specify location(s), if possible: ______________________________

Lymph-Vascular Invasion

____ Not identified

____ Present

____ Indeterminate

Invasion of Bone, Muscle, Fascia, or Cartilage

____ Present (specify structures involved):______________________________

____ Not identified

____ Not applicable (e.g., for superficial biopsy)

^*Mitotic Index

^*____< 1/mm²

^*____ Specify: __________ /mm²

^*Tumor-Infiltrating Lymphocytes

^*____Not identified

^*____ Present, nonbrisk

^*____ Present, brisk

^*Tumor Growth Pattern

^*____Nodular

^*____ Infiltrative

^*Presence of Second Malignancy

^*____ Present (specify type): ______________________________

^*____Not identified

Lymph Nodes (required only if lymph nodes are present in the specimen)

Number of sentinel nodes examined: __________

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

Number of lymph nodes with metastases: __________

Macroscopic tumor

____ Present

____ Not identified

____ Indeterminate

^*Size of largest metastatic focus: __________ mm

^*Extranodal extension

^*____ Present

^*____ Not identified

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

____ pT0: No evidence of primary tumor (e.g., nodal/metastatic presentation without associated primary)

____ pTis: In situ primary tumor

____ pT1: ≤ 2 cm maximum tumor dimension

____ pT2: > 2 cm but ≤ 5 cm maximum tumor dimension

____ pT3: > 5 cm maximum tumor dimension

____ pT4: Primary tumor invades bone, muscle, fascia, or cartilage

Regional lymph nodes (pN)

____ pNX: Nodes not examined pathologically

____ pN0: Nodes negative by pathologic exam

____ pN1: Metastasis in regional lymph node(s)

^*____ pN1a: Micrometastasis

^*____ pN1b: Macrometastasis

____ pN2: In transit metastasis

Distant metastasis (pM)

____ Not applicable

____ pM1: Metastasis beyond regional lymph nodes

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

____ ^*pM1b: Metastasis to lung

____ ^*pM1c: Metastasis to all other visceral sites

^*Additional Pathologic Findings

^*Specify: ______________________________

Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Merkel Cell Carcinoma of the Skin.” Web posting date: February 2011, www.cap.org. Note: Use of checklist is not required for punch or shave biopsies. Protocol applies to Merkel cell carcinoma of cutaneous surfaces only.
^* Data elements with asterisks are not required. These elements may be clinically important but are not yet validated or regularly used in patient management.