Tumor Tip of the Week 03-15-2024 Melanoma pT1 cN0

03-15-2024 Melanoma pT1 cN0

Scenario:

• [Physical exam showed no lymphadenopathy], patient dx on Shave biopsy, went on to have Wide excision
• Snip from Path Report from Wide Excision

• Tumor Site Skin of trunk
• Histologic Type Melanoma, NOS
• (Breslow) Thickness 0.2mm (residual) mm
• Ulceration Not identified
• Anatomic (Clark) Level II
• REGIONAL LYMPH NODES
• Regional Lymph Node Status Not applicable (no regional lymph nodes submitted or found)
• PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
• pT Category pT1a
• pN Category pN not assigned (no nodes submitted or found)

Question: How would you assign Pathologic N category?

• pNX
• cN0
• pN BLANK

Answer: cN0

Rationale: This case does meet the eligibility criteria for pathologic staging-the primary site was resected, but no nodes were removed. In this instance instead of assigning a pNX we can assign a cN0. There are certain site/histology combinations/situations when you can assign a cN0 in the path N category. This is one of those situations, for Melanoma pT1 cases can be assigned a cN0. For a complete list of Sites where Node Status Not required in Rare Circumstances refer to the AJCC Registrar Education refer to Critical Clarifications Document entitled Node Status & AJCC 8th Edition Melanoma Staging https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/