Www.iccr-cancer.org
Core/Non-coreElement nameValuesCommentaryImplementation notesCoreOPERATIVE PROCEDUREMulti selection value list (select all that apply):? Not specifiedOR? Biopsy (excisional, incisional), specify? Resection, specify (e.g. maxillectomy, hemiglossectomy, partial laryngectomy, etc.) ? Neck (lymph node) dissection*, specify? Other, specify*If a neck dissection is submitted, then a separate dataset is used to record the information.CoreSPECIMENS SUBMITTEDMulti selection value list (select all that apply):? Not specifiedOR? Anatomic site, specify (may be multiple separate sites, but excluding lymph node dissection as that is a separate form)The surgical approach for mucosal melanoma largely depends on the site of the primary tumour. In some locations such as gingiva, a single specimen may be received with/without additional separate margins. This may be a mucosal based resection or a composite resection with underlying tissues including bone. In the sinonasal cavity, while there may be a primary tumour specimen, numerous further specimens are received from contiguous anatomic sites in a 3-dimensional approach. The specimens submitted help to delineate the anatomic extent required for resection and may include bilateral tissues. Lymph node dissections are dealt with in a separate dataset. .CoreTUMOUR SITEMulti selection value list (select all that apply) and text:? Cannot be assessedOR? Sinonasal, specify subsite(s)LeftRightMidlineLaterality not specifiedSubsite(s)? Oral cavity, specify subsite(s)LeftRightMidlineLaterality not specifiedSubsite(s)? Larynx, specify subsite(s)LeftRightMidlineLaterality not specifiedSubsites(s)? Nasopharynx, specify subsites(s)LeftRightMidlineLaterality not specifiedSubsite(s)? Other, specify site/subsite(s)LeftRightMidlineLaterality not specifiedSubsite(s)Mucosal melanomas of the head and neck show specific sites of predilection, but in general are rare. Nasal cavity: The majority of tumours are identified within the nasal cavity or septum, while other anatomic sites are rarely affected.1,2Oral cavity: Most tumours are found on the palate or gingiva, although any site may be affected.3-5Primary melanoma within nasopharynx, oropharynx, larynx and hypopharynx are exceedingly uncommon. However, nasopharyngeal primaries have an even worse prognosis than other head and neck sites.1 References1 Thompson LD, Wieneke JA and Miettinen M (2003). Sinonasal tract and nasopharyngeal melanomas: a clinicopathologic study of 115 cases with a proposed staging system. Am J Surg Pathol 27(5):594-611.2 Moreno MA, Roberts DB, Kupferman ME, DeMonte F, El-Naggar AK, Williams M, Rosenthal DS and Hanna EY (2010). Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson Cancer Center. Cancer 116(9):2215-2223.3 de-Andrade BA, Toral-Rizo VH, Leon JE, Contreras E, Carlos R, Delgado-Azanero W, Mosqueda-Taylor A and de-Almeida OP (2012). Primary oral melanoma: a histopathological and immunohistochemical study of 22 cases of Latin America. Med Oral Patol Oral Cir Bucal 17(3):e383-388.4 Rapini RP, Golitz LE, Greer RO, Jr., Krekorian EA and Poulson T (1985). Primary malignant melanoma of the oral cavity. A review of 177 cases. Cancer 55(7):1543-1551.5 Sortino-Rachou AM, Cancela Mde C, Voti L and Curado MP (2009). Primary oral melanoma: population-based incidence. Oral Oncol 45(3):254-258.Non-coreTUMOUR FOCALITYSingle selection value list:? Unifocal? Multifocal, specify number of tumours in specimen? Cannot be assessed, specifyCore andNon-coreTUMOUR DIMENSIONSNumeric:? Maximum tumour dimension (largest focus in a single specimen) ___ mm Non-core? Additional dimensions (largest tumour) ___ mm x ___ mm OR? Cannot be assessed, specifyUnlike melanoma in cutaneous sites, tumour thickness (Breslow) and tumour level (Clark) are not clinically significant as a prognostic factor, nor are they easily determined due to the specimen type.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MeWRpYXR0PC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48
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ADDIN EN.CITE.DATA 2-5 but does not impact on T stage. The single largest tumour dimension in any one of the samples submitted should be entered, as trying to combine multiple smaller measurements from multiple different sites (especially if fragmented) does not yield clinically meaningful data. References ADDIN EN.REFLIST 1 Lydiatt WM, Patel SG, O'Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM and Shah JP (2017). Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin 67(2):122-137.2 Thompson LD, Wieneke JA and Miettinen M (2003). Sinonasal tract and nasopharyngeal melanomas: a clinicopathologic study of 115 cases with a proposed staging system. Am J Surg Pathol 27(5):594-611.3 Prasad ML, Patel SG, Huvos AG, Shah JP and Busam KJ (2004). Primary mucosal melanoma of the head and neck: a proposal for microstaging localized, Stage I (lymph node-negative) tumors. Cancer 100(8):1657-1664.4 Shuman AG, Light E, Olsen SH, Pynnonen MA, Taylor JM, Johnson TM and Bradford CR (2011). Mucosal melanoma of the head and neck: predictors of prognosis. Arch Otolaryngol Head Neck Surg 137(4):331-337.5 Mucke T, Holzle F, Kesting MR, Loeffelbein DJ, Robitzky LK, Hohlweg-Majert B, Tannapfel A and Wolff KD (2009). Tumor size and depth in primary malignant melanoma in the oral cavity influences survival. J Oral Maxillofac Surg 67(7):1409-1415.Core andNon-coreHISTOLOGICAL TUMOUR TYPEMulti selection value list (select all that apply):? Mucosal melanoma? Melanoma (uncertain origin), specify/comment? Cannot be assessed, specifyNon-CoreHistologic subtypes ? Balloon cell melanoma? Mixed epithelioid and spindle cell melanoma? Epithelioid cell melanoma? Spindle cell melanoma? Amelanotic melanoma? Undifferentiated melanoma? Other, specifyThe inclusion of the specific histologic type or pattern of melanoma is primarily for differential diagnostic considerations, while the specific type does not impact patient outcome or management.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaHVtYW48L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 1,2 As mucosal melanomas are molecularly distinct from those of cutaneous origin occasional cases may require further molecular evaluation prior to definitively classifying as being of mucosal origin. References ADDIN EN.REFLIST 1 Shuman AG, Light E, Olsen SH, Pynnonen MA, Taylor JM, Johnson TM and Bradford CR (2011). Mucosal melanoma of the head and neck: predictors of prognosis. Arch Otolaryngol Head Neck Surg 137(4):331-337.2 Thompson LD, Wieneke JA and Miettinen M (2003). Sinonasal tract and nasopharyngeal melanomas: a clinicopathologic study of 115 cases with a proposed staging system. Am J Surg Pathol 27(5):594-611.Value list from the WHO Classification of Head and Neck Tumours (2017).Note that permission to publish the WHO classification of tumours may be needed in your implementation. It is advisable to check with the International Agency for Research on Cancer (IARC).Non-coreMARGIN STATUSSingle selection value list/text/numeric:? Cannot be assessed, specifyInvasive melanoma? InvolvedSpecify margin(s), if possible? Not involvedDistance invasive melanoma from closest margin ___ mm Distance not assessableSpecify closest margin, if possibleMelanoma in situ? InvolvedSpecify margin(s), if possible? Not involvedDistance of melanoma in situ from closest margin ___ mm Distance not assessableSpecify closest margin, if possibleIn general, tumour margins are reported, but margin status is not an independent prognostic factor for head and neck mucosal melanomas. Further, melanoma in situ (if detected) may not be meaningful and thus reporting is encouraged but is not a core element. Non-coreCOEXISTENT PATHOLOGYMulti selection value list (select all that apply): ? None identifiedOR? Melanoma in situ/pagetoid spread? Melanosis? Other, specifyMelanosis is considered to be a potential precursor, although with conflicting data based on anatomic site and geographic distribution of the reported patients.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NZWxldGk8L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 1-3 Pagetoid spread within the surface epithelium is often identical to melanoma in situ, without a meaningful separation between these entities at this time.References ADDIN EN.REFLIST 1 Meleti M, Vescovi P, Mooi WJ and van der Waal I (2008). Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105(5):606-616.2 Cicek Y and Ertas U (2003). The normal and pathological pigmentation of oral mucous membrane: a review. J Contemp Dent Pract 4(3):76-86.3 Takagi M, Ishikawa G and Mori W (1974). Primary malignant melanoma of the oral cavity in Japan. With special reference to mucosal melanosis. Cancer 34(2):358-370.Non-coreANCILLARY STUDIESSingle selection value list:? Not performed? Performed, specifyThe diagnosis of melanoma is supported by the use of melanoma markers, including S100 protein, SOX10, HMB45, Melan A and tyrosinase, among others. Further, molecular studies can also be performed in selected cases, either for diagnostic purposes (helping to confirm the diagnosis), or for potential use in targeted therapies based on the results. Molecular findings in mucosal melanoma are different from cutaneous primaries, with KIT and NRAS mutations occurring more frequently than BRAF mutations in tumours of mucosal sites.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DYXJ2YWphbDwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
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ADDIN EN.CITE.DATA 1-5References ADDIN EN.REFLIST 1 Carvajal RD, Antonescu CR, Wolchok JD, Chapman PB, Roman RA, Teitcher J, Panageas KS, Busam KJ, Chmielowski B, Lutzky J, Pavlick AC, Fusco A, Cane L, Takebe N, Vemula S, Bouvier N, Bastian BC and Schwartz GK (2011). KIT as a therapeutic target in metastatic melanoma. Jama 305(22):2327-2334.2 Lopez F, Rodrigo JP, Cardesa A, Triantafyllou A, Devaney KO, Mendenhall WM, Haigentz M, Jr., Strojan P, Pellitteri PK, Bradford CR, Shaha AR, Hunt JL, de Bree R, Takes RP, Rinaldo A and Ferlito A (2016). Update on primary head and neck mucosal melanoma. Head Neck 38(1):147-155.3 Rivera RS, Nagatsuka H, Gunduz M, Cengiz B, Gunduz E, Siar CH, Tsujigiwa H, Tamamura R, Han KN and Nagai N (2008). C-kit protein expression correlated with activating mutations in KIT gene in oral mucosal melanoma. Virchows Arch 452(1):27-32.4 Cancer Genome Atlas Network (2015). Genomic Classification of Cutaneous Melanoma. Cell 161(7):1681-1696.5 Zebary A, Jangard M, Omholt K, Ragnarsson-Olding B and Hansson J (2013). KIT, NRAS and BRAF mutations in sinonasal mucosal melanoma: a study of 56 cases. Br J Cancer 109(3):559-564.CorePATHOLOGICAL STAGING (UICC TNM 8th edition)TNM descriptorsChoose if applicable:? m - multiple primary tumours? r - recurrent? y - post-therapyBy American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) convention, the designation “T” refers to a primary tumour that has not been previously treated. The symbol “p” refers to the pathologic classification of the TNM, as opposed to the clinical classification, and is based on gross and microscopic examination. pT entails a resection of the primary tumour or biopsy adequate to evaluate the highest pT category, pN entails removal of nodes adequate to validate lymph node metastasis, and pM implies microscopic examination of distant lesions. Clinical classification (cTNM) is usually carried out by the referring physician before treatment during initial evaluation of the patient or when pathologic classification is not possible.Pathologic staging is usually performed after surgical resection of the primary tumour. Pathologic staging depends on pathologic documentation of the anatomic extent of disease, whether or not the primary tumour has been completely removed. If a biopsied tumour is not resected for any reason (e.g. when technically unfeasible) and if the highest T and N categories or the M1 category of the tumour can be confirmed microscopically, the criteria for pathologic classification and staging have been satisfied without total removal of the primary cancer.TNM DescriptorsFor identification of special cases of TNM or pTNM classifications, the “m” suffix and “y” and “r” prefixes are used. Although they do not affect the stage grouping, they indicate cases needing separate analysis.The “m” suffix indicates the presence of multiple primary tumours in a single site and is recorded inparentheses: pT(m)NM.The “y” prefix indicates those cases in which classification is performed during or following initialmultimodality therapy (i.e. neoadjuvant chemotherapy, radiation therapy, or both chemotherapy and radiation therapy). The cTNM or pTNM category is identified by a “y” prefix. The ycTNM or ypTNM categorizes the extent of tumour actually present at the time of that examination. The “y” categorization is not an estimate of tumour prior to multimodality therapy (i.e. before initiation of neoadjuvant therapy).The “r” prefix indicates a recurrent tumour when staged after a documented disease-free interval, and is identified by the “r” prefix: rTNM.Additional DescriptorsResidual Tumour (R)Tumour remaining in a patient after therapy with curative intent (e.g. surgical resection for cure) iscategorized by a system known as R classification, shown below.RX Presence of residual tumour cannot be assessedR0 No residual tumourR1 Microscopic residual tumourR2 Macroscopic residual tumourFor the surgeon, the R classification may be useful to indicate the known or assumed status of thecompleteness of a surgical excision. For the pathologist, the R classification is relevant to the status of the margins of a surgical resection specimen. That is, tumour involving the resection margin onpathologic examination may suggest residual tumour in the patient and may be classified as macroscopic or microscopic according to the findings at the specimen margin(s).The 8th edition of the AJCC/UICC staging of head and neck cancers includes a separate chapter for mucosal melanomas. ADDIN EN.CITE <EndNote><Cite><Author>Amin MB</Author><Year>2017</Year><RecNum>2011</RecNum><DisplayText><style face="superscript">1,2</style></DisplayText><record><rec-number>2011</rec-number><foreign-keys><key app="EN" db-id="20defpxt3as20tew5zepsdts5xe2att2e2va" timestamp="1478141607">2011</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Amin MB, Edge, S., Greene, F.L., Byrd, D.R., Brookland, R.K., Washington, M.K., Gershenwald, J.E., Compton, C.C., Hess, K.R., Sullivan, D.C., Jessup, J.M., Brierley, J.D., Gaspar, L.E., Schilsky, R.L., Balch, C.M., Winchester, D.P., Asare, E.A., Madera, M., Gress, D.M., Meyer, L.R. (Eds.) </author></authors></contributors><titles><title>AJCC Cancer Staging Manual 8th ed.</title></titles><dates><year>2017</year></dates><pub-location>New York</pub-location><publisher>Springer</publisher><urls></urls></record></Cite><Cite><Author>(UICC)</Author><Year>2016</Year><RecNum>384</RecNum><record><rec-number>384</rec-number><foreign-keys><key app="EN" db-id="z522tatv02df9met5x7vz2p4s2vwwv0v5r99" timestamp="1511685115">384</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Union for International Cancer Control (UICC)</author></authors><secondary-authors><author>James D. Brierley, Mary K. Gospodarowicz, Christian Wittekind (Eds)</author></secondary-authors></contributors><titles><title>TNM Classification of Malignant Tumours, 8th edition</title></titles><dates><year>2016</year></dates><publisher>Wiley-Blackwell</publisher><urls></urls></record></Cite></EndNote>1,2 Approximately two-thirds of mucosal melanomas arise in the sinonasal tract, one-quarter are found in the oral cavity and the remainder occur only sporadically in other mucosal sites of the head and neck. ADDIN EN.CITE <EndNote><Cite><Author>Patel S</Author><Year>2009</Year><RecNum>280</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="z522tatv02df9met5x7vz2p4s2vwwv0v5r99" timestamp="1487746747">280</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Patel S</author><author>Shah JP</author></authors><secondary-authors><author>Edge SB, Byrd DR, Carducci MA, Compton CA</author></secondary-authors></contributors><titles><title>Lip and oral cavity</title><secondary-title>AJCC Cancer Staging Manual</secondary-title></titles><section>29-40</section><dates><year>2009</year></dates><pub-location>New York</pub-location><publisher>Springer</publisher><urls></urls></record></Cite></EndNote>3 Even small tumours behave aggressively with high rates of recurrence and death. ADDIN EN.CITE <EndNote><Cite><Author>Patel S</Author><Year>2009</Year><RecNum>280</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="z522tatv02df9met5x7vz2p4s2vwwv0v5r99" timestamp="1487746747">280</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Patel S</author><author>Shah JP</author></authors><secondary-authors><author>Edge SB, Byrd DR, Carducci MA, Compton CA</author></secondary-authors></contributors><titles><title>Lip and oral cavity</title><secondary-title>AJCC Cancer Staging Manual</secondary-title></titles><section>29-40</section><dates><year>2009</year></dates><pub-location>New York</pub-location><publisher>Springer</publisher><urls></urls></record></Cite></EndNote>3 To reflect this aggressive behaviour, primary cancers limited to the mucosa are considered T3 lesions. Advanced mucosal melanomas are classified as T4a and T4b. The anatomic extent criteria to define moderately advanced (T4a) and very advanced (T4b) disease are given above. The AJCC staging for mucosal melanomas does not provide for the histologic definition of a T3 lesion; as the majority of mucosal melanomas are invasive at presentation, mucosal based melanomas (T3 lesions) include those lesions that involve either the epithelium and/or lamina propria of the involved site. Rare examples of in situ mucosal melanomas occur but in situ mucosal melanomas are excluded from staging, as they are extremely rare. ADDIN EN.CITE <EndNote><Cite><Author>Patel S</Author><Year>2009</Year><RecNum>280</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>280</rec-number><foreign-keys><key app="EN" db-id="z522tatv02df9met5x7vz2p4s2vwwv0v5r99" timestamp="1487746747">280</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Patel S</author><author>Shah JP</author></authors><secondary-authors><author>Edge SB, Byrd DR, Carducci MA, Compton CA</author></secondary-authors></contributors><titles><title>Lip and oral cavity</title><secondary-title>AJCC Cancer Staging Manual</secondary-title></titles><section>29-40</section><dates><year>2009</year></dates><pub-location>New York</pub-location><publisher>Springer</publisher><urls></urls></record></Cite></EndNote>3References ADDIN EN.REFLIST 1 Amin MB, Edge S, Greene FL, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR (eds) (2017). AJCC Cancer Staging Manual 8th ed. Springer, New York.2 International Union against Cancer (UICC) (2016). TNM Classification of Malignant Tumours (8th Edition). Brierley JD, Gospodarowicz MK, Wittekind C (eds). New York: Wiley-Blackwell.3 Patel S and Shah JP (2010). Lip and oral cavity. In AJCC Cancer Staging Manual 7th ed. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds). Springer, New YorkNote that permission to publish the TNM cancer staging tables may be needed in your implementation. It is advisable to check.Reproduced with permission. Source: UICC TNM Classification of Malignant Tumours, 8th Edition, eds James D. Brierley, Mary K. Gospodarowicz, Christian Wittekind. 2017, Publisher Wiley-Blackwell.CorePrimary tumour (pT)Single selection value list:? TX Primary tumour cannot be assessed? T3 Tumour limited to the epithelium and/or submucosa (mucosal disease)? T4a Moderately advanced diseaseTumour invades deep soft tissue, cartilage, bone, or overlying skin? T4b Very advanced diseaseTumour invades any of the following: brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structuresNote that the results of lymph node/neck dissection are derived from a separate dataset. ................
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