Created at 6:04 a.m. Sep, 16, 2025
Author:
zja001
Type of change:
Updated content
Rationale for change
pT1b is still Stage IA per AJCC 8th, the attached table in extras is wrong
https://pmc.ncbi.nlm.nih.gov/articles/PMC7652033/figure/F5/
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Personal Notes
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Missed Questions
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DermPath
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Dermoscopy
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VisualDx
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DermNet
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Full Spectrum of Dermatology
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Dermnemonics
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Dermatographix
Melanoma Histology, Staging, and Treatment of Localized Melanomas (DermatoGraphix)
Histology
•Fragmented nest: Discohesion (nest fragments into individual cells) with asymmetry, poor circumscription, irregularly sized, and shaped junctional nests
•Consuming a worm: Epidermal consumption (melanoma effaces the epidermis leading to epidermal thinning and ulceration)
•Immature birds underneath: Lack of maturation of dermal component
•Red eggs in nucleus-like nest: Cytologic atypia with irregular, large nuclei with prominent red nucleoli
•Woodpecker digging deep ulcer in tree: Most important staging parameter is Breslow thickness and ulceration
Staging
•Bee coming out of ulcerated hole: For T classifications, the presence of ulceration upgrades the stage to b
•1, 2, 3, 4 etched on the tree trunk: T classification corresponds to Breslow thickness and generally correlates with millimeters
•T1: ≤1.0 mm Breslow thickness
•T2: >1.0-2.0 mm
•T3: >2.0-4.0 mm (average is 3)
•T4: >4.0 mm
•#8 underneath #1: 0.8 mm is the cut-off for T1a without ulceration. If >0.8 mm or ulceration → stage T1b
Treatment
•Knife: Wide local excision (margins corresponding to Breslow depth)
#1,2,3,4:
•Breslow depth ≤1 mm → take 1 cm margin
•Breslow depth 1-2 mm → take 1-2 cm margins
•Breslow depth >2.0 mm → take 2 cm margin
•Green pearl necklace coming out of ulcer: Ulcer signifies at least stage T1b, at which point a sentinel lymph node biopsy should be considered (offered for higher stages)
Textbook
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