Melanoma — SCE Dermatology MCQ

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ModerateSkin CancerMelanomaSCE Dermatology

A 60-year-old man has a melanoma excised. The pathology report states: Breslow thickness 2.5 mm, ulcerated, mitotic rate 4/mm², no lymphovascular invasion. According to AJCC 8th edition, what is the T stage?

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Correct answer: C — T3b

AJCC 8th edition T-staging: T3 = 2.01-4.0 mm. The suffix 'a' = without ulceration, 'b' = with ulceration. A 2.5 mm melanoma WITH ulceration = T3b. Ulceration upstages within each T category and is an independent adverse prognostic factor. In the 8th edition, mitotic rate was removed from the T-staging criteria (previously used in 7th edition for T1 subdivision only) but remains an important prognostic factor reported in pathology. T3b melanoma has a 10-year melanoma-specific survival of approximately 68%. Sentinel lymph node biopsy and discussion of adjuvant therapy are indicated.

Reference: AJCC 2017 8th Edition; BAD 2017 Melanoma Guidelines