Melanoma Staging — SCE Dermatology MCQ

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ModerateSkin CancerMelanoma StagingSCE Dermatology

A 60-year-old man with a Breslow 4.5 mm melanoma has wide local excision with 2 cm margins. His SLNB is negative. What is his AJCC stage?

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Correct answer: C — Stage II (T4aN0M0 = Stage IIB or IIC depending on ulceration)

A Breslow 4.5 mm melanoma is T4 (>4.0 mm). Without ulceration = T4a; with ulceration = T4b. With negative SLNB (N0) and no distant metastases (M0): T4aN0M0 = Stage IIB; T4bN0M0 = Stage IIC. Stage II melanoma has no nodal or distant metastatic disease but carries significant recurrence risk based on tumour thickness and ulceration. Adjuvant systemic therapy (Pembrolizumab) is now NICE-approved for resected stage IIB/IIC melanoma (KEYNOTE-716 trial), representing a paradigm shift in treating high-risk stage II disease. This patient should be offered adjuvant immunotherapy regardless of negative SLNB. Enhanced surveillance with imaging is also recommended.

Reference: AJCC 8th Edition; NICE; BAD 2017