How are head and neck mucosal melanomas staged?

Updated: May 07, 2020
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

No universally accepted staging system for mucosal melanoma exists. Because of the absence of histologic landmarks analogous to the papillary and reticular dermis, the prognostic value of various levels of invasion, as established in the Clark classification for cutaneous melanoma, does not apply to mucosal melanoma. The following is the system that suffices for staging:

  • Stage I – Localized disease

  • Stage II – Metastases to regional lymphatics

  • Stage III – Distant metastatic disease

Most patients (75-83%) present with stage I disease. Among patients with oral cavity lesions, however, a higher prevalence of stage II disease is noted.

The Memorial Sloan Kettering Cancer Center proposed a microstaging system for Stage I disease based on the architectural anatomy of the mucosa, as follows [8] :

  • level I - In situ mucosal melanoma without invasion or with microinvasion

  • level II - Invasion up to the lamina propria

  • level III - Deep invasion into bone, cartilage, or skeletal muscle

According to the authors, these levels represent different microanatomic compartments separated by tissue barriers that are easily and reliably identifiable on light microscopy. They found this staging system to be a significant and independent predictor of survival in patients with localized, lymph node–negative, stage I disease. [9]


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