Stage IA T1a: no
T1aN0M0 ulceration
no adverse Breslow (U-), Clark
features ≤ 1mm level ≤ III
Margins Mohs? SLN bx PET
ESMO 1 cm no no no
NCCN 1 cm no no no
U of Iowa 1 cm* no** no no
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
Stage IA
T1aN0M0
T1a: no
adverse
features: ulceration
mitotic rate >1 Breslow (U-), Clark
mm2, LVI ≤ 1mm level ≤ III
Margins Mohs? SLN bx PET
ESMO 1 cm no no no
NCCN 1 cm no yes no
U of Iowa 1 cm* no** yes*** no
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
T1b:with
ulceration or
Stage IB Breslow Clark level
T1bN0M0 ≤ 1mm IV or V
Margins Mohs? SLN bx PET
ESMO 1 cm no no no
NCCN 1 cm no yes no
U of Iowa 1 cm* no** yes*** no
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
Stage IB Breslow T2a: no
T2aN0M0 1.01-2.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 1 - 2 cm no yes no#
U of Iowa 1 -2 cm* no** yes*** no#
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage IIA Breslow T2b: with
T2bN0M0 1.01-2.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 1 - 2 cm no yes no#
U of Iowa 1 -2 cm* no** yes*** no#
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage IIA Breslow T3a: no
T3aN0M0 2.01-4.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 2 cm no yes no#
U of Iowa 2 cm* no** yes*** no#
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage IIB Breslow T3b: with
T3bN0M0 2.01-4.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 2 cm no yes no#
U of Iowa 2 cm* no** yes*** no#
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage IIB Breslow T4a: no
T4aN0M0 >4.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 2 cm no yes no#
U of Iowa 2 cm* no** yes*** yes
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage IIC Breslow T4b: with
T4bN0M0 >4.0 mm ulceration
Margins Mohs? SLN bx PET
ESMO
NCCN 2 cm no yes no#
U of Iowa 2 cm* no** yes*** yes
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
***comment: consider SLN bx: >0.75 mm invasion, other listed adverse feat
desmoplastic melanoma
#comment: PET/CT imaging may be useful to evaluate signs/symptoms but
Stage III
T - any
N - positive
M-0
Margins Mohs? SLN bx PET
ESMO
NCCN per T no no yes
U of Iowa per T* no** no yes
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
Stage IV
T - any
N - any
M-0
Margins Mohs? SLN bx PET
ESMO
NCCN per T no no yes
U of Iowa per T* no** no yes
*comment: margins are not inviolate and may be modified by proximity to cri
structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo ma
extending beyond the 1 margin encompassing melanoma
10 yr survival =
87.9%
CT Radiation Adjuvant
no no no
no no no
consider: PNI,
no desmoplastic no
ed by proximity to critical
noma with lentigo maligna
CT Radiation Adjuvant
no no no
no no no
consider: PNI,
no desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
CT Radiation Adjuvant
no no no
no no no
consider: PNI,
no desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
CT Radiation Adjuvant
no# no no
consider: PNI,
no# desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
no# no no
consider: PNI,
no# desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
no# no no
consider: PNI,
no# desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
no# no no
consider: PNI,
no# desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
no# no no
consider: PNI,
yes desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
no# no no
consider: PNI,
yes desmoplastic no
ed by proximity to critical
noma with lentigo maligna
er listed adverse features; SLN not useful
signs/symptoms but are not routine.
CT Radiation Adjuvant
yes yes yes
yes yes yes
ed by proximity to critical
noma with lentigo maligna
CT Radiation Adjuvant
yes yes yes
yes yes yes
ed by proximity to critical
noma with lentigo maligna