Diagnosis

SKIN, SITE (R/ L / MIDLINE / NOT SPECIFIED), BIOPSY/ EXCISION/RE-EXCISION / LYMPHADENECTOMY (SPECIFY): -Malignant melanoma -Tumor thickness: ____ mm -Ulceration: Absent / Present 2 -Mitotic rate: 0 or # / mm -Clarks level: __________ -Margin status: Negative / Positive -Pathologic stage:________________

ADDITIONAL SYNOPTIC DETAILS

Tumor size (only if tumor is grossly present): Greatest dimension: ___cm Macroscopic satellite nodule (for excision): Not identified / Present / Indeterminate Histologic subtype: Lentigo Maligna / Superficial spreading / Nodular / Acral-lentiginous / Desmoplastic / other. Maximum tumor thickness: Specify: ___mm / At least _____ Clarks Level: I (in situ), II (papillary dermis), III (up to papillary-reticular interface), IV (reticular dermis), V (subcutis).
MARGINS

Peripheral margins:
Cannot be assessed Negative for invasive melanoma (Distance from tumor to closest peripheral margin____mm, for excision only) Positive for invasive melanoma Negative for melanoma in-situ (Distance from tumor to closest peripheral margin____mm, for excision only) Positive for melanoma in-situ Deep margin: Cannot be assessed / Negative for invasive melanoma (Distance from tumor to closest peripheral margin____mm, for excision only) / Positive for invasive melanoma Microsatellitosis: Not identified / Present / Indeterminate Lymph-Vascular Invasion: Not identified / Present / Indeterminate -

Pathologic Stage: (pTNM): ____________

pTX Primary tumor cannot be assessed PTO No evidence of primary tumor pTis Melanoma in-situ pT1a Melanoma 1 mm or less thick, no ulceration and mitosis 0 per mm squared pT1b Melanoma 1 mm or less thick, with ulceration or mitosis 1 or more per mm squared pT2a Melanoma 1.01 2 mm thick, no ulceration pT2b Melanoma 1.01- 2 mm thick, with ulceration pT3a Melanoma 2.01 4 mm thick, no ulceration pT3b Melanoma 2.01 4 mm thick, with ulceration pT4a Melanoma > 4 mm thick, no ulceration pT4b Melanoma > 4 mm thick, with ulceration Regional Lymph Nodes (pN) ___________________ Distant Metastasis (pM) _______________________