Pathologic Staging (pTNM)

CAP Approved  Skin • Merkel Cell Carcinoma of the Skin 4.0.0.0

TNM Descriptors (required only if applicable) (select all that apply)

____ m (multiple)

____ r (recurrent)

____ y (posttreatment)

Primary Tumor (pT)

Note: If clinical tumor size is unavailable, gross or microscopic tumor measurement should be used for determining the T category. 

___ pTX:        Primary tumor cannot be assessed (eg, curetted)

___ pT0:        No evidence of primary tumor

___ pTis:        In situ primary tumor

___ pT1:        Maximum clinical tumor diameter ≤2 cm

___ pT2:        Maximum clinical tumor diameter >2 but ≤5 cm

___ pT3:        Maximum clinical tumor diameter >5 cm

___ pT4:        Primary tumor invades bone, muscle, fascia, or cartilage

Regional Lymph Nodes (pN)

___ pNX:        Regional lymph nodes cannot be assessed (eg, previously removed for another reason or not removed for pathological evaluation)

___ pN0:        No regional lymph node metastasis detected on pathological evaluation

___ pN1:        Metastasis in regional lymph node(s)

___ pN1a(sn):        Clinically occult regional lymph node metastasis identified only by sentinel lymph node biopsy

___ pN1a:        Clinically occult regional lymph node metastasis following lymph node dissection

___ pN1b:        Clinically and/or radiologically detected regional lymph node metastasis#

___ pN2:        In transit metastasis (discontinuous from primary tumor; located between primary tumor and draining regional nodal basin, or distal to the primary tumor) without lymph node metastasis

___ pN3:        In transit metastasis (discontinuous from primary tumor; located between primary tumor and draining regional nodal basin, or distal to the primary tumor) with lymph node metastasis

# Note: The pN1b, subcategory is dependent on clinical information that may be unavailable to the pathologist. If this information is not available, the parent category (pN1) should be selected.

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ pM1:        Distant metastasis microscopically confirmed 

___ pM1a:        Metastasis to distant skin, distant subcutaneous tissue, or distant lymph node(s), microscopically confirmed

___ pM1b:        Metastasis to lung, microscopically confirmed

___ pM1c:        Metastasis to all other distant sites, microscopically confirmed

Summary of changes

• Multiple changes in pN categories – see CAP protocol for details

Skin

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