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{
"id" : "path_n_dam",
"algorithm" : "tnm",
"version" : "1.6",
"name" : "Path N Melanoma Skin",
"title" : "Pathologic N",
"notes" : "**Note 1:** Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. (1)\n\n**Note 2:** Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in M (distant metastasis).\n\n**Note 3:** Any finding of melanoma in lymph nodes, regardless of size and including isolated tumor cells (ITCs), are coded as positive lymph nodes.\n* Assign N1 If only ITCs are present\n\n**Note 4:** Bilateral or contralateral nodes are classified as regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy.\n* Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed\n\n\n **Note 5:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins. Secondary basins are regional for TNM staging.\n\n**Note 6:** Assign N2c if there are satellite(s) or in-transit metastasis without regional lymph node involvement. Assign N3 if both satellite nodules/in-transit metastases and regional lymph nodes are present. \n\n**Regional lymph nodes by skin primary site**\n* Head and Neck sites include bilateral or contralateral nodes\n\n**Lip (C440)**\n \n Cervical\n Facial, NOS \n Buccinator (buccal) \n Nasolabial \n Mandibular, NOS \n Parotid, NOS \n Infra-auricular \n Preauricular \n Submental \n Submandibular (submaxillary) \n \n**External ear/auditory canal (C442)**\n \n Cervical\n Mastoid (post-/retro-auricular) (occipital) \n Preauricular \n \n**Face, Other (cheek, chin, forehead, jaw, nose and temple) (C443)** \n \n Cervical\n Facial, NOS \n Buccinator (buccal) \n Nasolabial \n Mandibular, NOS \n Parotid, NOS \n Infra-auricular \n Preauricular \n Submental\n Submandibular (submaxillary) \n \n**Scalp (C444)** \n \n Mastoid (post-/retro-auricular) (occipital) \n Parotid, NOS \n Infra-auricular \n Preauricular \n Spinal accessory (posterior cervical)\n \n**Neck (C444)**\n \n Axillary \n Mandibular, NOS \n Mastoid (post-/retro-auricular) (occipital) \n Parotid, NOS \n Infra-auricular \n Preauricular \n Spinal accessory (posterior cervical) \n Submental \n Supraclavicular (transverse cervical) \n \n**Trunk (C445)** \n \n Axillary \n Cervical \n Internal mammary (parasternal)\n Femoral (superficial inguinal) \n Supraclavicular (transverse cervical) \n \n**Arm/Shoulder (C446)**\n \n Axillary \n Epitrochlear for hand/forearm \n Spinal accessory for shoulder \n \n**Leg/Hip (C447)**\n \n Femoral (superficial inguinal) \n Popliteal for heel and calf \n \n **Bidirectional nodal involvement (includes bilateral or contralateral nodes)**\n\n Upper Trunk: Femoral (or cephalad/caudal drainage from primary tumor) \n Lower Trunk: Axillary (or cephalad/caudal drainage from primary tumor)\n \n**Secondary nodal basin involvement (includes bilateral or contralateral nodes)**\n \n Head and Neck: Supraclavicular \n Arm/Shoulder: Supraclavicular \n Leg/Hip: Iliac \n All sites: Regional lymph node(s) in secondary nodal basins, NOS",
"footnotes" : "(1) International Union Against Cancer (UICC) *TNM Classification of Malignant Tumors,* 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 174",
"last_modified" : "2018-02-02T14:54:22.598Z",
"definition" : [ {
"key" : "path_n",
"name" : "Pathologic N",
"type" : "INPUT"
}, {
"key" : "path_n_display",
"name" : "Pathologic N Display",
"type" : "DESCRIPTION"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
}, {
"key" : "notes",
"name" : "Registrar Notes",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "pX", "pNX", "Regional lymph nodes cannot be assessed", "Pathologic classification criteria met, evaluation done:\n Physician unable to assess N\n Surgical resection primary tumor, no regional lymph nodes removed\n Involvement of regional lymph nodes not documented\nPhysician assigns pNX, no other information available to determine N" ], [ "p0", "pN0", "No regional lymph node metastasis", "No regional lymph node involvement " ], [ "p1", "pN1", "Metastasis in one regional lymph node", "Note: N1 has subcategories of N1a and N1b. Assign N1 only when there is no information available to assign one of the subcategories\n\nRegional lymph nodes, NOS\nLymph nodes, NOS\n\nStated as N1 [NOS]" ], [ "p1A", "pN1a", "Only microscopic metastasis (clinically occult)", "One positive node identified by sentinel lymph node OR after completion of lymphadenectomy\n\nStated as N1a" ], [ "p1B", "pN1b", "Macroscopic metastasis (clinically apparent)", "One positive node clinically detected and confirmed by lymphadenectomy OR when there is gross extracapsular extension\n\nStated as N1b" ], [ "p2", "pN2", "Metastasis in two or three regional lymph nodes or satellite(s) or in-transit metastasis", "Note: N2 has subcategories of N2a, N2b and N2c. Assign N2 only when there is no information available to assign one of the subcategories\n\nStated as N2 [NOS]" ], [ "p2A", "pN2a", "Only microscopic nodal metastasis", "Two to three nodes identified by sentinel lymph node OR after completion of lymphadenectomy\n\nStated as N2a" ], [ "p2B", "pN2b", "Macroscopic nodal metastasis", "Two to three nodes clinically detected and confirmed by lymphadenectomy OR when there is gross extracapsular extension\n\nStated as N2b" ], [ "p2C", "pN2c", "Satellite(s) or in-transit metastasis WITHOUT regional nodal metastasis", "Satellite nodule(s) or in transit metastasis, distance from primary tumor less than or equal to 2 cm or distance not stated WITHOUT regional lymph node involvement. \n\nDescribed as tumor with satellite nodule(s) or in transit metastasis, NOS WITHOUT regional lymph node involvement\n\nStated as N2c" ], [ "p3", "pN3", "Metastasis in four or more regional lymph nodes, or matted metastatic regional lymph nodes, or satellite(s) or in-transit metastasis with metastasis in regional lymph node(s)", "Matted lymph nodes\n\nSatellite nodule(s) or in-transit metastases WITH regional lymph nodes\n\nStated as N3" ], [ "c0", "cN0", "Clinically: No regional lymph node metastasis", "Use only for TNM defined pTis cases where there is a resection of the primary and the nodes are not evaluated pathologically" ], [ "88", "88", "Not applicable", "Death certificate only (DCO) case" ], [ "", "BLANK", "See Registrar Notes", "Pathologic classification criteria not met \nNo surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category\nEvidence of metastatic disease (pM1), no other workup\nOnly Pathologic Stage Group documented (no T, N, or M information available)" ] ]
}
