## AJCC 8th Edition Stage Assignment ### Step-by-Step Staging **Step 1: Determine T Stage** - Breslow thickness = 2.8 mm → falls in the 2.01–4.0 mm range → **T3** - No ulceration → **T3a** (ulceration would make it T3b) **Step 2: Determine N Stage** - Sentinel lymph node biopsy: no metastatic disease → **N0** **Step 3: Determine M Stage** - No distant metastases mentioned → **M0** **Step 4: Consult Stage Grouping Table (AJCC 8th Edition)** | Stage | T | N | M | |-------|---|---|---| | IA | T1a | N0 | M0 | | IB | T1b or T2a | N0 | M0 | | **IIA** | **T2b or T3a** | **N0** | **M0** | | IIB | T3b or T4a | N0 | M0 | | IIC | T4b | N0 | M0 | | IIIA | T1–T4a | N1a or N2a | M0 | | IIIB | T1–T4b | N1b, N2b, or N2c | M0 | | IIIC | Any T | N3 | M0 | | IV | Any T | Any N | M1 | **Key Point:** T3a (2.01–4.0 mm, **no** ulceration) + N0 + M0 = **Stage IIA** (Option B). The original answer of Stage IIB was incorrect; IIB requires T3b (same thickness WITH ulceration) or T4a. **High-Yield:** Ulceration is a critical upstaging factor in melanoma. T3a → Stage IIA, but T3b (ulcerated) → Stage IIB. Always check for ulceration before assigning the final stage. **Clinical Pearl:** Sentinel lymph node biopsy is recommended for melanomas >1 mm thick (AJCC 8th Edition guidelines) to accurately stage disease and guide adjuvant therapy decisions. A negative SLNB confirms N0 status. [cite: AJCC Cancer Staging Manual, 8th Edition — Melanoma of the Skin, Chapter 47]
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