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Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The TNM classification for cutaneous melanoma is a system used to determine the stage of melanoma by assessing the size and extent of the primary tumor, the involvement of lymph nodes, and the presence of distant metastasis. The calculator takes three key inputs: tumor classification, lymph node classification, and distant metastasis, each assigned specific categories or descriptions.

Inputs:
1. Tumor Classification: This is categorized from Tx to T4b, where Tx indicates the primary tumor cannot be assessed, T0 means no evidence of primary tumor, Tis is melanoma in situ, and ranges to T4b, which indicates a tumor > 4 mm in thickness with ulceration.
2. Lymph Node Classification: Options range from Nx, indicating regional lymph nodes cannot be assessed, to N3c, which involves criteria such as the number of tumor-involved nodes and the presence of metastases.
3. Distant Metastasis: Classified from M0, meaning no distant metastasis, to M1d, indicating distant metastasis to the central nervous system.

Computation:
The calculator evaluates the inputs based on predefined logic to determine the stage of melanoma:

- Stage 0 is identified if the tumor is in situ (Tis), there is no lymph node metastasis (N0), and no distant metastasis (M0).
- Stages IA to IIC are determined based on varying combinations of tumor size, ulceration, and the absence of nodal and distant metastasis.
- Stages IIIA to IIID involve the presence of lymph node metastasis with combinations of primary tumor characteristics, without distant metastasis.
- Stage IV is assigned if any level of tumor classification and lymph node involvement is coupled with the presence of distant metastasis.
- If the necessary inputs do not fit into the criteria for the specified stages, the result is "Stage cannot be fully assessed."

The calculator in question is the TNM Classification for Cutaneous Melanoma. TNM stands for Tumor, Node, Metastasis, and it is a globally recognized system used for classifying the extent of spread of cancer. This specific TNM classification is applicable to patients diagnosed with cutaneous melanoma, a type of skin cancer.

The clinical utility of this calculator is to stage the disease, which is crucial for determining the appropriate treatment strategy and predicting patient prognosis. The TNM system for cutaneous melanoma takes into account the thickness and ulceration of the primary tumor (T), whether the cancer has spread to nearby lymph nodes (N), and whether there are distant metastases (M).

There are no specific exclusion criteria for the use of the TNM classification for cutaneous melanoma. However, it is not applicable to other types of skin cancer or melanoma that is not cutaneous. It is also less useful in early-stage melanoma where lymph node involvement and metastasis are not yet present.

TNM classification for cutaneous melanoma

The 7-point dermoscopy checklist offers a systematic way to evaluate the likelihood of melanoma by examining specific features of a skin lesion. By answering seven yes-or-no questions about distinct lesion characteristics, the checklist produces a score and interpretation that estimate melanoma risk.

The checklist assesses the following seven features:

- Atypical pigment network
- Gray-blue areas
- Atypical vascular pattern
- Radial streaming or streaks
- Irregular diffuse pigmentation or blotches
- Irregular dots and globules
- Regression pattern

Each detected feature contributes to a score based on its significance:

| Feature                              | Score |
|--------------------------------------|-------|
| Atypical pigment network             | 2     |
| Gray-blue areas                      | 2     |
| Atypical vascular pattern            | 2     |
| Radial streaming, streaks            | 1     |
| Irregular diffuse pigmentation, blotches  | 1     |
| Irregular dots and globules          | 1     |
| Regression pattern                   | 1     |

The checklist's algorithm adds up the scores for each present feature. This cumulative score provides an overall assessment of melanoma risk.

The resulting interpretation depends on the total score:

- A score of 4 or more suggests "Melanoma is likely" with 93% sensitivity and 78% specificity. This indicates a high probability of the lesion being melanoma.
  
- A score of 3 or less implies "The risk of melanoma is low," suggesting a lower probability of the lesion being melanoma.

The process results in a straightforward summary that aids clinicians in evaluating the risk of melanoma, delivering both the numerical score and the pertinent interpretation.

The calculator in question is the "7-point dermoscopy checklist for melanoma". This clinical scoring system is used in the field of dermatology, specifically for patients who present with suspicious skin lesions that may be indicative of melanoma. 

The 7-point dermoscopy checklist is a diagnostic tool that aids clinicians in determining the likelihood of a skin lesion being a melanoma. It uses seven criteria, each assigned a score of 1 or 2, to evaluate the characteristics of the lesion. The total score can range from 0 to 8, with higher scores suggesting a higher probability of melanoma.

The clinical utility of this calculator is to assist in early detection of melanoma, thereby improving patient outcomes through early intervention. It is particularly useful in primary care or dermatology settings where a biopsy may not be immediately available or feasible.

There are no specific exclusion criteria for the use of this calculator. However, it should be noted that it is a diagnostic aid and not a definitive diagnostic tool. Therefore, it should be used in conjunction with other clinical assessments and diagnostic procedures. It may also be less accurate in assessing atypical or rare forms of melanoma.

7-point dermoscopy checklist for melanoma

The revised 7-point dermoscopy checklist for melanoma assessment takes as input seven binary features associated with potential signs of melanoma. Each feature represents a potential indicator of melanoma and can either be present (true) or absent (false). These features are:

atypical pigment network
blue-white veil
atypical vascular pattern
irregular streaks
irregular blotches
irregular dots/globules
regression structures.

To compute the melanoma score, each feature that is present (true) contributes a score of 1. The total score is the sum of the scores for all present features, ranging from 0 to 7. The detailed scoring system is as follows:

| Feature                      | Score if Present |
|------------------------------|------------------|
| Atypical pigment network     | 1                |
| Blue-white veil              | 1                |
| Atypical vascular pattern    | 1                |
| Irregular streaks            | 1                |
| Irregular blotches           | 1                |
| Irregular dots/globules      | 1                |
| Regression structures        | 1                |

The interpretation of the score is straightforward: if the total score is 1 or more, it indicates that melanoma is likely, and excision of the suspected lesion is recommended. Therefore, any positive feature finding (i.e., any score of at least 1) necessitates further medical action. The outputs of the computation are the total score and its interpretation, which always suggests the likelihood of melanoma and the need for excision when the score is non-zero.

The calculator in question is the Revised 7-point Dermoscopy Checklist for Melanoma. This clinical tool is used in the dermatological field, specifically for patients who present with suspicious skin lesions that may be indicative of melanoma. The checklist is designed to aid clinicians in the early detection of melanoma by assessing seven key dermoscopic features of skin lesions. These features include atypical pigment network, blue-whitish veil, atypical vascular pattern, irregular streaks, irregular pigmentation, irregular dots/globules, and regression structures. 

The clinical utility of this calculator is to provide a systematic approach to evaluate skin lesions and to determine the likelihood of the lesion being a melanoma. It helps in stratifying the risk and guiding further management, including the decision for biopsy or excision. 

The Revised 7-point Dermoscopy Checklist for Melanoma is not recommended for use in patients with known melanoma or in those with non-pigmented skin lesions, as the features assessed in the checklist are specific to pigmented lesions. It should also be used with caution in patients with multiple atypical moles or a personal or family history of melanoma, as these patients may require a more comprehensive evaluation.

Revised 7-point dermoscopy checklist for melanoma

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Cutaneous melanoma

Management of melanoma in situ

Management of melanoma in situ, wide-local excision

Excisional biopsy

Management of locoregional disease

Management of locoregional disease (management of in-transit metastases)

Management of advanced/metastatic disease

Management of advanced/metastatic disease (management of extracranial metastases)

Management of advanced/metastatic disease, third-line therapy

Management of melanoma in situ (primary radiotherapy)

Concurrent use of exogenous hormones

Management of advanced/metastatic disease (management of brain metastases)

Assessment for cutaneous toxicity

Management of locoregional disease, wide-local excision

Management of locoregional disease (general principles)

Physical examination

Follow-up

Imaging for staging

Management of locoregional disease, adjuvant systemic therapy

Skin reconstruction after tumor resection

Skin reconstruction after tumor resection (perioperative analgesics)

Management of melanoma in situ (topical therapy)

Pregnant patients

Management of locoregional disease, lymph node dissection

Management of locoregional disease, adjuvant radiotherapy

Primary prevention

Management of locoregional disease, neoadjuvant therapy

General counseling

Management of advanced/metastatic disease, second-line therapy

Indications for screening

Laboratory tests

Management of advanced/metastatic disease, first-line therapy

Genetic counseling

Skin reconstruction after tumor resection (perioperative antibiotics)

Management of advanced/metastatic disease (general principles)

Skin reconstruction after tumor resection (timing)

Sentinel lymph node biopsy

Patients with vulvar melanoma

Skin reconstruction after tumor resection (perioperative antithrombotics)

Patients with mucosal melanoma

Skin reconstruction after tumor resection (follow-up)

Molecular testing

Staging

Updated 2025 ESMO guidelines for the diagnosis and management of cutaneous melanoma


Cutaneous melanoma

Background

Overview

Guidelines

Key sources