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ISCL/EORTC proposal on TNM classification of cutaneous lymphoma other than mycosis fungoides or Sézary syndrome

ISCL/EORTC proposal on TNM classification of cutaneous lymphoma other than mycosis fungoides or Sézary syndrome
T
T1: Solitary skin involvement
T1a: A solitary lesion <5 cm diameter
T1b: A solitary lesion >5 cm diameter
T2: Regional skin involvement: multiple lesions limited to one body region or two contiguous body regions*
T2a: All-disease-encompassed in a <15 cm-diameter circular area
T2b: All-disease-encompassed in a >15 cm- and <30 cm-diameter circular area
T2c: All-disease-encompassed in a >30 cm-diameter circular area
T3: Generalized skin involvement
T3a: Multiple lesions involving two noncontiguous body regions*
T3b: Multiple lesions involving ≥3 body regions
N
N0: No clinical or pathologic lymph node involvement
N1: Involvement of one peripheral lymph node region that drains an area of current or prior skin involvement
N2: Involvement of two or more peripheral lymph node regions or involvement of any lymph node region that does not drain an area of current or prior skin involvement
N3: Involvement of central lymph nodes
M
M0: No evidence of extracutaneous non-lymph node disease
M1: Extracutaneous non-lymph node disease present
* Definition of body regions:
  • Head and neck: inferior border- superior border of clavicles, T1 spinous process.
  • Chest: superior border- superior border of clavicles; inferior border- inferior margin of rib cage; lateral borders- mid-axillary lines, glenohumeral joints (inclusive of axillae).
  • Abdomen/genital: superior border- inferior margin of rib cage; inferior border- inguinal folds, anterior perineum; lateral borders- mid-axillary lines.
  • Upper back: superior border- T1 spinous process; inferior border- inferior margin of rib cage; lateral borders- mid-axillary lines.
  • Lower back/buttocks: superior border- inferior margin of rib cage; inferior border- inferior gluteal fold, anterior perineum (inclusive of perineum); lateral borders- mid-axillary lines.
  • Each upper arm: superior borders- glenohumeral joints (exclusive of axillae); inferior borders- ulnar/radial-humeral (elbow) joint.
  • Each lower arm/hand: superior borders- ulnar/radial-humeral (elbow) joint.
  • Each upper leg (thigh): superior borders- inguinal folds, inferior gluteal folds; inferior borders- mid-patellae, mid-popliteal fossae.
  • Each lower leg/foot: superior borders- mid-patellae, mid-popliteal fossae.
¶ Definition of lymph node regions is consistent with the Ann Arbor system: Peripheral sites: antecubital, cervical, supraclavicular, axillary, inguinal-femoral, and popliteal. Central sites: mediastinal, pulmonary hilar, paraortic, iliac.
This research was originally published in Blood. Kim YH, Willemze R, Pimpinelli N, et al. TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007; 110:479.
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