A melanoma biopsy report reads: Clark level IV, Breslow thickness 2.2 mm, ulceration present, mitotic rate 3/mm², no microsatellitosis. According to the current AJCC staging, this would be staged as:
- A T2b
- B T3a
- C T3b ✓
- D T4b
Correct answer: C. T3b
Explanation
In the AJCC 8th edition melanoma staging: T3 = Breslow thickness 2.01-4.0 mm. The 'b' suffix denotes presence of ulceration: T3b = 2.01-4.0 mm with ulceration. T3a = 2.01-4.0 mm without ulceration. Clark level IV alone no longer determines T category in AJCC 8th edition (Clark level only matters as a tie-breaker for T1b when mitotic rate is unavailable in some guidelines). Ulceration upgrades any T category from 'a' to 'b'. Breslow thickness is the most important prognostic factor. T2b = 1.01-2.0 mm with ulceration. T4b = >4.0 mm with ulceration.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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