Term

Definition

Adjuvant therapy or treatment

A treatment given after the main treatment for cancer to reduce the risk of recurrence.

Adverse event

Detrimental change in health occurring in a person receiving the treatment whether or not it has been caused by the treatment.

Axillary

In the armpit.

Biopsy

Removal of a sample of tissue from the body to assist in diagnosis or inform the choice of treatment of a disease.

BRAF V600 mutation

BRAF is a human gene that makes a protein called B‐Raf which is involved in the control of cell growth. BRAF mutations (damaged DNA) occur in around 40% of melanomas, which can then be treated with particular drugs.

BRAF inhibitors

Therapeutic agents which inhibit the serine‐threonine protein kinase BRAF mutated metastatic melanoma.

Breslow thickness

A scale for measuring the thickness of melanomas by the pathologist using a microscope, measured in mm from the top layer of skin to the bottom of the tumour.

Cervical (lymph nodes)

Lymph nodes found in the neck area of the body.

Computed tomography (CT)

Imaging technique in which the person lies on a table within an x‐ray gantry. The images are acquired using a spiral (helical) path and banks of detectors, allowing presentation of the internal organs and blood vessels in different projections including 3‐D views.

Coronal

Frontal plane dividing the body into front and back.

False negative

An individual who is truly positive for a disease, but whom a diagnostic test classifies them as disease‐free.

False positive

An individual who is truly disease‐free, but whom a diagnostic test classifies them as having the disease.

Histopathology

The study of tissue, usually obtained by biopsy or excision, for example under a microscope.

Incidence

The number of new cases of a disease in a given time period.

Inguinal

Lymph nodes in or just above or just below the groin.

Isolated limb perfusion

A medical procedure that directly delivers a drug through the bloodstream in a limb to the site affected by melanoma.

Local recurrence

Regrowth of a tumour in the area from which it was originally removed.

Locoregional recurrence

Regrowth of a tumour in the area from which it was originally removed or in the regional lymph nodes (usually nearest to the original tumour site).

Lymph node

Lymph nodes filter the lymphatic fluid (clear fluid containing white blood cells) that travels around the body to help fight disease; they are located throughout the body often in clusters (nodal basins).

Lymph node dissection

Surgical removal or one or more lymph nodes in the absence of proven involvement with melanoma.

Lymphadenectomy

Lymphadenectomy or lymph node dissection is a surgical operation to remove one or more groups of lymph nodes.

Lymphoscintigraphy

An imaging technique used to identify the lymph drainage basin, determine the number of sentinel nodes, differentiate sentinel nodes from subsequent nodes, locate the sentinel node in an unexpected location, and mark the sentinel node over the skin for biopsy. It requires the injection of a radioisotope into the skin around the biopsy scar and a scan some hours later to determine to which lymph nodes the tracer has travelled.

Lymphovascular invasion

Tumour cells which have spread to involve the blood vessels and lymphatic vessels within the skin.

Magnetic resonance imaging (MRI)

A type of scan which uses a magnetic field and radio waves to produce images of sections of the body.

Mediastinal and hilar adenopathy

Enlargement of the pulmonary lymph nodes.

MEK inhibitors

Drugs that inhibit the mitogen‐activated protein kinase enzymes which are often upregulated in melanoma.

Meta‐analysis

A form of statistical analysis used to synthesise results from a collection of individual studies.

Metastases/metastatic disease

Spread of cancer away from the primary site to somewhere else through the bloodstream or the lymphatic system.

Micrometastases

Micrometastases are metastases so small that they can only be seen under a microscope.

Mitotic rate

Microscopic evaluation of number of cells actively dividing in a tumour.

Morbidity

Detrimental effects on health.

Mortality

Either (1) the condition of being subject to death; or (2) the death rate, which reflects the number of deaths per unit of population in relation to any specific region, age group, disease, treatment or other classification, usually expressed as deaths per 100, 1000, 10,000 or 100,000 people.

Multidisciplinary team

A team with members from different healthcare professions and specialties (e.g. urology, oncology, pathology, radiology, and nursing). Cancer care in the National Health Service (NHS) uses this system to ensure that all relevant health professionals are engaged to discuss the best possible care for that patient.

Nodal basin

Cluster of lymph nodes which filter lymphatic fluid as it travels around the body; clusters are located under the arm (axilla), in the groin, neck, chest and abdomen.

Oncology

The study of cancers. This term also refers to the medical specialty of cancer care, with particular reference to the use of radiotherapy or drugs to treat cancer. The medical specialty is often split into clinical oncology (doctors who use radiotherapy and drug treatment) and medical oncology (doctors who use drug treatment).

Palpation

Feeling with the fingers or hands as part of a clinical examination of the body.

Positron emission tomography (PET)

A nuclear medicine imaging technique whereby a radioactive glucose (usually ¹⁸FDG) is administered intravenously before a scan is conducted to create an image using colours to show where the FDG (or other radioactive tracer) has been taken up in the body.

Prevalence

The proportion of a population found to have a condition.

Prognostic factors/indicators

Specific characteristics of a cancer or the person who has it which might affect the patient’s prognosis.

Radiotherapy

The use of radiation, usually high energy x‐rays to control the growth of cancer cells.

RAS‐RAF‐MEK‐ERK signalling pathway

A chain of proteins which allow signals from a receptor on the surface of a cell to be sent to the DNA in the cell nucleus; a mutation in one of the proteins in the pathway is associated with the development of many cancers.

Recurrence

Recurrence is when new cancer cells are detected following treatment. This can occur either at the site of the original tumour or at other sites in the body.

Relapse

Where cancer starts to grow again after treatment.

Sagittal

Median plane dividing the body into left and right.

Sensitivity

In this context the term is used to mean the proportion of individuals with a disease who have that disease correctly identified by the study test.

Sentinel lymph node biopsy (SLNB)

A radioactive tracer and blue dye are injected into the skin surrounding the primary lesion and the 'sentinel' lymph nodes to which the tracer drains are located by imaging (usually lymphoscintigraphy) and then removed and examined for nodal metastatic spread that cannot be detected clinically or on imaging.

Signal transduction

Occurs when extracellular signalling molecules activate a specific receptor which then triggers cellular pathways.

Staging

Clinical description of the size and spread of a patient’s tumour, fitting into internationally agreed categories.

Stereotactic radiotherapy

A technique for delivering high dose radiotherapy very accurately to small areas inside the body which reduces the damage done by the radiotherapy to adjacent healthy tissues.

Subclinical (disease)

Disease that is usually asymptomatic and not easily observable, e.g. by clinical or physical examination.

Systemic treatment

Treatment, usually given by mouth or by injection, that reaches and affects cancer cells throughout the body rather than targeting one specific area.

Ultrasound

A type of scan in which high‐frequency sound waves are used to outline a part of the body.

a. TNM staging categories for cutaneous melanoma

Classification

T

Thickness (mm)

Ulceration status/mitoses

Tis

NA

NA

T1

<= 1.00

a: Without ulceration and mitosis 1/mm²

b: With ulceration or mitoses 1/mm²

T2

1.01 to 2.00

a: Without ulceration

b: With ulceration

T3

2.01 to 4.00

a: Without ulceration

b: With ulceration

T4

> 4.00

a: Without ulceration

b: With ulceration

N

Number of metastatic nodes

Nodal metastatic burden

N0

0

NA

N1

1

a: Micrometastasis*

b: Macrometastasis^†

N2

2 to 3

a: Micrometastasis*

b: Macrometastasis^†

c: In transit metastases/satellites without metastatic nodes

N3

4 metastatic nodes, or matted nodes, or in transit metastases/satellites with metastatic nodes

M

Site

Serum LDH

M0

No distant metastases

NA

M1a

Distant skin, subcutaneous, or nodal metastases

Normal

M1b

Lung metastases

Normal

M1c

All other visceral metastases

Normal

Any distant metastasis

Elevated

b. Anatomical stage groupings

Clinical stage‡

T

N

M

Pathological stage δ

T

N

M

0

Tis

N0

M0

0

Tis

N0

M0

IA

T1a

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

IB

T1b

N0

M0

T2a

N0

M0

T2a

N0

M0

IIA

T2b

N0

M0

IIA

T2b

N0

M0

T3a

N0

M0

T3a

N0

M0

IIB

T3b

N0

M0

IIB

T3b

N0

M0

T4a

N0

M0

T4a

N0

M0

IIC

T4b

N0

M0

IIC

T4b

N0

M0

III

Any T

N > N0

M0

IIIA

T1‐ T4a

N1a

M0

T1‐ T4a

N2a

M0

IIIB

T1‐ T4b

N1a

M0

T1‐ T4b

N2a

M0

T1‐ T4a

N1b

M0

T1‐ T4a

N2b

M0

T1‐ T4a

N2c

M0

IIIC

T1‐ T4b

N1b

M0

T1‐ T4b

N2b

M0

T1‐ T4b

N2c

M0

Any T

N3

M0

IV

Any T

Any N

M1

IV

Any T

Any N

M1