MerkelCellSkin - CS Lymph Nodes

Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in CS Mets at DX.
Note 2: Bilateral or contralateral nodes are considered regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy. Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed.
Note 3: Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins. Secondary basins are considered regional for AJCC staging but may be distant for Summary Stage. Use code 250 for involvement of nodes in secondary nodal basins not specified in codes 100 and 200.
Note 4: In transit metastasis is defined as a tumor distinct from the primary lesion and located either between the primary lesion and the draining regional lymph nodes or distal to the primary lesion. In transit metastasis is coded in CS Lymph Nodes.
Note 5: Isolated tumor cells (ITCs) should be considered positive nodes. If only ITCs are present, defined as any tumor deposits in lymph nodess less than or equal to 0.2mm, use code 010.
Note 6: If the only information about lymph nodes is a statement of N1 involvement without a clinical or pathologic designation, use code 360.

^ When CS Lymph Nodes Eval is coded, for CS Lymph Nodes codes 010-370 ONLY, the N category for AJCC 7 staging is assigned based on the value of CS Lymph Nodes Eval and CS Site-Specific Factor 3, Status of Lymph Node Mets, as shown in the Lymph Nodes and Nodal Status Eval AJCC 7 Table. When CS Lymph Nodes Eval is blank, for CS Lymph Nodes codes 010-370 ONLY, the N category for AJCC 7 staging is assigned based on the value of CS Site-Specific Factor 3, Status of Lymph Node Mets, and Regional Nodes Positive, as shown in the Lymph Nodes and Nodal Status Eval Blank AJCC 7 Table.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	No regional lymph node involvement	N0	N0	NONE	NONE
010	Isolated tumor cells (ITCs) only	^	N0	NONE	NONE
100	Regional lymph nodes by primary site (includes bilateral or contralateral nodes for head, neck, and trunk) Head and Neck: All subsites: Cervical Lip: Mandibular, NOS: Submandibular (submaxillary) External ear/auditory canal: Mastoid (post-/retro-auricular) (occipital) Preauricular Face, Other (cheek, chin, forehead, jaw, nose and temple): Facial, NOS: Buccinator (buccal) Nasolabial Mandibular, NOS: Submandibular (submaxillary) Parotid, NOS: Infra-auricular Preauricular Scalp: Mastoid (post-/retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Neck: Axillary Mandibular, NOS Mastoid (post-/retro-auricular) (occipital) Parotid, NOS: Infra-auricular Preauricular Spinal accessory (posterior cervical) Supraclavicular (transverse cervical) Upper Trunk: Axillary Cervical Internal mammary (parasternal) Supraclavicular (transverse cervical) Lower Trunk: Femoral (superficial inguinal) Arm/Shoulder: Axillary Epitrochlear for hand/forearm Spinal accessory for shoulder Leg/Hip: Femoral (superficial inguinal) Popliteal for heel and calf All sites: Regional lymph node(s), NOS (See Note 2)	^	N1	RN	RN
200	Head and Neck (includes bilateral or contralateral nodes for head and neck): Lip: Facial, NOS: Buccinator (buccal) Nasolabial Submental Parotid, NOS: Infra-auricular Preauricular Face, Other (cheek, chin, forehead, jaw, nose, and temple): Submental Neck: Submental (See Note 2)	^	N1	D	RN
250	Bidirectional nodal involvement (includes bilateral or contralateral nodes) (See Note 2): Upper Trunk: Femoral (or cephalad/caudal drainage from primary tumor) Lower Trunk: Axillary (or cephalad/caudal drainage from primary tumor) Secondary nodal basin involvement (includes bilateral or contralateral nodes for head and trunk) (See Note 3): Head: All subsites: Supraclavicular Arm/Shoulder: Supraclavicular Leg/Hip: Iliac All sites: Regional lymph node(s) in secondary nodal basins , NOS	^	N1	D	D
300	200 + 100 Regional lymph nodes coded in 200 plus regional lymph nodes coded in 100	^	N1	D	RN
305	250 + (100 and/or 200) Regional lymph nodes coded in 250 plus regional lymph nodes coded in 100 and/or 200	^	N1	D	D
310	Evaluated clinically: Clinically stated as N1 with no other information on regional lymph nodes	^	N1	RN	RN
320	Evaluated pathologically: Pathologically stated as N1a with no other information on regional lymph nodes	^	N1	RN	RN
340	Evaluated pathologically: Pathologically stated as N1b with no other information on regional lymph nodes	^	N1	RN	RN
350	Evaluated pathologically: Pathologically stated as N1 [NOS] with no other information on regional lymph nodes	^	N1	RN	RN
360	Stated as N1[NOS] with no information on pathologic or clinical evaluation	^	N1	RN	RN
390	Satellite nodule(s) or in transit metastasis, distance from primary tumor less than or equal to 2 cm or distance not stated WITHOUT regional lymph node involvement. Includes cases with ITCs only and cases with regional lymph node involvement not stated OR Described as tumor with satellite nodule(s), NOS WITHOUT regional lymph node involvement or regional lymph node involvement not stated (See Note 4)	N2	N0	RE	RE
400	Satellite nodule(s) or in transit metastasis, distance from primary tumor greater than 2 cm or distance not stated WITHOUT regional lymph node involvement. Includes cases with ITCs only and cases with regional lymph node involvement not stated OR Described as tumor with in transit metastasis, NOS WITHOUT regional lymph node involvement or regional lymph node involvement not stated (See Note 4)	N2	N1	RE	RN
420	400 + 100 Satellite nodule(s) or in transit metastasis WITH regional lymph nodes listed in code 100 (See Note 4)	N2	N1	RN	RN
440	400 + 200 Satellite nodule(s) or in transit metastasis WITH regional lymph nodes listed in code 200 (See Note 4)	N2	N1	D	RN
460	400 + 300 Satellite nodule(s) or in transit metastasis WITH regional lymph nodes listed in code 300 (See Note 4)	N2	N1	D	RN
470	400 + (250 or 305) Satellite nodule(s) or in transit metastasis WITH regional lymph nodes listed in code 250 or code 305 (See Note 4)	N2	N1	D	D
475	Satellite nodule(s) or in transit metastasis WITH regional lymph node(s), NOS	N2	N1	RN	RN
480	Stated as N2 [NOS] with no other information on regional lymph nodes	N2	N1	RE	RE
800	Lymph nodes, NOS	N1NOS	N1	RN	RN
999	Unknown; regional lymph nodes not stated Regional lymph nodes cannot be assessed Not documented in patient record	NX	NX	U	U