archetype (adl_version=1.4)
	openEHR-EHR-CLUSTER.tnm_staging-melanoma.v1
specialise
	openEHR-EHR-CLUSTER.tnm_staging.v1

concept
	[at0000.1]	-- TNM staging - Melanoma of skin (Sixth edition)
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Dr Ian McNicoll">
		["organisation"] = <"Ocean Informatics Scotland">
		["email"] = <"ian.mcnicoll@oceaninformatics.com">
		["date"] = <"27/07/2009">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record the TNM staging classification for melanoma of skin (Sixth Edition).">
			use = <"Use only for the Sixth edition of TNM melanoma of skin classification.">
			keywords = <"tumour", "TNM", "malignancy", "cancer", "staging", "classification", "grade", "grading", "stage", "lymph node", "metastasis", "melanoma">
			misuse = <"Not to be used for other editions of TNM classification.">
			copyright = <"copyright (c) 2009 openEHR Foundation">
		>
	>
	lifecycle_state = <"AuthorDraft">
	other_contributors = <"Heather Leslie Ocean Informatics Australia", "Sam Heard Ocean Informatics Australia", "Koray Atalag, University of Auckland, New Zealand">
	other_details = <
		["MD5-CAM-1.0.1"] = <"77DA0DB2120ED76F3EF208EF4AC1468E">
		["references"] = <"American Joint Committee on Cancer. TNM schema files [Internet]. [cited 2009 Jul 27 ] 
Available from: http://www.cancerstaging.org/education/tnmschema/tnmschema.html

Greene FL, Page DL, Fleming ID. et al, eds, for the American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer-Verlag; 2002. 

">
	>

definition
	CLUSTER[at0000.1] matches {	-- TNM staging - Melanoma of skin (Sixth edition)
		items cardinality matches {1..*; unordered} matches {
			CLUSTER[at0002] occurrences matches {0..1} matches {	-- Clinical (cTNM)
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0003] occurrences matches {0..1} matches {	-- Primary tumour (T)
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0004] occurrences matches {0..1} matches {	-- Regional lymph nodes (N)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.58, 	-- NX
									at0.59, 	-- N0
									at0.60, 	-- N1
									at0.61, 	-- N1a
									at0.62, 	-- N1b
									at0.63, 	-- N2
									at0.64, 	-- N2a
									at0.65, 	-- N2b
									at0.66, 	-- N2c
									at0.67]	-- N3
								}
							}
						}
					}
					ELEMENT[at0005] occurrences matches {0..1} matches {	-- Distant metastasis (M)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.78, 	-- MX
									at0.79, 	-- M0
									at0.80, 	-- M1
									at0.81, 	-- M1a
									at0.82, 	-- M1b
									at0.83]	-- M1c
								}
							}
						}
					}
					ELEMENT[at0025] occurrences matches {0..1} matches {	-- Residual tumour (R)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0026, 	-- RX
									at0027, 	-- R0
									at0028, 	-- R1
									at0029]	-- R2
								}
							}
						}
					}
					ELEMENT[at0010] occurrences matches {0..1} matches {	-- Clinical staging
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.90, 	-- Stage 0
									at0.91, 	-- Stage I
									at0.92, 	-- Stage 1A
									at0.93, 	-- Stage IIA
									at0.94, 	-- Stage IIA
									at0.95, 	-- Stage IIB
									at0.96, 	-- Stage IIC
									at0.97, 	-- Stage III
									at0.98, 	-- Stage IIIA
									at0.99, 	-- Stage IIIB
									at0.100, 	-- Stage IIIC
									at0.101]	-- Stage IV
								}
							}
						}
					}
					ELEMENT[at0014] occurrences matches {0..1} matches {	-- Clinical stage grouping
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0012] occurrences matches {0..1} matches {	-- Comment
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0006] occurrences matches {0..1} matches {	-- Pathological (pTNM)
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0007] occurrences matches {0..1} matches {	-- Primary tumour (pT)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.43, 	-- pTX
									at0.44, 	-- pT0
									at0.45, 	-- pTis
									at0.46, 	-- pT1
									at0.47, 	-- pT3
									at0.48, 	-- pT1b
									at0.49, 	-- pT2
									at0.50, 	-- pT2a
									at0.51, 	-- pT2b
									at0.52, 	-- pT3
									at0.53, 	-- pT3a
									at0.54, 	-- pT3b
									at0.55, 	-- pT4
									at0.56, 	-- pT4a
									at0.57]	-- pT4b
								}
							}
						}
					}
					ELEMENT[at0008] occurrences matches {0..1} matches {	-- Regional lymph node (pN)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.68, 	-- NX
									at0.69, 	-- N0
									at0.70, 	-- N1
									at0.71, 	-- N1a
									at0.72, 	-- N1b
									at0.73, 	-- N2
									at0.74, 	-- N2a
									at0.75, 	-- N2b
									at0.76, 	-- N2c
									at0.77]	-- N3
								}
							}
						}
					}
					ELEMENT[at0009] occurrences matches {0..1} matches {	-- Distant metastasis (pM)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0.84, 	-- pMX
									at0.85, 	-- pM0
									at0.86, 	-- pM1
									at0.87, 	-- pM1a
									at0.88, 	-- pM1b
									at0.89]	-- pM1c
								}
							}
						}
					}
					ELEMENT[at0030] occurrences matches {0..1} matches {	-- Residual tumour (pR)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {[local::]}
							}
						}
					}
					ELEMENT[at0035] occurrences matches {0..1} matches {	-- Histopathological grading (G)
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0038, 	-- GX
									at0039, 	-- G1
									at0040, 	-- G2
									at0041, 	-- G3
									at0042]	-- G4
								}
							}
						}
					}
					ELEMENT[at0011] occurrences matches {0..1} matches {	-- Pathological staging
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {[local::]}
							}
						}
					}
					ELEMENT[at0015] occurrences matches {0..1} matches {	-- Pathological stage grouping
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0013] occurrences matches {0..1} matches {	-- Comment
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
		}
	}

ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0.100"] = <
					text = <"Stage IIIC">
					description = <"pT1b-pT4b,N1b,N2b,M0;  Any pT,Any N,M0">
				>
				["at0.101"] = <
					text = <"Stage IV">
					description = <"Any PT, Any N, M1">
				>
				["at0.102"] = <
					text = <"Stage 0">
					description = <"pTis,N0,M0">
				>
				["at0.103"] = <
					text = <"Stage I">
					description = <"pT1,N0,M0">
				>
				["at0.104"] = <
					text = <"Stage 1A">
					description = <"pT1a,N0,M0">
				>
				["at0.105"] = <
					text = <"Stage IIA">
					description = <"pT1b,N0,M0; pT2a,N0,M0">
				>
				["at0.106"] = <
					text = <"Stage IIA">
					description = <"pT2b,N0,M0; pT3a,N0,M0">
				>
				["at0.107"] = <
					text = <"Stage IIB">
					description = <"pT3b,N0,M0; pT4a,N0,M0">
				>
				["at0.108"] = <
					text = <"Stage IIC">
					description = <"pT4b,N0,M0">
				>
				["at0.109"] = <
					text = <"Stage III">
					description = <"Any pT,N1-3">
				>
				["at0.110"] = <
					text = <"Stage IIIA">
					description = <"pT1a-pT4a, N1a,N1b, M0">
				>
				["at0.111"] = <
					text = <"Stage IIIB">
					description = <"pT1a-pT4a,N1b,N2b,N2c,M0; pT1a-4b,N1a,N2a,N2c,M0">
				>
				["at0.112"] = <
					text = <"Stage IIIC">
					description = <"pT1b-pT4b,N1b,N2b,M0;  Any pT,Any N,M0">
				>
				["at0.113"] = <
					text = <"Stage IV">
					description = <"Any PT, Any N, M1">
				>
				["at0.43"] = <
					text = <"pTX">
					description = <"Primary tumour cannot be assessed.
">
				>
				["at0.44"] = <
					text = <"pT0">
					description = <"No evidence of primary tumour.
">
				>
				["at0.45"] = <
					text = <"pTis">
					description = <"Melanoma in situ (Clark level I) (atypical melanocytic hyperplasia, severe melanocytic dysplasia, not an invasive malignant lesion).
">
				>
				["at0.46"] = <
					text = <"pT1">
					description = <"Tumour 1 mm or less in thickness.
">
				>
				["at0.47"] = <
					text = <"pT3">
					description = <"Clark level II or III, without ulceration.
">
				>
				["at0.48"] = <
					text = <"pT1b">
					description = <"Clark level IV or V, or with ulceration.
">
				>
				["at0.49"] = <
					text = <"pT2">
					description = <"Tumour more than 1 mm but not more than 2 mm in thickness.
">
				>
				["at0.50"] = <
					text = <"pT2a">
					description = <" Tumour more than 1 mm but not more than 2 mm in thickness, without ulceration.
">
				>
				["at0.51"] = <
					text = <"pT2b">
					description = <" Tumour more than 1 mm but not more than 2 mm in thickness, with ulceration.
">
				>
				["at0.52"] = <
					text = <"pT3">
					description = <"Tumour more than 2 mm but not more than 4 mm in thickness.
">
				>
				["at0.53"] = <
					text = <"pT3a">
					description = <"Tumour more than 2 mm but not more than 4 mm in thickness, without ulceration.
">
				>
				["at0.54"] = <
					text = <"pT3b">
					description = <"Tumour more than 2 mm but not more than 4 mm in thickness with ulceration.
">
				>
				["at0.55"] = <
					text = <"pT4">
					description = <"Tumour more than 4 mm in thickness.
">
				>
				["at0.56"] = <
					text = <"pT4a">
					description = <"Tumour more than 4 mm in thickness, without ulceration.
">
				>
				["at0.57"] = <
					text = <"pT4b">
					description = <"Tumour more than 4 mm in thickness, with ulceration.
">
				>
				["at0.58"] = <
					text = <"NX">
					description = <"Regional lymph nodes cannot be assessed.
">
				>
				["at0.59"] = <
					text = <"N0">
					description = <"No regional lymph node metastasis.
">
				>
				["at0.60"] = <
					text = <"N1">
					description = <"Metastasis in one regional lymph node.
">
				>
				["at0.61"] = <
					text = <"N1a">
					description = <"Only microscopic metastasis (clinically occult).
">
				>
				["at0.62"] = <
					text = <"N1b">
					description = <"Macroscopic metastasis (clinically apparent).
">
				>
				["at0.63"] = <
					text = <"N2">
					description = <"Metastasis in two or three regional lymph nodes or intralymphatic regional metastasis.
">
				>
				["at0.64"] = <
					text = <"N2a">
					description = <"Only microscopic nodal metastasis.
">
				>
				["at0.65"] = <
					text = <"N2b">
					description = <"Macroscopic nodal metastasis.
">
				>
				["at0.66"] = <
					text = <"N2c">
					description = <"Satellite or in-transit metastasis without regional nodal metastasis.
">
				>
				["at0.67"] = <
					text = <"N3">
					description = <"Metastasis in four or more regional lymph nodes, or matted metastatic regional lymph nodes, or satellite or in-transit metastasis with metastasis in regional lymph node(s).
">
				>
				["at0.68"] = <
					text = <"NX">
					description = <"Regional lymph nodes cannot be assessed.
">
				>
				["at0.69"] = <
					text = <"N0">
					description = <"No regional lymph node metastasis.
">
				>
				["at0.70"] = <
					text = <"N1">
					description = <"Metastasis in one regional lymph node.
">
				>
				["at0.71"] = <
					text = <"N1a">
					description = <"Only microscopic metastasis (clinically occult).
">
				>
				["at0.72"] = <
					text = <"N1b">
					description = <"Macroscopic metastasis (clinically apparent).
">
				>
				["at0.73"] = <
					text = <"N2">
					description = <"Metastasis in two or three regional lymph nodes or intralymphatic regional metastasis.
">
				>
				["at0.74"] = <
					text = <"N2a">
					description = <"Only microscopic nodal metastasis.
">
				>
				["at0.75"] = <
					text = <"N2b">
					description = <"Macroscopic nodal metastasis.
">
				>
				["at0.76"] = <
					text = <"N2c">
					description = <"Satellite or in-transit metastasis without regional nodal metastasis.
">
				>
				["at0.77"] = <
					text = <"N3">
					description = <"Metastasis in four or more regional lymph nodes, or matted metastatic regional lymph nodes, or satellite or in-transit metastasis with metastasis in regional lymph node(s).
">
				>
				["at0.78"] = <
					text = <"MX">
					description = <"Distant metastasis cannot be assessed.
">
				>
				["at0.79"] = <
					text = <"M0">
					description = <"No distant metastasis.
">
				>
				["at0.80"] = <
					text = <"M1">
					description = <"Distant metastasis.
">
				>
				["at0.81"] = <
					text = <"M1a">
					description = <"Metastasis to skin, subcutaneous tissue or lymph node(s) beyond the regional lymph nodes.
">
				>
				["at0.82"] = <
					text = <"M1b">
					description = <"Metastasis to lung.
">
				>
				["at0.83"] = <
					text = <"M1c">
					description = <"Metastasis to other sites, or any site with elevated serum lactic dehydrogenase (LDH).
">
				>
				["at0.84"] = <
					text = <"pMX">
					description = <"Distant metastasis cannot be assessed.
">
				>
				["at0.85"] = <
					text = <"pM0">
					description = <"No distant metastasis.
">
				>
				["at0.86"] = <
					text = <"pM1">
					description = <"Distant metastasis.
">
				>
				["at0.87"] = <
					text = <"pM1a">
					description = <"Metastasis to skin, subcutaneous tissue or lymph node(s) beyond the regional lymph nodes.
">
				>
				["at0.88"] = <
					text = <"pM1b">
					description = <"Metastasis to lung.
">
				>
				["at0.89"] = <
					text = <"pM1c">
					description = <"Metastasis to other sites, or any site with elevated serum lactic dehydrogenase (LDH).
">
				>
				["at0.90"] = <
					text = <"Stage 0">
					description = <"pTis,N0,M0">
				>
				["at0.91"] = <
					text = <"Stage I">
					description = <"pT1,N0,M0">
				>
				["at0.92"] = <
					text = <"Stage 1A">
					description = <"pT1a,N0,M0">
				>
				["at0.93"] = <
					text = <"Stage IIA">
					description = <"pT1b,N0,M0; pT2a,N0,M0">
				>
				["at0.94"] = <
					text = <"Stage IIA">
					description = <"pT2b,N0,M0; pT3a,N0,M0">
				>
				["at0.95"] = <
					text = <"Stage IIB">
					description = <"pT3b,N0,M0; pT4a,N0,M0">
				>
				["at0.96"] = <
					text = <"Stage IIC">
					description = <"pT4b,N0,M0">
				>
				["at0.97"] = <
					text = <"Stage III">
					description = <"Any pT,N1-3">
				>
				["at0.98"] = <
					text = <"Stage IIIA">
					description = <"pT1a-pT4a, N1a,N1b, M0">
				>
				["at0.99"] = <
					text = <"Stage IIIB">
					description = <"pT1a-pT4a,N1b,N2b,N2c,M0; pT1a-4b,N1a,N2a,N2c,M0">
				>
				["at0000"] = <
					text = <"Tumour - TNM Cancer staging">
					description = <"A framework for the classification and grading of malignancies using the TNM classification system.">
				>
				["at0000.1"] = <
					text = <"TNM staging - Melanoma of skin (Sixth edition)">
					description = <"TNM Staging classification for melanoma of skin (Sixth edition).">
				>
				["at0002"] = <
					text = <"Clinical (cTNM)">
					description = <"Clinical TNM pre-treatment classification based on physical examination, imaging and biopsies.">
				>
				["at0003"] = <
					text = <"Primary tumour (T)">
					description = <"Clincal assessment of the primary tumour.">
				>
				["at0004"] = <
					text = <"Regional lymph nodes (N)">
					description = <"Clinical assessment of the regional lymph nodes.">
				>
				["at0005"] = <
					text = <"Distant metastasis (M)">
					description = <"Clinical assessment of distant metastasis.">
				>
				["at0006"] = <
					text = <"Pathological (pTNM)">
					description = <"Pathological staging. Based on the clinical staging, results of procedures and pathological/histo-pathological assessment.">
				>
				["at0007"] = <
					text = <"Primary tumour (pT)">
					description = <"Pathological assessment of the primary tumour.">
				>
				["at0008"] = <
					text = <"Regional lymph node (pN)">
					description = <"Pathological assessment of the regional lymph nodes.">
				>
				["at0009"] = <
					text = <"Distant metastasis (pM)">
					description = <"Pathological assessment of distant metastases.">
				>
				["at0010"] = <
					text = <"Clinical staging">
					description = <"The overall Clinical staging derived from each T, N and M component e.g T1aM0NX. May include additional TNM descriptors.">
				>
				["at0011"] = <
					text = <"Pathological staging">
					description = <"The overall Pathological staging derived from each pT, pN and pM component. May include additional TNM descriptors.">
				>
				["at0012"] = <
					text = <"Comment">
					description = <"A text comment on the Clinical staging.">
				>
				["at0013"] = <
					text = <"Comment">
					description = <"A text comment on the Pathological staging.">
				>
				["at0014"] = <
					text = <"Clinical stage grouping">
					description = <"The TNM Clinical stage grouping.">
				>
				["at0015"] = <
					text = <"Pathological stage grouping">
					description = <"The TNM Pathological stage grouping.">
				>
				["at0025"] = <
					text = <"Residual tumour (R)">
					description = <"Clinical assessment of post-treatment residual tumour.">
				>
				["at0026"] = <
					text = <"RX">
					description = <"Presence of residual tumour cannot be assessed.">
				>
				["at0027"] = <
					text = <"R0">
					description = <"No residual tumour.">
				>
				["at0028"] = <
					text = <"R1">
					description = <"Microscopic residual tumour.">
				>
				["at0029"] = <
					text = <"R2">
					description = <"Macroscopic residual tumour.">
				>
				["at0030"] = <
					text = <"Residual tumour (pR)">
					description = <"Pathological assessment of post-treatment residual tumour.">
				>
				["at0031"] = <
					text = <"pRX">
					description = <"Presence of residual tumour cannot be assessed. ">
				>
				["at0032"] = <
					text = <"pR0">
					description = <"No residual tumour.">
				>
				["at0033"] = <
					text = <"pR1">
					description = <"Microscopic residual tumour.">
				>
				["at0034"] = <
					text = <"pR2">
					description = <"Macroscopic residual tumour.">
				>
				["at0035"] = <
					text = <"Histopathological grading (G)">
					description = <"TNM histopathological grading classification. ">
				>
				["at0038"] = <
					text = <"GX">
					description = <"Grade of differentiation cannot be assessed.">
				>
				["at0039"] = <
					text = <"G1">
					description = <"Well differentiated.">
				>
				["at0040"] = <
					text = <"G2">
					description = <"Moderately differentiated.">
				>
				["at0041"] = <
					text = <"G3">
					description = <"Poorly differentiated.">
				>
				["at0042"] = <
					text = <"G4">
					description = <"Undifferentiated.">
				>
			>
		>
	>