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HN-Nasal cavity and Nasal sinuses.html
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<img id="top" src="top.png" alt="">
<div id="form_container">
<div class="form_description">
<h2>
<a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf" target="_blank">
<div class="tooltip">
Carcinoma of the nasal cavity and paranasal sinuses
<span class="tooltiptext">click to access explanations in the original CAP template</span>
</div>
</a>
</h2>
</div>
<p>
Please also refer to <a href=".\cap\Cancer-Protocols-2021-11-Update\HN.Bmk_2.0.0.1.REL_CAPCP.pdf" target="_blank">H&N biomarker protocol (HeadNeckBiomarkers 2.0.0.1, Nov-2021)</a> for possible ancillary testings.
</p>
<form>
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<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Gross descriptions:</label></legend>
<p>
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<col width="40%">
<tr>
<td>
<label class="description">- Procedure:</label>
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<td>
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<option value=""></option>
<option value="Excision">Excision</option>
<option value="Partial maxillectomy">Partial maxillectomy</option>
<option value="Radical maxillectomy">Radical maxillectomy</option>
<option value="Neck (lymph node) dissection (specify):">Neck (lymph node) dissection (specify):</option>
<option value="Other (specify):">Other (specify):</option>
<option value="Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Tumor site:</label>
</td>
<td>
<select class="element select large" ID="A02">
<option value=""></option>
<option value="Nasal septum">Nasal septum</option>
<option value="Nasal floor">Nasal floor</option>
<option value="Nasal lateral wall">Nasal lateral wall</option>
<option value="Nasal vestibule">Nasal vestibule</option>
<option value="Nasal cavity, not otherwise specified">Nasal cavity, not otherwise specified</option>
<option value="Paranasal sinus(es), maxillary">Paranasal sinus(es), maxillary</option>
<option value="Paranasal sinus(es), ethmoid">Paranasal sinus(es), ethmoid</option>
<option value="Paranasal sinus(es), frontal">Paranasal sinus(es), frontal</option>
<option value="Paranasal sinus(es), sphenoid">Paranasal sinus(es), sphenoid</option>
<option value="Other (specify):">Other (specify):</option>
<option value="Not specified">Not specified</option>
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<option value="Right">Right</option>
<option value="Left">Left</option>
<option value="Midline">Midline</option>
<option value="Not specified">Cannot be determined (explain):</option>
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</td>
</tr>
<tr>
<td>
<label class="description">- Tumor focality:</label>
</td>
<td>
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<option value=""></option>
<option value="Unifocal">Unifocal</option>
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</tr>
<tr>
<td>
<label class="description">- Tumor size:</label>
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<option value="Greatest dimension (mm): ">Greatest dimension (mm): </option>
<option value="All dimensions (mm x mm x mm): ">All dimensions (mm x mm x mm):</option>
<option value="Cannot be determined (explain):">Cannot be determined (explain):</option>
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</tr>
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</p>
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<p>
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<legend><label class="description">Microscopic descriptions:</label></legend>
<p>
<label class="description">- Tumor histology and immunohistochemical studies: </label>
<textarea ID="A06" class="element textarea medium"></textarea>
</p>
<p>
<table border="1">
<col width="40%">
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=15" target="_blank">SCC and variants (WHO 5e)</a>:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A16" value=" - Squamous cell carcinoma, keratinizing"><label class="choice">Squamous cell carcinoma, keratinizing</label>
<input class="element checkbox" type="checkbox" id="A07" value=" - Squamous cell carcinoma, nonkeratinizing"><label class="choice">Squamous cell carcinoma, nonkeratinizing</label>
<input class="element checkbox" type="checkbox" id="A14" value=" - Squamous cell carcinoma, nonkeratinizing, transcriptionally active high-risk HPV-associated"><label class="choice">Squamous cell carcinoma, nonkeratinizing, transcriptionally active high-risk HPV-associated</label>
<input class="element checkbox" type="checkbox" id="A15" value=" - Squamous cell carcinoma, nonkeratinizing, DEK::AFF2 translocated"><label class="choice">Squamous cell carcinoma, nonkeratinizing, DEK::AFF2 translocated</label>
<input class="element checkbox" type="checkbox" id="A08" value=" - Adenosquamous carcinoma"><label class="choice">Adenosquamous carcinoma</label>
<input class="element checkbox" type="checkbox" id="A09" value=" - Basaloid squamous cell carcinoma"><label class="choice">Basaloid squamous cell carcinoma</label>
<input class="element checkbox" type="checkbox" id="A10" value=" - Papillary squamous cell carcinoma"><label class="choice">Papillary squamous cell carcinoma</label>
<input class="element checkbox" type="checkbox" id="A11" value=" - Spindle cell squamous cell carcinoma"><label class="choice" >Spindle cell squamous cell carcinoma</label>
<input class="element checkbox" type="checkbox" id="A12" value=" - Verrucous squamous cell carcinoma"><label class="choice">Verrucous squamous cell carcinoma</label>
<input class="element checkbox" type="checkbox" id="A13" value=" - Other (specify):"><label class="choice">Other (specify):</label>
</label>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=15" target="_blank">Other CA</a> :</label>
</td>
<td>
<select class="element select large" ID="A17">
<option value=""></option>
<option value="NUT carcinoma"><label >NUT carcinoma</label></option>
<option value="SWI / SNF complex-deficient sinonasal carcinoma"><label >SWI / SNF complex-deficient sinonasal carcinoma</label></option>
<option value="Sinonasal lymphoepithelial carcinoma"><label >Sinonasal lymphoepithelial carcinoma</label></option>
<option value="Sinonasal undifferentiated carcinoma (SNUC), IDH mutated"><label >Sinonasal undifferentiated carcinoma (SNUC), IDH mutated</label></option>
<option value="Sinonasal undifferentiated carcinoma (SNUC), IDH wild type"><label >Sinonasal undifferentiated carcinoma (SNUC), IDH wild type</label></option>
<option value="Sinonasal undifferentiated carcinoma (SNUC), IDH status unknown"><label >Sinonasal undifferentiated carcinoma (SNUC), IDH status unknown</label></option>
<option value="Teratocarcinosarcoma"><label >Teratocarcinosarcoma</label></option>
<option value="HPV-associated multiphenotypic sinonasal carcinoma"><label >HPV-associated multiphenotypic sinonasal carcinoma</label></option>
<option value="Intestinal adenocarcinoma, papillary pattern"><label >Intestinal adenocarcinoma, papillary pattern</label></option>
<option value="Intestinal adenocarcinoma, colonic pattern"><label >Intestinal adenocarcinoma, colonic pattern</label></option>
<option value="Intestinal adenocarcinoma, solid pattern"><label >Intestinal adenocarcinoma, solid pattern</label></option>
<option value="Intestinal adenocarcinoma, mixed pattern"><label >Intestinal adenocarcinoma, mixed pattern</label></option>
<option value="Non-intestinal (seromucinous) adenocarcinoma"><label >Non-intestinal (seromucinous) adenocarcinoma</label></option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=15" target="_blank">Minor salivary glands CA</a> :</label>
</td>
<td>
<select class="element select large" ID="A18">
<option value=""></option>
<option value="Carcinoma ex pleomorphic adenoma, minimally invasive + malignant component">Carcinoma ex pleomorphic adenoma, minimally invasive + malignant component</option>
<option value="Carcinoma ex pleomorphic adenoma, invasive + malignant component">Carcinoma ex pleomorphic adenoma, invasive + malignant component</option>
<option value="Carcinoma ex pleomorphic adenoma, intracapsular (noninvasive) + malignant component">Carcinoma ex pleomorphic adenoma, intracapsular (noninvasive) + malignant component</option>
<option value="Carcinoma ex pleomorphic adenoma, extent cannot be determined + malignant component">Carcinoma ex pleomorphic adenoma, extent cannot be determined + malignant component</option>
<option value="Mucoepidermoid carcinoma, low grade">Mucoepidermoid carcinoma, low grade</option>
<option value="Mucoepidermoid carcinoma, intermediate grade">Mucoepidermoid carcinoma, intermediate grade</option>
<option value="Mucoepidermoid carcinoma, high grade">Mucoepidermoid carcinoma, high grade</option>
<option value="Adenoid cystic carcinoma, tubular pattern, specify percentage of solid component:">Adenoid cystic carcinoma, tubular pattern, specify percentage of solid component:</option>
<option value="Adenoid cystic carcinoma, cribriform pattern, specify percentage of solid component:">Adenoid cystic carcinoma, cribriform pattern, specify percentage of solid component:</option>
<option value="Adenoid cystic carcinoma, solid pattern, specify percentage of solid component:">Adenoid cystic carcinoma, solid pattern, specify percentage of solid component:</option>
<option value="Acinic cell carcinoma">Acinic cell carcinoma</option>
<option value="Secretory carcinoma">Secretory carcinoma</option>
<option value="Polymorphous adenocarcinoma, conventional">Polymorphous adenocarcinoma, conventional</option>
<option value="Polymorphous adenocarcinoma, cribriform subtype (% papillary and cribriform components)">Polymorphous adenocarcinoma, cribriform subtype (% papillary and cribriform components)</option>
<option value="Salivary duct carcinoma">Salivary duct carcinoma</option>
<option value="Epithelial-myoepithelial carcinoma">Epithelial-myoepithelial carcinoma</option>
<option value="Hyalinizing clear cell carcinoma">Hyalinizing clear cell carcinoma</option>
<option value="Microsecretory adenocarcinoma">Microsecretory adenocarcinoma</option>
<option value="Intraductal carcinoma (specify subtype):">Intraductal carcinoma (specify subtype):</option>
<option value="Basal cell adenocarcinoma">Basal cell adenocarcinoma</option>
<option value="Carcinosarcoma">Carcinosarcoma</option>
<option value="Mucinous adenocarcinoma, not otherwise specified">Mucinous adenocarcinoma, not otherwise specified</option>
<option value="Mucinous adenocarcinoma, intraductal papillary mucinous neoplasia subtype">Mucinous adenocarcinoma, intraductal papillary mucinous neoplasia subtype</option>
<option value="Mucinous adenocarcinoma, colloid / signet ring subtype">Mucinous adenocarcinoma, colloid / signet ring subtype</option>
<option value="Sclerosing microcystic adenocarcinoma">Sclerosing microcystic adenocarcinoma</option>
<option value="Lymphoepithelial carcinoma">Lymphoepithelial carcinoma</option>
<option value="Myoepithelial carcinoma">Myoepithelial carcinoma</option>
<option value="Sebaceous adenocarcinoma">Sebaceous adenocarcinoma</option>
<option value="Sialoblastoma">Sialoblastoma</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=15" target="_blank">Neuroendocrine carcinoma</a>:</label>
</td>
<td>
<select class="element select large" ID="A19">
<option value=""></option>
<option value="Neuroendocrine tumor, grade 1"><label >Neuroendocrine tumor, grade 1</label></option>
<option value="Neuroendocrine tumor, grade 2"><label >Neuroendocrine tumor, grade 2</label></option>
<option value="Neuroendocrine tumor, grade 3"><label >Neuroendocrine tumor, grade 3</label></option>
<option value="Neuroendocrine carcinoma, small cell type"><label >Neuroendocrine carcinoma, small cell type</label></option>
<option value="Neuroendocrine carcinoma, large cell type"><label >Neuroendocrine carcinoma, large cell type</label></option>
<option value="Combined (or composite) neuroendocrine carcinoma with (specify types):"><label >Combined (or composite) neuroendocrine carcinoma with (specify types):</label></option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=15" target="_blank">Other histologic type</a> :</label>
</td>
<td>
<select class="element select large" ID="A20">
<option value=""></option>
<option value="Mucosal melanoma"><label >Mucosal melanoma</label></option>
<option value="Carcinoma, type cannot be determined"><label >Carcinoma, type cannot be determined</label></option>
<option value="Other histologic type not listed (specify):"><label >Other histologic type not listed (specify):</label></option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=17" target="_blank">Histologic grade</a>:</label>
</td>
<td>
<select class="element select large" ID="A21">
<option value=""></option>
<option value="G1: Well differentiated">G1: Well differentiated</option>
<option value="G2: Moderately differentiated">G2: Moderately differentiated</option>
<option value="G3: Poorly differentiated">G3: Poorly differentiated</option>
<option value="GX: Cannot be assessed">GX: Cannot be assessed</option>
<option value="Other (specify):">Other (specify):</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=17" target="_blank">Grade/Intrinsic biologic potential</a>:</label>
</td>
<td>
<select class="element select large" ID="A70">
<option value=""></option>
<option value="Not applicable">Not applicable</option>
<option value="Low">Low</option>
<option value="Intermediate">Intermediate</option>
<option value="High / High-grade transformation">High / High-grade transformation</option>
<option value="Cannot be assessed">Cannot be assessed</option>
</select>
</td>
</tr>
<tr>
<td>
<label class=""> + Tumor extension:</label>
</td>
<td>
<input type="text" name="A56" class="element text large" ID="A22" size="45">
</td>
</tr>
<tr>
<td>
<label class="description">- Lymphatic and/or Vascular Invasion: </label>
</td>
<td>
<select class="element select large" ID="A23">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2023-06-Update\Head and Neck Protocol Folder\HN.Nasal_4.2.0.0.REL_CAPCP.pdf#page=21" target="_blank">Perineural invasion</a>: </label>
</td>
<td>
<select class="element select large" ID="A24">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Present, intratumoral">Present, intratumoral</option>
<option value="Present, extratumoral">Present, extratumoral</option>
<option value="Present, intraneural, size of nerve">Present, intraneural, size of nerve</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Surgical margins of excision specimen: </label></legend>
<p>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-11-Update\HN.Nasal_4.1.1.0.REL_CAPCP.pdf#page=12" target="_blank">Surgical margins</a>:</label>
<select class="element select medium" ID="A25">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by invasive carcinoma, specify location and closest distance:">Uninvolved by invasive carcinoma, specify location and closest distance:</option>
<option value="Uninvolved by high grade dysplasia/ in situ disease, specify location and closest distance:">Uninvolved by high grade dysplasia/ in situ disease, specify location and closest distance:</option>
<option value="Involved by invasive carcinoma, specify location:">Involved by invasive carcinoma, specify location:</option>
<option value="Involved by high grade dysplasia/ in situ disease, specify location:">Involved by high grade dysplasia/ in situ disease, specify location:</option>
</select>
</p>
<br>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> <a href=".\cap\Cancer-Protocols-2021-11-Update\HN.Nasal_4.1.1.0.REL_CAPCP.pdf#page=16" target="_blank">Lymph nodes examination</a> : </label></legend>
<p>
<table border="1">
<col width="60%">
<tr>
<td>
<label class="description">- Number of regional lymph nodes examined :</label>
</td>
<td>
<input type="text" class="element text large" ID="A26" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes involved :</label>
</td>
<td>
<input type="text" class="element text large" ID="A27" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Extranodal extension (ENE) :</label>
</td>
<td>
<select class="element select large" ID="A28">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present, distance from capsule (mm): (> 2 mm, ENEma)">Present, distance from capsule (mm): (> 2 mm)</option>
<option value="Present, distance from capsule (mm): (< or = 2 mm, ENEmi)">Present, distance from capsule (mm): (< or = 2 mm)</option>
<option value="Present, distance from capsule (mm): (< 1 mm)">Present, distance from capsule (mm): (< 1 mm)</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest metastatic deposit (mm), specify site :</label>
</td>
<td>
<input type="text" class="element text large" ID="A29" size="20">
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest lymph node involved (mm), specify site :</label>
</td>
<td>
<input type="text" class="element text large" ID="A30" size="20">
</td>
</tr>
<tr>
<td>
<label class="description">- Laterality:</label>
</td>
<td>
<select class="element select large" ID="A31">
<option value=""></option>
<option value="Ipsilateral (including midline)">Ipsilateral (including midline)</option>
<option value="Contralateral">Contralateral</option>
<option value="Bilateral">Bilateral</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> Distant Metastasis: </label></legend>
<input class="element checkbox" type="checkbox" id="A61" value=" - Not applicable"><label class="choice" >Not applicable</label>
<input class="element checkbox" type="checkbox" id="A62" value=" - Not identified"><label class="choice" >Not identified</label>
<input class="element checkbox" type="checkbox" id="A63" value=" - Non-regional lymph node(s) (specify):"><label class="choice" >Non-regional lymph node(s) (specify):</label>
<input class="element checkbox" type="checkbox" id="A64" value=" - Lung (specify):"><label class="choice" >Lung (specify):</label>
<input class="element checkbox" type="checkbox" id="A65" value=" - Liver (specify):"><label class="choice" >Liver (specify):</label>
<input class="element checkbox" type="checkbox" id="A66" value=" - Bone (specify):"><label class="choice" >Bone (specify):</label>
<input class="element checkbox" type="checkbox" id="A67" value=" - Brain (specify):"><label class="choice" >Brain (specify):</label>
<input class="element checkbox" type="checkbox" id="A68" value=" - Other (specify):"><label class="choice" >Other (specify):</label>
<input class="element checkbox" type="checkbox" id="A69" value=" - Cannot be determined: "><label class="choice" >Cannot be determined: </label>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> <a href=".\cap\Cancer-Protocols-2021-11-Update\HN.Nasal_4.1.1.0.REL_CAPCP.pdf#page=20" target="_blank">Pathologic Stage Classification (AJCC 8e)</a>:</label></legend>
<p>
<table border="1">
<col width="70%">
<tr>
<td valign="top">
<label class="description"> - TNM Descriptors:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A32" value="m (multiple primary tumors) "><label class="choice">m (multiple primary)</label>
<input class="element checkbox" type="checkbox" id="A33" value="r (recurrent) "><label class="choice">r (recurrent)</label>
<input class="element checkbox" type="checkbox" id="A34" value="y (post treatment) "><label class="choice">y (post treatment)</label>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT) (for the maxillary sinus):</label>
</td>
<td>
<select class="element select large" ID="A35">
<option value=""></option>
<option value="pT not assigned (cannot be determined based on available pathological information)">pT not assigned (cannot be determined based on available pathological information)</option>
<option value="pT0: No evidence of primary tumor">pT0: No evidence of primary tumor</option>
<option value="pTis: Carcinoma in situ">pTis: Carcinoma in situ</option>
<option value="pT1: Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone">pT1: Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone</option>
<option value="pT2: Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates">pT2: Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates</option>
<option value="pT3: Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses">pT3: Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses</option>
<option value="pT4: Moderately advanced or very advanced local disease">pT4: Moderately advanced or very advanced local disease</option>
<option value="pT4a: Moderately advanced local disease. Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses">pT4a: Moderately advanced local disease. Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses</option>
<option value="pT4b: Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus">pT4b: Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT) (for the nasal cavity and ethmoid sinus):</label>
</td>
<td>
<select class="element select large" ID="A36">
<option value=""></option>
<option value="pT not assigned (cannot be determined based on available pathological information)">pT not assigned (cannot be determined based on available pathological information)</option>
<option value="pT0: No evidence of primary tumor">pT0: No evidence of primary tumor</option>
<option value="pTis: Carcinoma in situ">pTis: Carcinoma in situ</option>
<option value="pT1: Tumor restricted to any one subsite, with or without bone invasion">pT1: Tumor restricted to any one subsite, with or without bone invasion</option>
<option value="pT2: Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with our without bony invasion">pT2: Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with our without bony invasion</option>
<option value="pT3: Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate">pT3: Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate</option>
<option value="pT4: Moderately advanced or very advanced local disease">pT4: Moderately advanced or very advanced local disease</option>
<option value="pT4a: Moderately advanced local disease. Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses">pT4a: Moderately advanced local disease. Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses</option>
<option value="pT4b: Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus">pT4b: Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Regional lymph nodes (pN):</label>
</td>
<td>
<select class="element select large" ID="A37">
<option value=""></option>
<option value=" - pN not assigned (no nodes submitted or found)">pN not assigned (no nodes submitted or found)</option>
<option value=" - pN not assigned (cannot be determined based on available pathological information)">pN not assigned (cannot be determined based on available pathological information)</option>
<option value=" - pN0: No regional lymph node metastasis">pN0: No regional lymph node metastasis</option>
<option value=" - pN1: Metastasis in a single ipsilateral lymph node, < or = 3 cm and ENE(-)">pN1: Metastasis in a single ipsilateral lymph node, < or = 3 cm and ENE(-)</option>
<option value=" - pN2a: Metastasis in single ipsilateral node < or = 3 cm and ENE(+)">pN2a: Metastasis in single ipsilateral node < or = 3 cm and ENE(+)</option>
<option value=" - pN2a: Metastasis in a single ipsilateral node > 3 cm but < or = 6 cm and ENE(−)">pN2a: Metastasis in a single ipsilateral node > 3 cm but < or = 6 cm and ENE(−)</option>
<option value=" - pN2b: Metastases in multiple ipsilateral nodes, < or = 6 cm and ENE(−)">pN2b: Metastases in multiple ipsilateral nodes, < or = 6 cm and ENE(−)</option>
<option value=" - pN2c: Metastases in bilateral or contralateral lymph node(s), < or = 6 cm and ENE(−)">pN2c: Metastases in bilateral or contralateral lymph node(s), < or = 6 cm and ENE(−)</option>
<option value=" - pN3a: Metastasis in a lymph node > 6 cm and ENE(−)">pN3a: Metastasis in a lymph node > 6 cm and ENE(−)</option>
<option value=" - pN3b: Metastasis in a single ipsilateral node > 3 cm and ENE(+)">pN3b: Metastasis in a single ipsilateral node > 3 cm and ENE(+)</option>
<option value=" - pN3b: Metastasis in multiple ipsilateral, contralateral or bilateral nodes, any with ENE(+)">pN3b: Metastasis in multiple ipsilateral, contralateral or bilateral nodes, any with ENE(+)</option>
<option value=" - pN3b: Metastasis in a single contralateral node of any size and ENE(+)">pN3b: Metastasis in a single contralateral node of any size and ENE(+)</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Distant metastasis (pM):</label>
</td>
<td>
<select class="element select large" ID="A38">
<option value=""></option>
<option value="Not applicable - pM cannot be determined from the submitted specimen(s)">Not applicable - pM cannot be determined from the submitted specimen(s)</option>
<option value="pM1: Distant metastasis">pM1:Distant metastasis</option>
</select>
</td>
</tr>
<!--
<tr>
<td>
- Specify site(s), if known:
<input type="text" class="element text large" ID="A39" size="35">
</td>
</tr>
-->
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> Pathologic Stage Classification (AJCC 8e) for mucosal melanoma:</label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td valign="top">
<label class="description"> - TNM Descriptors:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A40" value="m (multiple primary tumors) "><label class="choice">m (multiple primary tumors)</label>
<input class="element checkbox" type="checkbox" id="A41" value="r (recurrent) "><label class="choice">r (recurrent)</label>
<input class="element checkbox" type="checkbox" id="A42" value="y (post treatment) "><label class="choice">y (post treatment)</label>
</td>
</tr>
<tr>
<td>
<label class="description"> - Primary tumor (pT):</label>
</td>
<td>
<select class="element select large" ID="A43">
<option value=""></option>
<option value="pT3: Tumors limited to the mucosa and immediately underlying soft tissue, regardless of thickness or greatest dimension; for example, polypoid nasal disease, pigmented or nonpigmented lesions of the oral cavity, pharynx, or larynx">pT3: Tumors limited to the mucosa and immediately underlying soft tissue, regardless of thickness or greatest dimension; for example, polypoid nasal disease, pigmented or nonpigmented lesions of the oral cavity, pharynx, or larynx</option>
<option value="pT4: Moderately advanced or very advanced disease">pT4: Moderately advanced or very advanced disease</option>
<option value="pT4a: Moderately advanced disease: Tumor involving deep soft tissue, cartilage, bone, or overlying skin">pT4a: Moderately advanced disease: Tumor involving deep soft tissue, cartilage, bone, or overlying skin</option>
<option value="pT4b: Very advanced disease: Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures">pT4b: Very advanced disease: Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description"> - Regional lymph nodes (pN): </label>
</td>
<td>
<select class="element select large" ID="A44">
<option value=""></option>
<option value=" - pN not assigned (no nodes submitted or found)">pN not assigned (no nodes submitted or found)</option>
<option value=" - pN not assigned (cannot be determined based on available pathological information)">pN not assigned (cannot be determined based on available pathological information)</option>
<option value="pN0: No regional lymph node metastasis">pN0: No regional lymph node metastasis</option>
<option value="pN1: Regional lymph node metastases present">pN1: Regional lymph node metastases present</option>
</select>
</td>
</tr>
<tr>
<td valign="top" rowspan="2">
<label class="description"> - Distant metastasis (pM): </label>
</td>
<td>
<select class="element select large" ID="A45">
<option value=""></option>
<option value="Not applicable - pM cannot be determined from the submitted specimen(s)">Not applicable - pM cannot be determined from the submitted specimen(s)</option>
<option value="pM1: Distant metastasis">pM1:Distant metastasis</option>
</select>
</td>
</tr>
<!--
<tr>
<td>
- Specify site(s), if known:
<input type="text" ID="A46" class="element text small" size="35">
</td>
</tr>
-->
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class=""> + Additional pathologic findings: </label></legend>
<p>
<input class="element checkbox" type="checkbox" id="A47" value=" - Keratinizing dysplasia, mild"><label class="choice">Keratinizing dysplasia, mild</label>
<input class="element checkbox" type="checkbox" id="A48" value=" - Keratinizing dysplasia, moderate"><label class="choice">Keratinizing dysplasia, moderate</label>
<input class="element checkbox" type="checkbox" id="A49" value=" - Keratinizing dysplasia, severe (carcinoma in situ)"><label class="choice">Keratinizing dysplasia, severe (carcinoma in situ)</label>
<input class="element checkbox" type="checkbox" id="A50" value=" - Nonkeratinizing dysplasia, mild"><label class="choice">Nonkeratinizing dysplasia, mild</label>
<input class="element checkbox" type="checkbox" id="A51" value=" - Nonkeratinizing dysplasia, moderate"><label class="choice">Nonkeratinizing dysplasia, moderate</label>
<input class="element checkbox" type="checkbox" id="A52" value=" - Nonkeratinizing dysplasia, severe (carcinoma in situ)"><label class="choice">Nonkeratinizing dysplasia, severe (carcinoma in situ)</label>
<input class="element checkbox" type="checkbox" id="A53" value=" - Inflammation (specify type):"><label class="choice">Inflammation (specify type):</label>
<input class="element checkbox" type="checkbox" id="A54" value=" - Squamous metaplasia"><label class="choice">Squamous metaplasia</label>
<input class="element checkbox" type="checkbox" id="A55" value=" - Epithelial hyperplasia"><label class="choice">Epithelial hyperplasia</label>
<input class="element checkbox" type="checkbox" id="A57" value=" - Colonization, bacterial"><label class="choice" >Colonization, bacterial</label>
<input class="element checkbox" type="checkbox" id="A60" value=" - Colonization, fungal"><label class="choice">Colonization, fungal</label>
- Other (specify):
<input type="text" class="element text medium" ID="A58" size="35">
</p>
<br>
</fieldset>
</p>
<p>
<label class="description">- Additional notes:</label>
<textarea ID="A59" class = "element textarea medium" style="border-color:grey;"></textarea>
</p>
<br><br>
<input type="button" name="copyform" value="Check your Report" onclick="updateDescription(this.form)"/>
<br>
<TEXTAREA ID="holdtext" name="holdtext" class="textarea large" style="border-color:coral;"></TEXTAREA>
<br><br>
<!-- The button used to copy the text -->
<button onclick="CopyToClipboard()">Copy text to Clipboard</button>