Modellbiblioteket openEHR Fork
Name
Microscopic findings - Melanoma of skin
Description
Microscopic anatomic pathology findings related to melanoma of skin.
Keywords
melanoma lab malignancy skin dermatology histology histopathology pathology cancer dermatopathology laboratory
Purpose
To record detailed findings about melanoma of skin found on microscopic examination.
Use
To record detailed findings about microscopic examination of tissue.
Use as a component archetype in the context of a suite of archetypes that make up a histopathology report ie OBSERVATION.lab_test.histopathology.
Misuse
Not designed to be used within any other archetype other than OBSERVATION.lab_test.histopathology.
References
Royal College of Pathologists of Australasia. Primary Cutaneous Melanoma Structured Reporting Protocol (1st Edition 2010). [Internet]. 2010;[cited 2010 Mar 21 ]
Available from: http://www.rcpa.edu.au//static/File/Asset%20library/public%20documents/Publications/StructuredReporting/PRIMARY%20CUTANEOUS%20MELANOMA%20STRUCTURED%20REPORTING%20PROTOCOL.pdf
College of American Pathologists. Melanoma of the skin - Full protocol [Internet]. 2005 Jan ;[cited 2009 Jul 25 ]
Available from: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2005/skinmelanoma05_pw.pdf
New Zealand Guidelines Group. Histopathological reporting of cutaneous melanoma
In: Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand [Internet]. 2008 Nov ;[cited 2009 Jul 25 ]
Available from: http://www.nzgg.org.nz/guidelines/0141/Chapter_7___Histopathological_reporting_of_cutaneous_melanoma.pdf
Mitotic index - Wikipedia, the free encyclopedia [Internet]. [cited 2009 Jul 25 ]
Available from: http://en.wikipedia.org/wiki/Mitotic_index
Archetype Id
openEHR-EHR-CLUSTER.microscopy_melanoma.v0
Copyright
© openEHR Foundation
Licencing
This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/.
Original Author
Dr Ian McNicoll
Ocean Informatics, UK
Date Originally Authored
To record detailed findings about melanoma of skin found on microscopic examination.
Language Details
Arabic (Syria)
Mona Saleh
Name Card Type Description
Depth of invasion
0..1 CLUSTER Depth of tumour invasion. Commonly expressed as the Breslow thickness.
Comment
Breslow thickness is measured from the top of the granular layer of the epidermis or, if the surface is ulcerated, from the base of the ulcer, to the deepest dermal invasive cell. This should be measured to nearest 0.1mm
CLUSTER
Breslow thickness
0..1 DV_QUANTITY Depth of tumour invasion. Measured to the nearest 0.1mm.
Comment
The Breslow thickness should be measured in the standard way when there is dermal regression (i.e. dermal regression extending to a greater thickness than the melanoma should not be included in the measurement of Breslow thickness).
DV_QUANTITY
Comment on invasion measurement
0..1 DV_TEXT Comment on invasion measurement issues or difficulties.
Surgical margins
0..* Slot (Cluster) Details of in-situ tumour at the peripheral surgical margins.
Slot
Slot
Clark Level
0..1 DV_CODED_TEXT Grading of invasion of the melanoma.
Constraint for DV_CODED_TEXT
  • Level I
    [Melanoma cells are confined to the epidermis (melanoma in situ).]
  • Level II
    [Melanoma cells invade into but do not fill or expand the papillary (superficial) dermis.]
  • Level III
    [Melanoma cells fill and expand the papillary dermis with extension of tumour to the papillary-reticular dermal interface.]
  • Level IV
    [Melanoma cells infiltrate into the reticular dermis.]
  • Level V
    [Melanoma cells infiltrate into the subcutaneous fat.]
Mitotic rate per mm2
0..1 DV_COUNT Mitotic rate is a measure of the proliferation status of a cell population, expressed as the number of mitoses per square millimetre.
Constraint for DV_COUNT
min: >= 0
Ulceration
0..1 CLUSTER Findings related to tumour-associated ulceration.
CLUSTER
Ulceration
0..1 DV_CODED_TEXT Finding of tumour-associated ulceration.
Constraint for DV_CODED_TEXT
  • Present
    [Tumour-associated ulceration is present.]
  • Absent
    [Tumour associated ulceration is absent.]
  • Indeterminate
    [Presence of tumour-associated ulceration has not been determined.]
Extent of ulceration
0..1 DV_QUANTITY Maximum diameter of tumour-ulceration visible.
DV_QUANTITY
Lymphovascular invasion
0..1 Slot (Cluster) Details of lymphovascular invasion.
Slot
Slot
Microsatellites
0..1 CLUSTER Findings related to microsatellites.
CLUSTER
Microsatellites
0..1 DV_CODED_TEXT Finding of microsatellites.
Constraint for DV_CODED_TEXT
  • Present
    [Microsatellites are present.]
  • Absent
    [Microsatellites are present.]
  • Indeterminate
    [Presence of microsatellites has not been determined.]
In-transit microsatellites
0..1 DV_CODED_TEXT Finding of in-transit microsatellites.
Constraint for DV_CODED_TEXT
  • Present
    [In-transit microsatellites are present.]
  • Absent
    [In-transit microsatellites are absent.]
  • Indeterminate
    [Findings of in-transit microsatellites has not been determined.]
Tumour infiltrating lymphocytes
0..1 CLUSTER Findings related to tumour infiltrating lymphocytes.
CLUSTER
Distribution
0..1 DV_CODED_TEXT Distribution pattern of tumour infiltrating lymphocytes.
Constraint for DV_CODED_TEXT
  • Present - Brisk / Diffuse
    [Tumour infilitrating lyphocytes are present, with infiltration of the entire base of the tumour, or of diffuse permeation of the invasive melanoma.]
  • Present - Nonbrisk / Focal
    [There are focal areas of tumour infiltrating lymphocytes.]
  • Absent
    [Tumour infiltrating lymphocytes are absent.]
  • Indeterminate
    [Presence of tumour infiltrating lymphocytes has not been determined.]
  • Present
    [Tumour infiltrating lymphocytes are present.]
Density
0..1 DV_CODED_TEXT Density of tumour infiltrating lymphocytes.
Constraint for DV_CODED_TEXT
  • Sparse
    [Sparse infiltration by lymphocytes.]
  • Dense
    [Dense infiltration by lymphocytes.]
  • Indeterminate
    [The density of tumour infiltration has not been determined.]
Regression
0..1 CLUSTER Findings related to melanoma regression.
CLUSTER
Intermediate/late regression
0..1 DV_CODED_TEXT Finding of tumour regression.
Constraint for DV_CODED_TEXT
  • Absent
    [Tumour regression is absent.]
  • Present involving less than 75%
    [Tumour regression is present, involving less than 75% of the tumour.]
  • Present involving 75% or more
    [Tumour regression is present, involving 75% or more of the tumour.]
  • Present (percentage not determined)
    [Tumour regression is present. Extent, as a percentage, has not been determined.]
  • Indeterminate
    [Presence of tumour regression has not been determined.]
Extent of regression
0..1 Slot (Cluster) Details of extent of regression.
Slot
Slot
Marginal clearance of regression
0..1 DV_QUANTITY Maximum distance of regression from the surgical margin.
DV_QUANTITY
Desmoplasia
0..1 CLUSTER Findings related to desmoplasia.
CLUSTER
Desmoplasia
0..1 DV_CODED_TEXT Finding of desmoplasia.
Constraint for DV_CODED_TEXT
  • Present
    [Desmoplasia is present.]
  • Absent
    [Desmoplasia is absent.]
  • Indeterminate
    [Presence of desmoplasia has not been determined.]
Extent of desmoplasia
0..1 DV_PROPORTION Extent of desmoplasia, expressed as a percentage of invasive component.
DV_PROPORTION
Solar elastosis
0..1 CLUSTER Findings related to solar elastosis.
CLUSTER
Solar elastosis
0..1 DV_CODED_TEXT Finding of solar elastosis.
Constraint for DV_CODED_TEXT
  • Present
    [Solar elastosis is present.]
  • Absent
    [Solar elastosis is absent.]
  • Indeterminate
    [Presence of solar elastosis has not been determined.]
Severity of solar elastosis
0..1 DV_TEXT Severity of solar elastosis.
Predominant cell type(s)
0..1 CLUSTER Findings of predominant cell types.
CLUSTER
Predominant cell type
0..1
CHOICE OF
DV_CODED_TEXT
DV_TEXT
Finding of a single predominant tumour cell type.
Constraint for DV_CODED_TEXT
  • Spindle cells
    [Spindle cells represent a predominant cell type.]
  • Epithelioid cells
    [Epithelioid cells represent a predominant cell type.]
  • Indeterminate
    [A predominant type of cell has not been determined.]
Neurotropism
0..* Slot (Cluster) Details of neurotropism or perineural invasion.
Slot
Slot
Associated benign melanocytic lesion(s)
0..1 CLUSTER Findings of any associated benign melanocytic lesions.
CLUSTER
Associated benign melanocytic lesion
0..* DV_TEXT Finding of an associated benign melanocytic lesion.
Growth pattern/phase
0..1 CLUSTER Findings related to growth pattern and growth phase.
CLUSTER
Intraepidermal growth pattern
0..1
CHOICE OF
DV_CODED_TEXT
DV_TEXT
Description of the melanoma growth pattern.
Constraint for DV_CODED_TEXT
  • Pagetoid
    [Pagetoid intraepidermal growth pattern.]
  • Lentiginous
    [Lentiginous intraepidermal growth pattern.]
  • Mixed
    [Mixed intraepidermal growth pattern.]
  • Indeterminate
    [The growth pattern has not been determined.]
Growth phase
0..1 DV_TEXT Description of the melanoma growth phase.
archetype (adl_version=1.4; uid=f3d21701-f9c3-4cf3-8a81-e05a8908a82f)
	openEHR-EHR-CLUSTER.microscopy_melanoma.v0

concept
	[at0000]	-- Microscopic findings - Melanoma of skin
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["ar-sy"] = <
			language = <[ISO_639-1::ar-sy]>
			author = <
				["name"] = <"Mona Saleh">
			>
		>
	>
description
	original_author = <
		["name"] = <"Dr Ian McNicoll">
		["organisation"] = <"Ocean Informatics, UK">
		["email"] = <"ian.mcnicoll@oceaninformatics.com">
		["date"] = <"17/05/2009">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record detailed findings about melanoma of skin found on microscopic examination.">
			use = <"To record detailed findings about microscopic examination of tissue. 
Use as a component archetype in the context of a suite of archetypes that make up a histopathology report ie OBSERVATION.lab_test.histopathology.">
			keywords = <"melanoma", "lab", "malignancy", "skin", "dermatology", "histology", "histopathology", "pathology", "cancer", "dermatopathology", "laboratory">
			misuse = <"Not designed to be used within any other archetype other than OBSERVATION.lab_test.histopathology.">
			copyright = <"© openEHR Foundation">
		>
		["ar-sy"] = <
			language = <[ISO_639-1::ar-sy]>
			purpose = <"لتسجيل الموجودات التفصيلية حول السرطان الميلانيني بالجلد/البشرة عند الفحص المجهري">
			use = <"لتسجيل الموجودات التفصيلية حول الفحص المجهري للنسيج.
يستخدم في سياق مجموعة من النماذج التي يتكون منها تقرير هيستوباثولوجي, و هو نموذج (ملاحظة.اختبار معملي.هيستوباثولوجيا)">
			keywords = <"السرطان الميلانيني", "المعمل/المختبر", "الخباثة", "الجلد/البشرة", "طب الجلد", "الهيستولوجيا", "الهيستوباثولوجيا", "الباثولوجيا/المَرَضية", "السرطان", "الباثولوجيا الجلدية", "المعمل/المختبر">
			misuse = <"لم يتم تصميم هذا النموذج في داخل أي نموذج غير (ملاحظة.اختبار معملي.هيستوباثولوجيا)">
			copyright = <"© openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Koray Atalag, University of Auckland, New Zealand", "Matt Cordell, NEHTA, Australia", "David Ellis, RCPA, Australia", "Heather Leslie, Ocean Informatics, Australia", "David McKillop, NEHTA, Australia", "Cathy Richardson, NEHTA, Australia">
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Royal College of Pathologists of Australasia. Primary Cutaneous Melanoma Structured Reporting Protocol (1st Edition 2010). [Internet]. 2010;[cited 2010 Mar 21 ]
Available from: http://www.rcpa.edu.au//static/File/Asset%20library/public%20documents/Publications/StructuredReporting/PRIMARY%20CUTANEOUS%20MELANOMA%20STRUCTURED%20REPORTING%20PROTOCOL.pdf

College of American Pathologists. Melanoma of the skin - Full protocol [Internet]. 2005 Jan ;[cited 2009 Jul 25 ] 
Available from: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2005/skinmelanoma05_pw.pdf

New Zealand Guidelines Group. Histopathological reporting of cutaneous melanoma
In: Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand [Internet]. 2008 Nov ;[cited 2009 Jul 25 ] 
Available from: http://www.nzgg.org.nz/guidelines/0141/Chapter_7___Histopathological_reporting_of_cutaneous_melanoma.pdf

Mitotic index - Wikipedia, the free encyclopedia [Internet]. [cited 2009 Jul 25 ] 
Available from: http://en.wikipedia.org/wiki/Mitotic_index

">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"1267987C10638F469EA547A5859E9663">
		["build_uid"] = <"358ccb69-42d7-4eca-8c2c-ec24a3251f31">
		["revision"] = <"0.0.1-alpha">
	>

definition
	CLUSTER[at0000] matches {	-- Microscopic findings - Melanoma of skin
		items cardinality matches {1..*; unordered} matches {
			CLUSTER[at0001] occurrences matches {0..1} matches {	-- Depth of invasion
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0002] occurrences matches {0..1} matches {	-- Breslow thickness
						value matches {
							C_DV_QUANTITY <
								property = <[openehr::122]>
								list = <
									["1"] = <
										units = <"mm">
										magnitude = <|>=0.0|>
										precision = <|1|>
									>
								>
							>
						}
					}
					ELEMENT[at0003] occurrences matches {0..1} matches {	-- Comment on invasion measurement
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			allow_archetype CLUSTER[at0067] occurrences matches {0..*} matches {	-- Surgical margins 
				include
					archetype_id/value matches {/openEHR-EHR-CLUSTER\.tumour_resection_margins(-[a-zA-Z0-9_]+)*\.v1/}
				exclude
					archetype_id/value matches {/.*/}
			}
			ELEMENT[at0007] occurrences matches {0..1} matches {	-- Clark Level
				value matches {
					DV_CODED_TEXT matches {
						defining_code matches {
							[local::
							at0008, 	-- Level I
							at0009, 	-- Level II
							at0010, 	-- Level III
							at0011, 	-- Level IV
							at0012]	-- Level V
						}
					}
				}
			}
			ELEMENT[at0013] occurrences matches {0..1} matches {	-- Mitotic rate per mm2
				value matches {
					DV_COUNT matches {
						magnitude matches {|>=0|}
					}
				}
			}
			CLUSTER[at0020] occurrences matches {0..1} matches {	-- Ulceration
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0022] occurrences matches {0..1} matches {	-- Ulceration
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0072, 	-- Present
									at0073, 	-- Absent
									at0074]	-- Indeterminate
								}
							}
						}
					}
					ELEMENT[at0023] occurrences matches {0..1} matches {	-- Extent of ulceration
						value matches {
							C_DV_QUANTITY <
								property = <[openehr::122]>
								list = <
									["1"] = <
										units = <"mm">
										magnitude = <|>=0.0|>
									>
								>
							>
						}
					}
				}
			}
			allow_archetype CLUSTER[at0125] occurrences matches {0..1} matches {	-- Lymphovascular invasion
				include
					archetype_id/value matches {/openEHR-EHR-CLUSTER\.tumour_invasion(-[a-zA-Z0-9_]+)*\.v1/}
				exclude
					archetype_id/value matches {/.*/}
			}
			CLUSTER[at0026] occurrences matches {0..1} matches {	-- Microsatellites
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0027] occurrences matches {0..1} matches {	-- Microsatellites
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0078, 	-- Present
									at0079, 	-- Absent
									at0080]	-- Indeterminate
								}
							}
						}
					}
					ELEMENT[at0028] occurrences matches {0..1} matches {	-- In-transit microsatellites
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0094, 	-- Present
									at0095, 	-- Absent
									at0096]	-- Indeterminate
								}
							}
						}
					}
				}
			}
			CLUSTER[at0047] occurrences matches {0..1} matches {	-- Tumour infiltrating lymphocytes
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0032] occurrences matches {0..1} matches {	-- Distribution
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0049, 	-- Present - Brisk / Diffuse
									at0050, 	-- Present - Nonbrisk /  Focal
									at0081, 	-- Absent
									at0082, 	-- Indeterminate
									at0128]	-- Present
								}
							}
						}
					}
					ELEMENT[at0083] occurrences matches {0..1} matches {	-- Density
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0084, 	-- Sparse
									at0085, 	-- Dense
									at0086]	-- Indeterminate
								}
							}
						}
					}
				}
			}
			CLUSTER[at0034] occurrences matches {0..1} matches {	-- Regression
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0051] occurrences matches {0..1} matches {	-- Intermediate/late regression
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0015, 	-- Absent
									at0052, 	-- Present involving less than 75%
									at0053, 	-- Present involving 75% or more
									at0111, 	-- Present (percentage not determined)
									at0118]	-- Indeterminate
								}
							}
						}
					}
					allow_archetype CLUSTER[at0112] occurrences matches {0..1} matches {	-- Extent of regression
						include
							archetype_id/value matches {/openEHR-EHR-CLUSTER\.physical_properties\.v1/}
						exclude
							archetype_id/value matches {/.*/}
					}
					ELEMENT[at0113] occurrences matches {0..1} matches {	-- Marginal clearance of regression
						value matches {
							C_DV_QUANTITY <
								property = <[openehr::122]>
								list = <
									["1"] = <
										units = <"mm">
										magnitude = <|>=0.0|>
									>
								>
							>
						}
					}
				}
			}
			CLUSTER[at0037] occurrences matches {0..1} matches {	-- Desmoplasia
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0038] occurrences matches {0..1} matches {	-- Desmoplasia
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0119, 	-- Present
									at0120, 	-- Absent
									at0121]	-- Indeterminate
								}
							}
						}
					}
					ELEMENT[at0039] occurrences matches {0..1} matches {	-- Extent of desmoplasia
						value matches {
							DV_PROPORTION matches {
								numerator matches {|0.0..100.0|}
								denominator matches {|0.0..100.0|}
								is_integral matches {False}
								type matches {2}
							}
						}
					}
				}
			}
			CLUSTER[at0100] occurrences matches {0..1} matches {	-- Solar elastosis
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0101] occurrences matches {0..1} matches {	-- Solar elastosis
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0102, 	-- Present
									at0103, 	-- Absent
									at0104]	-- Indeterminate
								}
							}
						}
					}
					ELEMENT[at0105] occurrences matches {0..1} matches {	-- Severity of solar elastosis
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0106] occurrences matches {0..1} matches {	-- Predominant cell type(s)
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0107] occurrences matches {0..1} matches {	-- Predominant cell type
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0108, 	-- Spindle cells
									at0109, 	-- Epithelioid cells
									at0110]	-- Indeterminate
								}
							}
							DV_TEXT matches {*}
						}
					}
				}
			}
			allow_archetype CLUSTER[at0127] occurrences matches {0..*} matches {	-- Neurotropism
				include
					archetype_id/value matches {/openEHR-EHR-CLUSTER\.tumour_invasion(-[a-zA-Z0-9_]+)*\.v1/}
				exclude
					archetype_id/value matches {/.*/}
			}
			CLUSTER[at0092] occurrences matches {0..1} matches {	-- Associated benign melanocytic lesion(s)
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0044] occurrences matches {0..*} matches {	-- Associated benign melanocytic lesion
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			CLUSTER[at0091] occurrences matches {0..1} matches {	-- Growth pattern/phase
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0045] occurrences matches {0..1} matches {	-- Intraepidermal growth pattern
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0114, 	-- Pagetoid
									at0115, 	-- Lentiginous
									at0116, 	-- Mixed
									at0117]	-- Indeterminate
								}
							}
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0090] occurrences matches {0..1} matches {	-- Growth phase
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
		}
	}


ontology
	terminologies_available = <"SNOMED-CT", ...>
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Microscopic findings - Melanoma of skin">
					description = <"Microscopic anatomic pathology findings related to melanoma of skin.">
				>
				["at0001"] = <
					text = <"Depth of invasion">
					description = <"Depth of tumour invasion. Commonly expressed as the Breslow thickness.">
					comment = <"Breslow thickness is measured from the top of the granular layer of the epidermis or, if the surface is ulcerated, from the base of the ulcer, to the deepest dermal invasive cell. 

This should be measured to nearest 0.1mm
">
				>
				["at0002"] = <
					text = <"Breslow thickness">
					description = <"Depth of tumour invasion. Measured to the nearest 0.1mm.">
					comment = <"The Breslow thickness should be measured in the standard way when there is dermal regression (i.e. dermal regression extending to a greater thickness than the melanoma should not be included in the measurement of Breslow thickness). ">
				>
				["at0003"] = <
					text = <"Comment on invasion measurement">
					description = <"Comment on invasion measurement issues or difficulties.">
				>
				["at0007"] = <
					text = <"Clark Level">
					description = <"Grading of invasion of the melanoma.">
				>
				["at0008"] = <
					text = <"Level I">
					description = <"Melanoma cells are confined to the epidermis (melanoma in situ).">
				>
				["at0009"] = <
					text = <"Level II">
					description = <"Melanoma cells invade into but do not fill or expand the papillary (superficial) dermis.">
				>
				["at0010"] = <
					text = <"Level III">
					description = <"Melanoma cells fill and expand the papillary dermis with extension of tumour to the papillary-reticular dermal interface.">
				>
				["at0011"] = <
					text = <"Level IV">
					description = <"Melanoma cells infiltrate into the reticular dermis.">
				>
				["at0012"] = <
					text = <"Level V">
					description = <"Melanoma cells infiltrate into the subcutaneous fat.">
				>
				["at0013"] = <
					text = <"Mitotic rate per mm2">
					description = <"Mitotic rate is a measure of the proliferation status of a cell population, expressed as the number of mitoses per square millimetre.">
				>
				["at0015"] = <
					text = <"Absent">
					description = <"Tumour regression is absent.">
				>
				["at0020"] = <
					text = <"Ulceration">
					description = <"Findings related to tumour-associated ulceration.">
				>
				["at0022"] = <
					text = <"Ulceration">
					description = <"Finding of tumour-associated ulceration.">
				>
				["at0023"] = <
					text = <"Extent of ulceration">
					description = <"Maximum diameter of tumour-ulceration visible.">
				>
				["at0026"] = <
					text = <"Microsatellites">
					description = <"Findings related to microsatellites.">
				>
				["at0027"] = <
					text = <"Microsatellites">
					description = <"Finding of microsatellites.">
				>
				["at0028"] = <
					text = <"In-transit microsatellites">
					description = <"Finding of in-transit microsatellites.">
				>
				["at0032"] = <
					text = <"Distribution">
					description = <"Distribution pattern of tumour infiltrating lymphocytes.">
				>
				["at0034"] = <
					text = <"Regression">
					description = <"Findings related to melanoma regression.">
				>
				["at0037"] = <
					text = <"Desmoplasia">
					description = <"Findings related to desmoplasia.">
				>
				["at0038"] = <
					text = <"Desmoplasia">
					description = <"Finding of desmoplasia.">
				>
				["at0039"] = <
					text = <"Extent of desmoplasia">
					description = <"Extent of desmoplasia, expressed as a percentage of invasive component.">
				>
				["at0044"] = <
					text = <"Associated benign melanocytic lesion">
					description = <"Finding of an associated benign melanocytic lesion.">
				>
				["at0045"] = <
					text = <"Intraepidermal growth pattern">
					description = <"Description of the melanoma growth pattern.">
				>
				["at0047"] = <
					text = <"Tumour infiltrating lymphocytes">
					description = <"Findings related to tumour infiltrating lymphocytes.">
				>
				["at0049"] = <
					text = <"Present - Brisk / Diffuse">
					description = <"Tumour infilitrating lyphocytes are present, with infiltration of the entire base of the tumour, or of diffuse permeation of the invasive melanoma.">
				>
				["at0050"] = <
					text = <"Present - Nonbrisk /  Focal">
					description = <"There are focal areas of tumour infiltrating lymphocytes.">
				>
				["at0051"] = <
					text = <"Intermediate/late regression">
					description = <"Finding of tumour regression.">
				>
				["at0052"] = <
					text = <"Present involving less than 75%">
					description = <"Tumour regression is present, involving less than 75% of the tumour.">
				>
				["at0053"] = <
					text = <"Present involving 75% or more">
					description = <"Tumour regression is present, involving 75% or more of the tumour.">
				>
				["at0067"] = <
					text = <"Surgical margins ">
					description = <"Details of in-situ tumour at the peripheral surgical margins.">
				>
				["at0072"] = <
					text = <"Present">
					description = <"Tumour-associated ulceration is present.">
				>
				["at0073"] = <
					text = <"Absent">
					description = <"Tumour associated ulceration is absent.">
				>
				["at0074"] = <
					text = <"Indeterminate">
					description = <"Presence of tumour-associated ulceration has not been determined.">
				>
				["at0078"] = <
					text = <"Present">
					description = <"Microsatellites are present.">
				>
				["at0079"] = <
					text = <"Absent">
					description = <"Microsatellites are present.">
				>
				["at0080"] = <
					text = <"Indeterminate">
					description = <"Presence of microsatellites has not been determined.">
				>
				["at0081"] = <
					text = <"Absent">
					description = <"Tumour infiltrating lymphocytes are absent.">
				>
				["at0082"] = <
					text = <"Indeterminate">
					description = <"Presence of tumour infiltrating lymphocytes has not been determined.">
				>
				["at0083"] = <
					text = <"Density">
					description = <"Density of tumour infiltrating lymphocytes.">
				>
				["at0084"] = <
					text = <"Sparse">
					description = <"Sparse infiltration by lymphocytes.">
				>
				["at0085"] = <
					text = <"Dense">
					description = <"Dense infiltration by lymphocytes.">
				>
				["at0086"] = <
					text = <"Indeterminate">
					description = <"The density of tumour infiltration has not been determined.">
				>
				["at0090"] = <
					text = <"Growth phase">
					description = <"Description of the melanoma growth phase.">
				>
				["at0091"] = <
					text = <"Growth pattern/phase">
					description = <"Findings related to growth pattern and growth phase.">
				>
				["at0092"] = <
					text = <"Associated benign melanocytic lesion(s)">
					description = <"Findings of any associated benign melanocytic lesions.">
				>
				["at0094"] = <
					text = <"Present">
					description = <"In-transit microsatellites are present.">
				>
				["at0095"] = <
					text = <"Absent">
					description = <"In-transit microsatellites are absent.">
				>
				["at0096"] = <
					text = <"Indeterminate">
					description = <"Findings of in-transit microsatellites has not been determined.">
				>
				["at0100"] = <
					text = <"Solar elastosis">
					description = <"Findings related to solar elastosis.">
				>
				["at0101"] = <
					text = <"Solar elastosis">
					description = <"Finding of solar elastosis.">
				>
				["at0102"] = <
					text = <"Present">
					description = <"Solar elastosis is present.">
				>
				["at0103"] = <
					text = <"Absent">
					description = <"Solar elastosis is absent.">
				>
				["at0104"] = <
					text = <"Indeterminate">
					description = <"Presence of solar elastosis has not been determined.">
				>
				["at0105"] = <
					text = <"Severity of solar elastosis">
					description = <"Severity of solar elastosis.">
				>
				["at0106"] = <
					text = <"Predominant cell type(s)">
					description = <"Findings of predominant cell types.">
				>
				["at0107"] = <
					text = <"Predominant cell type">
					description = <"Finding of a single predominant tumour cell type.">
				>
				["at0108"] = <
					text = <"Spindle cells">
					description = <"Spindle cells represent a predominant cell type.">
				>
				["at0109"] = <
					text = <"Epithelioid cells">
					description = <"Epithelioid cells represent a predominant cell type.">
				>
				["at0110"] = <
					text = <"Indeterminate">
					description = <"A predominant type of cell has not been determined.">
				>
				["at0111"] = <
					text = <"Present (percentage not determined)">
					description = <"Tumour regression is present. Extent, as a percentage, has not been determined.">
				>
				["at0112"] = <
					text = <"Extent of regression">
					description = <"Details of extent of regression.">
				>
				["at0113"] = <
					text = <"Marginal clearance of regression">
					description = <"Maximum distance of regression from the surgical margin.">
				>
				["at0114"] = <
					text = <"Pagetoid">
					description = <"Pagetoid intraepidermal growth pattern.">
				>
				["at0115"] = <
					text = <"Lentiginous">
					description = <"Lentiginous intraepidermal growth pattern.">
				>
				["at0116"] = <
					text = <"Mixed">
					description = <"Mixed intraepidermal growth pattern.">
				>
				["at0117"] = <
					text = <"Indeterminate">
					description = <"The growth pattern has not been determined.">
				>
				["at0118"] = <
					text = <"Indeterminate">
					description = <"Presence of tumour regression has not been determined.">
				>
				["at0119"] = <
					text = <"Present">
					description = <"Desmoplasia is present.">
				>
				["at0120"] = <
					text = <"Absent">
					description = <"Desmoplasia is absent.">
				>
				["at0121"] = <
					text = <"Indeterminate">
					description = <"Presence of desmoplasia has not been determined.">
				>
				["at0125"] = <
					text = <"Lymphovascular invasion">
					description = <"Details of lymphovascular invasion.">
				>
				["at0127"] = <
					text = <"Neurotropism">
					description = <"Details of neurotropism or perineural invasion.">
				>
				["at0128"] = <
					text = <"Present">
					description = <"Tumour infiltrating lymphocytes are present.">
				>
			>
		>
		["ar-sy"] = <
			items = <
				["at0000"] = <
					text = <"الموجودات المجهرية - السرطان الميلانيني بالجلد/البشرة">
					description = <"الموجودات الباثولوجية التشريحية للفحص المجهري المتعلق بالسرطان الميلانيني للجلد/البشرة">
				>
				["at0001"] = <
					text = <"عمق الغزو">
					description = <"عمق غزو الورم. عادة ما يعبر عنه بثِخَن بريسلو">
					comment = <"يتم قياس ثِخَن برسيلو من قمة الطبقة الحُبَيْبِية للبشرة,, أو إذا كان السطح مُتَقَرِّحاً, من قاعدة القرحة إلى أعمق خلية بشرية غازية. 

و يتم تقريبه إلى أقرب 0.1 ميلليمتر.">
				>
				["at0002"] = <
					text = <"ثِخَن بريسلو">
					description = <"عمق غزو الورم. يتم قياسه إلى أقرب 0.1 ميلليمتر.">
					comment = <"يتم قياس ثِخَن بريسلو بالطريقة العيارية إذا كان هناك تقهقر للبشرة, يعني لا ينبغي اشتمال قياس ثِخَن بريسلو على أي تقهقر للبشرة يمتد إلى ثِخَن أكبر من السرطان الميلانيني ">
				>
				["at0003"] = <
					text = <"تعليق حول قياس الغزو">
					description = <"تعليق حول قضايا أو صعوبات قياس الغزو">
				>
				["at0007"] = <
					text = <"مستوى كلاك">
					description = <"درجة غزو السرطان الميلانيني">
				>
				["at0008"] = <
					text = <"المستوى الأول">
					description = <"خلايا السرطان ماخِضة في البشرة - سرطان ميلانيني لابِد/في موضعه.">
				>
				["at0009"] = <
					text = <"المستوى الثاني">
					description = <"خلايا السرطان الميلانيني تغزو/تغير عى الأدمة الحُلَيْمِية السطحية,, و لكنها لا تملأها و لا تتوسع فيها.">
				>
				["at0010"] = <
					text = <"المستوى الثالث">
					description = <"خلايا السرطان الميلانيني تملأ و تتوسع في الأدمة الحُلَيْمِية مع امتداد الورم إلى الوُجَيْهة/الخط الفاصل في البشرة بين الطبقة الحليمية و الطبقة الشبكية.">
				>
				["at0011"] = <
					text = <"المستوى الرابع">
					description = <"خلايا السرطان الميلانيني ترتشح في داخل البشرة الشبكية.">
				>
				["at0012"] = <
					text = <"المستوى الخامس">
					description = <"خلايا السرطان الميلانيني ترتشح في الشحم الموجود تحت الجلد.">
				>
				["at0013"] = <
					text = <"معدل الانقسام الفَتيلي لكل ميلليمتر مربع">
					description = <"معدل الانقاسم الفَتيلي هو قياس حالة التكاثر لمجموعة من الخلايا, يتم التعبير عنها بعدد الانقاسمات الفتيلية لكل ميلليمتر مربع.">
				>
				["at0015"] = <
					text = <"غائب">
					description = <"لا يوجد تقهقر للورم">
				>
				["at0020"] = <
					text = <"التقرح">
					description = <"الموجودات المتعلقة بالتقرح المصاحب للورم.">
				>
				["at0022"] = <
					text = <"التقرح">
					description = <"موجودات متعلقة بالتقرح المصاحب بالورم.">
				>
				["at0023"] = <
					text = <"مدى التقرح">
					description = <"الحد الأقصى المرئي للتقرح المصاحب للورم.">
				>
				["at0026"] = <
					text = <"السواتل المجهرية">
					description = <"الموجودات المتعلقة بالسواتل المجهرية">
				>
				["at0027"] = <
					text = <"السواتل المجهرية">
					description = <"الموجودات المتعلقة بالسواتل المجهرية">
				>
				["at0028"] = <
					text = <"السواتل المجهرية العابرة ">
					description = <"الموجودات المتعلقة بالسواتل المجهرية العابرة">
				>
				["at0032"] = <
					text = <"التوزيع">
					description = <"نمط توزيع الخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0034"] = <
					text = <"التقهقر">
					description = <"الموجودات المتعلقة بتقهقر السرطان الميلانيني">
				>
				["at0037"] = <
					text = <"تكون النسيج الليفي">
					description = <"الموجودات المتعلقة بتكون النسيج الليفي">
				>
				["at0038"] = <
					text = <"تكون النسيج الليفي">
					description = <"الموجودات المتعلقة بتكون النسيج الليفي">
				>
				["at0039"] = <
					text = <"مدى تكون النسيج الليفي">
					description = <"مدى تكون النسيج الليفي, يتم التعبير عنه كنسبة مئوية من الجزء الغازي">
				>
				["at0044"] = <
					text = <"الآفة المصاحبة بالخلايا الميلانينية الحميدة">
					description = <"الموجودات المتعلقة بالآفة المصاحبة بالخلايا الميلانينية الحميدة">
				>
				["at0045"] = <
					text = <"نمط النمو في داخل البشرة">
					description = <"وصف نمط نمو السرطان الميلانيني">
				>
				["at0047"] = <
					text = <"الخلايا الليمفاوية المسئولة عن ارتشح الورم">
					description = <"الموجودات المتعلقة بالخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0049"] = <
					text = <"موجود - متغلغل/منتشر">
					description = <"الخلايا الليمفاوية المسئولة عن ارتشح الورم موجودة, مع ارتشاح القاعدة الكلية للورم, أو تغلغل للسرطان الميلانيني الغازي">
				>
				["at0050"] = <
					text = <"موجود - غير متغلغل/بؤري">
					description = <"يوجد مناطق بؤرية للخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0051"] = <
					text = <"تقهقر متوسط/متأخر">
					description = <"الموجودات المتعلقة بتقهقر الورم">
				>
				["at0052"] = <
					text = <"موجود و يكتنف أقل من 75%">
					description = <"يوجد تقهقر للورم, و هو يكتنف أقل من 75% من الورم">
				>
				["at0053"] = <
					text = <"موجود و يكتنف 75% أو أكثر">
					description = <"يوجد تقهقر للورم, و هو يكتنف 75% أو أكثر من الورم">
				>
				["at0067"] = <
					text = <"الحواف/الهوامش الجراحية">
					description = <"تفاصيل الورم اللابِد/في موضعه عند الحواف/الهوامش الجراحية الطرفية.">
				>
				["at0072"] = <
					text = <"موجود">
					description = <"يوجد تقرح مصاحب للورم">
				>
				["at0073"] = <
					text = <"غائب">
					description = <"لا يوجد تقرح مصاحب للورم">
				>
				["at0074"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد وجود تقرح مصاحب للورم">
				>
				["at0078"] = <
					text = <"موجود">
					description = <"السواتل المجهرية موجودة">
				>
				["at0079"] = <
					text = <"غائبة">
					description = <"لا يوجد سواتل مجهرية">
				>
				["at0080"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد وجود السواتل المجهرية">
				>
				["at0081"] = <
					text = <"غائب">
					description = <"الخلايا الليمفاوية المسئولة عن ارتشح الورم غير موجودة">
				>
				["at0082"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد وجود الخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0083"] = <
					text = <"الكثافة">
					description = <"كثافة الخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0084"] = <
					text = <"متناثر">
					description = <"ارتشاخ الخلايا الليمفاوية بشكل متناثر">
				>
				["at0085"] = <
					text = <"كثيف">
					description = <"ارتشاح الخلايا الليمفاوية كثيف">
				>
				["at0086"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد ارتشاح الخلايا الليمفاوية المسئولة عن ارتشح الورم">
				>
				["at0090"] = <
					text = <"طور النمو">
					description = <"وصف طور النمو في السرطان الميلانيني">
				>
				["at0091"] = <
					text = <"نمط/طور النمو">
					description = <"الموجودات المتعلقة بنمط النمو و طور النمو">
				>
				["at0092"] = <
					text = <"الآفة/الآفات الميلانينية الحميدة المصاحبة">
					description = <"الموجودات المتعلقة بأي آفات مصاحبة للخلايا الميلانينية الحميدة">
				>
				["at0094"] = <
					text = <"موجود">
					description = <"يوجد سواتل مجهرية عابرة">
				>
				["at0095"] = <
					text = <"غائب">
					description = <"لا يوجد سواتل مجهرية عابرة">
				>
				["at0096"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد السواتل المجهرية العابرة">
				>
				["at0100"] = <
					text = <"تنكس النسيج المرن الشمسي">
					description = <"الموجودات المتعلقة بتنكس النسيج المرن الشمسي">
				>
				["at0101"] = <
					text = <"تنكس النسيج المرن الشمسي">
					description = <"الموجودات المتعلقة بتنكس النسيج المرن الشمسي">
				>
				["at0102"] = <
					text = <"موجود">
					description = <"يوجد تنكس للنسيج المرن الشمسي">
				>
				["at0103"] = <
					text = <"غائب">
					description = <"لا يوجد تنكس للنسيج المرن الشمسي">
				>
				["at0104"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد وجود تنكس للنسيج المرن الشمسي">
				>
				["at0105"] = <
					text = <"شدة تنكس النسيج المرن الشمسي">
					description = <"شدة تنكس النسيج المرن الشمسي">
				>
				["at0106"] = <
					text = <"نوع/أنواع الخلايا السائدة">
					description = <"الموجودات المتعلقة بأنواع الخلايا السائدة">
				>
				["at0107"] = <
					text = <"نوع الخلية السائدة">
					description = <"الموجودات المتعلقة بنوع واحد من خلايا الورم السائدة">
				>
				["at0108"] = <
					text = <"الخلايا المغزلية">
					description = <"الخلايا المغزلية تمثل نوع الخلايا السائدة">
				>
				["at0109"] = <
					text = <"خلايا شبيهة بالظهارة">
					description = <"الخلايا الشبيهة بالظهارة هي نوع الخلايا السائدة">
				>
				["at0110"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد نوع الخلايا السائدة">
				>
				["at0111"] = <
					text = <"موجود - لم يتم تحديد النسبة المئوية">
					description = <"يوجد تقهقر للورم. و لم يتم تحديد المدى في صورة نسبة مئوية">
				>
				["at0112"] = <
					text = <"مدى التقهقر">
					description = <"تفاصيل مدى التقهقر">
				>
				["at0113"] = <
					text = <"التصفية الهامشية للتقهقر">
					description = <"الحد الأقصى لمسافة التقهقر من الهامش/الحافة الجراحية">
				>
				["at0114"] = <
					text = <"شبيه بداء باجيت">
					description = <"نمط نمو داخل البشرة يشبه داء باجيت">
				>
				["at0115"] = <
					text = <"أنمش">
					description = <"نمط نمو أنمش داخل البشرة">
				>
				["at0116"] = <
					text = <"مختلط">
					description = <"نمط النمو داخل البشرة مختلط">
				>
				["at0117"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد نمط النمو">
				>
				["at0118"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد تقهقر الورم">
				>
				["at0119"] = <
					text = <"موجود">
					description = <"تكون النسيج الليفي موجود">
				>
				["at0120"] = <
					text = <"غائب">
					description = <"لا يوجد تكون للنسيج الليفي">
				>
				["at0121"] = <
					text = <"غير محدد">
					description = <"لم يتم تحديد وجود تكون النسيج الليفي">
				>
				["at0125"] = <
					text = <"غزو الخلايا الليمفاوية و الأوعية الدموية">
					description = <"تفاصيل غزو الخلايا الليمفاوية و الأوعية الدموية">
				>
				["at0127"] = <
					text = <"التوجه العصبي">
					description = <"تفاصيل حول التوجه العصبي أو غزو النسيج الموجود حول الأعصاب">
				>
				["at0128"] = <
					text = <"موجود">
					description = <"الخلايا الليمفاوية المسئولة عن ارتشح الورم موجودة">
				>
			>
		>
	>