Is Clark level still used in melanoma staging?

Clark level was removed from AJCC 8th edition primary tumor staging but is still reported histologically. It had value for thin melanomas (Breslow <=1mm) but was superseded by ulceration and mitotic rate as better prognosticators.

What Clark level is clinically important?

Clark IV (reticular dermis) and V (subcutaneous fat) were historically important for T1b classification. Now Breslow depth (0.8mm threshold with ulceration) is the primary staging criterion.

How does Clark level relate to lymphatic invasion risk?

Dermal lymphatics begin at the papillary-reticular junction (Clark III-IV). Invasion into reticular dermis (Clark IV+) correlates with lymphatic involvement risk, which is why Breslow >0.8mm triggers SLNB consideration.

Clark Level Dermis Invasion

Assess melanoma anatomical invasion level using Clark classification: Level I (epidermis), II (papillary dermis), III (papillary-reticular junction), IV (reticular dermis), V (subcutaneous fat).

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