archetype (adl_version=1.4; uid=6c917788-26b0-4d0a-ae35-1dd6e0d32434)
	openEHR-EHR-CLUSTER.microscopy_melanoma.v0

concept
	[at0000]	-- Microscopic findings - Melanoma of skin
language
	original_language = <[ISO_639-1::en]>
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">
		>
	>
	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 = <
		["custodian_organisation"] = <"Nasjonal IKT">
		["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"] = <"no.nasjonalikt">
		["original_publisher"] = <"Nasjonal IKT">
		["custodian_namespace"] = <"no.nasjonalikt">
		["MD5-CAM-1.0.1"] = <"DBD848CE4827BA63C7ADF3F5AB0BB7D7">
		["build_uid"] = <"a2ffd14a-ad7c-4ce9-ab27-6df6ddbf7c01">
		["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.">
				>
			>
		>
	>