ID
6893
Description
Advanced Melanoma-On-study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A996-3FA4-E034-080020C9C0E0
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/8/15 1/8/15 - Martin Dugas
Uploaded on
January 8, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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On-Study - Advanced Melanoma-On-study Form - 2020195v2.31
No Instruction available.
- StudyEvent: Advanced Melanoma-On-study Form
Description
Melanoma: Form Administration
Description
PersonCompletingForm,LastName
Data type
text
Description
PersonCompletingForm,FirstName
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
AmendedDataInd
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Description
Melanoma (advanced): Disease Description
Description
InitialDiagnosisDate,Pathologic
Data type
date
Description
PrimarySurgeryType
Data type
text
Description
PrimarySurgery,OtherType
Data type
text
Description
PrimarySurgeryDate
Data type
date
Description
AdvancedDiseaseRegistrationStatus
Data type
text
Description
PrimarySite
Data type
text
Description
PrimarySite,Other
Data type
text
Description
PrimaryTumorResectionStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus Property
- C15232
- UMLS 2011AA Property
- C0728940
Description
InvolvementPattern
Data type
text
Description
InvolvementPattern,Other
Data type
text
Description
BreslowDepth
Data type
float
Description
Lab,Chemistry,LactateDehydrogenase
Data type
float
Description
ClarkLevel
Data type
text
Description
UlcerationInd
Data type
text
Description
LymphNode(s)ExaminedNumber
Data type
float
Alias
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
Description
LymphNode(s)PositiveNumber
Data type
float
Alias
- NCI Thesaurus Property
- C25246
- UMLS 2011AA Property
- C1446409
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
Description
LymphNodeInvolvement
Data type
text
Description
Intransitmetastases/satellitelesionsInd
Data type
text
Description
LymphNodes,MattedInd
Data type
text
Description
MetastaticSite
Data type
text
Description
MetastaticSite,OtherVisceral
Data type
text
Description
MetastaticSite,OtherNon-visceral
Data type
text
Description
TStage,Pathologic
Data type
text
Description
NStage,Pathologic
Data type
text
Description
MStage,Pathologic
Data type
text
Description
Melanoma (advanced): Sentinel Node Biopsy
Description
SentinelNodeBiopsyInd
Data type
text
Description
SentinelNodeBiopsyDate
Data type
date
Description
SentinelNode(s)ExaminedNumber
Data type
float
Description
SentinelNode(s)PositiveNumber
Data type
float
Description
SentinelNodeSize
Data type
float
Description
SentinelNodeBiopsyResults
Data type
text
Alias
- NCI Thesaurus Property
- C15189
- UMLS 2011AA Property
- C0005558
- NCI Thesaurus Property-2
- C13363
- UMLS 2011AA Property-2
- C0555952
- NCI Thesaurus ObjectClass
- C12947
- UMLS 2011AA ObjectClass
- C1522495
Description
Melanoma (advanced): Prior Treatment
Description
PriorSurgeryInd
Data type
text
Description
PriorSurgeryType
Data type
text
Description
PriorSurgeryType,Other
Data type
text
Description
PrimarySurgeryDate
Data type
date
Description
PriorRTInd
Data type
text
Description
RTSite
Data type
text
Description
PriorRTEndDate
Data type
date
Description
RTSite,Other
Data type
text
Description
PriorVaccineInd
Data type
text
Description
PriorVaccineType
Data type
text
Description
PriorVaccinationDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25629
- UMLS 2011AA ObjectClass
- C0332152
- NCI Thesaurus ObjectClass-2
- C923
- UMLS 2011AA ObjectClass-2
- C0042210
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
PriorILPInd
Data type
text
Description
PriorILP,specify
Data type
text
Description
PriorILPDate
Data type
date
Description
PriorHormonalTherapyInd
Data type
text
Description
PriorChemotherapyInd
Data type
text
Description
PriorImmunotherapyInd
Data type
text
Description
Melanoma: Prior Treatment-systemic Regimens
Description
PriorTreatmentRegimenName(s)
Data type
text
Description
PriorTreatmentRegimenBeginDate
Data type
date
Description
PriorTreatmentRegimenEndDate
Data type
date
Description
PriorTreatmentRegimenType
Data type
text
Description
Allows Documentation Of Any Additional Cooments
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