Breslow Depth / Clark Level
Stages melanoma depth for prognosis and surgical margin determination
- Highest activation tier
- Mandatory
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Breslow Depth / Clark Level can activate when the transcript or pasted chart context documents any of these:
- Melanoma staging
- Melanoma prognosis assessment
- Wide local excision margin planning
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: C43.
Inputs the note needs
2 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; an input marked "asks you" is requested as a clarification when it is undocumented.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Breslow depth in mm | exam | ||
| Clark level (1-5)optional | exam |
Scoring
Breslow: T1 ≤1.0mm, T2 1.01-2.0mm, T3 2.01-4.0mm, T4 >4.0mm. Clark: I=epidermis, II=papillary dermis, III=papillary-reticular junction, IV=reticular dermis, V=subcutaneous fat.
Interpretation
T1 ≤1.0mm: 1cm margins, excellent prognosis. T2 1.01-2.0mm: 1-2cm margins. T3 2.01-4.0mm: 2cm margins, sentinel node biopsy. T4 >4.0mm: 2cm margins, sentinel node biopsy, high recurrence risk.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Breslow 1970.
- Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanomaBreslow (Melanoma Thickness) 1970 · 1970 · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Breslow Depth / Clark Level at the mandatory tier, Scribeable resolves its inputs from the transcript, the pasted chart context and any charted labs, and asks you for a missing input you can supply before the note is finalised. Bedside-exam and separately ordered study values are not requested one input at a time; a calculator that carries a combined clarification question may still put that single question to you.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Breslow Depth / Clark Level value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
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