Final Version of 2009 AJCC Melanoma Staging and Classification

Abstract

A B S T R A C T PurposeTo revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database. MethodsThe melanoma staging recommendations were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria. ResultsFindings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm 2 ), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level. ConclusionUsing an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.

Vitronectin and dermcidin serum levels predict the metastatic progression of AJCC I–II early‐stage melanoma

“…LDH as well as S100B serum levels have been correlated with poor prognosis in AJCC stage III–IV melanoma patients3; however, the poor sensitivity and specificity of those markers limit their use in early melanoma patients (AJCC stage I–II). Thus, there are still no prognostic factors that are suitable to use at early stages of tumor development 2, 15.…”

“…Classically, melanoma is divided into four stages according to the American Joint Committee on Cancer (AJCC) classification3: stage I–II involves primary tumors of distinct thickness; stage III is defined by locoregional spread of the disease and stage IV where melanoma cells spread to distant organs (metastasize). Surgical resection of melanoma is the curative treatment in the early stages (stage I–II), yet some high‐risk patients at this stage subsequently develop a fatal metastasis 4…”

Intratumoral neutrophils and plasmacytoid dendritic cells indicate poor prognosis and are associated with pSTAT3 expression in AJCC stage I/II melanoma

“…Before the analysis, we therefore chose as covariates 2 powerful independent prognostic factors in stage I/II melanoma: ulceration and tumor thickness. 23 The independent prognostic importance of immune cell infiltration and pSTAT3 expression by melanoma cells were tested separately. All estimates are presented with 95% confidence limits.…”

Up‐regulated deubiquitinase USP4 plays an oncogenic role in melanoma

“…Recently, some innovative therapies including BRAF/MEK inhibitors and immune checkpoint inhibitors have gained revolutionary advances for the outcome of melanoma patients 1. However, for the most part, the metastatic melanoma remains an incurable disease for its notorious aggressiveness, and the survival rate can be even <20% upon the occurrence of metastasis 3, 4, 5. Therefore, to further clarify the mechanism underlying melanoma pathogenesis is of great importance for improving the efficiency of melanoma therapy and the management of melanoma patients.…”