Final version of 2009 AJCC melanoma staging and classification
- PMID: 19917835
- PMCID: PMC2793035
- DOI: 10.1200/JCO.2009.23.4799
Final version of 2009 AJCC melanoma staging and classification
Abstract
Purpose: To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database.
Methods: The 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.
Results: Findings 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.
Conclusion: Using 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.
Conflict of interest statement
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
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Comment in
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Some of the 2009 American Joint Committee on Cancer melanoma staging and classification is not evidence based.J Clin Oncol. 2010 Sep 20;28(27):e479; author reply e480-1. doi: 10.1200/JCO.2010.28.2194. Epub 2010 Jun 21. J Clin Oncol. 2010. PMID: 20566996 No abstract available.
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Melanoma staging: implications of histologic sectioning procedures.J Clin Oncol. 2011 Oct 10;29(29):3943-4. doi: 10.1200/JCO.2011.37.5188. Epub 2011 Sep 6. J Clin Oncol. 2011. PMID: 21900101 No abstract available.
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Mitotic figures and the evolving staging of melanoma.J Cutan Pathol. 2017 Apr;44(4):358-359. doi: 10.1111/cup.12913. Epub 2017 Feb 14. J Cutan Pathol. 2017. PMID: 28116802 No abstract available.
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