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Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma

From the Johns Hopkins Medical Institutions, Baltimore, MD; American Society of Clinical Oncology, Alexandria, VA; Hospital Sirio Libanes, San Paulo, Brazil; University of Alabama at Birmingham, Birmingham, AL; Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA; Istituto Nazionale Tumori and World Health Organization Melanoma Program, Milan, Italy; Memorial Sloan-Kettering Cancer Center, New York, NY; Methodist Hospital Cancer Center, Memphis, TN; University of Texas, M.D. Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of Louisville Medical Center, Louisville, KY; John Wayne Cancer Institute, Santa Monica, CA; H. Lee Moffit Cancer Center, University of South Florida, Tampa, FL; University of Washington Medical Center, Seattle, WA; and Sydney Melanoma Unit, University of Sydney, Sydney, New South Wales, Australia.

Address reprint requests to Charles M. Balch, MD, American Society of Clinical Oncology, 1900 Duke St, Ste 200, Alexandria, VA 22314; email: balchc{at}asco.org

PURPOSE: To revise the staging system for cutaneous melanoma under the auspices of the American Joint Committee on Cancer (AJCC).

MATERIALS AND METHODS: The prognostic factors analysis described in the companion publication (this issue), as well as evidence from the published literature, was used to assemble the tumor-node-metastasis criteria and stage grouping for the melanoma staging system.

RESULTS: Major changes include (1) melanoma thickness and ulceration but not level of invasion to be used in the T category (except for T1 melanomas); (2) the number of metastatic lymph nodes rather than their gross dimensions and the delineation of clinically occult (ie, microscopic) versus clinically apparent (ie, macroscopic) nodal metastases to be used in the N category; (3) the site of distant metastases and the presence of elevated serum lactic dehydrogenase to be used in the M category; (4) an upstaging of all patients with stage I, II, and III disease when a primary melanoma is ulcerated; (5) a merging of satellite metastases around a primary melanoma and in-transit metastases into a single staging entity that is grouped into stage III disease; and (6) a new convention for defining clinical and pathologic staging so as to take into account the staging information gained from intraoperative lymphatic mapping and sentinel node biopsy.

CONCLUSION: This revision will become official with publication of the sixth edition of the AJCC Cancer Staging Manual in the year 2002.

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				E de Vries, S Houterman, M. Janssen-Heijnen, T Nijsten, S. van de Schans, A. Eggermont, and J. Coebergh Up-to-date survival estimates and historical trends of cutaneous malignant melanoma in the south-east of The Netherlands Ann. Onc., June 1, 2007; 18(6): 1110 - 1116. [Abstract] [Full Text] [PDF]

				G. C. Karakousis, P. A. Gimotty, B. J. Czerniecki, D. E. Elder, R. Elenitsas, M. E. Ming, D. L. Fraker, D. Guerry, and F. R. Spitz Regional Nodal Metastatic Disease Is the Strongest Predictor of Survival in Patients with Thin Vertical Growth Phase Melanomas: A Case for SLN Staging Biopsy in These Patients Ann. Surg. Oncol., May 1, 2007; 14(5): 1596 - 1603. [Abstract] [Full Text] [PDF]

				T. G. Zogakis, R. Essner, H.-j. Wang, L. J. Foshag, and D. L. Morton Natural History of Melanoma in 773 Patients with Tumor-Negative Sentinel Lymph Nodes Ann. Surg. Oncol., May 1, 2007; 14(5): 1604 - 1611. [Abstract] [Full Text] [PDF]

				H. Schmidt, S. Suciu, C. J.A. Punt, M. Gore, W. Kruit, P. Patel, D. Lienard, H. von der Maase, A. M.M. Eggermont, and U. Keilholz Pretreatment Levels of Peripheral Neutrophils and Leukocytes As Independent Predictors of Overall Survival in Patients With American Joint Committee on Cancer Stage IV Melanoma: Results of the EORTC 18951 Biochemotherapy Trial J. Clin. Oncol., April 20, 2007; 25(12): 1562 - 1569. [Abstract] [Full Text] [PDF]

				M. L. Pennie, S. L. Soon, J. B. Risser, E. Veledar, S. D. Culler, and S. C. Chen Melanoma Outcomes for Medicare Patients: Association of Stage and Survival With Detection by a Dermatologist vs a Nondermatologist Arch Dermatol, April 1, 2007; 143(4): 488 - 494. [Abstract] [Full Text] [PDF]

				S. N. Markovic, L. A. Erickson, R. D. Rao, R. H. Weenig, B. A. Pockaj, A. Bardia, C. M. Vachon, S. E. Schild, R. R. McWilliams, J. L. Hand, et al. Malignant Melanoma in the 21st Century, Part 2: Staging, Prognosis, and Treatment Mayo Clin. Proc., April 1, 2007; 82(4): 490 - 513. [Abstract] [Full Text] [PDF]

				P. A. Gimotty, D. E. Elder, D. L. Fraker, J. Botbyl, K. Sellers, R. Elenitsas, M. E. Ming, L. Schuchter, F. R. Spitz, B. J. Czerniecki, et al. Identification of High-Risk Patients Among Those Diagnosed With Thin Cutaneous Melanomas J. Clin. Oncol., March 20, 2007; 25(9): 1129 - 1134. [Abstract] [Full Text] [PDF]

				V. H. Stell, H. J. Norton, K. S. Smith, J. C. Salo, and R. L. White Jr. Method of Biopsy and Incidence of Positive Margins in Primary Melanoma Ann. Surg. Oncol., February 1, 2007; 14(2): 893 - 898. [Abstract] [Full Text] [PDF]

				J. F. Thompson, F. S. Hodi, and A. Zembowicz Case 2-2007 -- A 49-Year-Old Woman with a Pigmented Lesion on the Arm N. Engl. J. Med., January 18, 2007; 356(3): 285 - 292. [Full Text] [PDF]

				A. J. Hayes, S. J. Neuhaus, M. A. Clark, and J. M. Thomas Isolated Limb Perfusion With Melphalan and Tumor Necrosis Factor {alpha} for Advanced Melanoma and Soft-Tissue Sarcoma Ann. Surg. Oncol., January 1, 2007; 14(1): 230 - 238. [Abstract] [Full Text] [PDF]

				E. Losina, R. P. Walensky, A. Geller, F. C. Beddingfield III, L. L. Wolf, B. A. Gilchrest, and K. A. Freedberg Visual Screening for Malignant Melanoma: A Cost-effectiveness Analysis Arch Dermatol, January 1, 2007; 143(1): 21 - 28. [Abstract] [Full Text] [PDF]

				S. M. Swetter, S. Soon, C. R. Harrington, and S. C. Chen Effect of Health Care Delivery Models on Melanoma Thickness and Stage in a University-Based Referral Center: An Observational Pilot Study Arch Dermatol, January 1, 2007; 143(1): 30 - 36. [Abstract] [Full Text] [PDF]

				M. Pashenkov, G. Goess, C. Wagner, M. Hormann, T. Jandl, A. Moser, C. M. Britten, J. Smolle, S. Koller, C. Mauch, et al. Phase II Trial of a Toll-Like Receptor 9-Activating Oligonucleotide in Patients With Metastatic Melanoma J. Clin. Oncol., December 20, 2006; 24(36): 5716 - 5724. [Abstract] [Full Text] [PDF]

				C. Li, Z. Hu, Z. Liu, L.-E Wang, S. S. Strom, J. E. Gershenwald, J. E. Lee, M. I. Ross, P. F. Mansfield, J. N. Cormier, et al. Polymorphisms in the DNA Repair Genes XPC, XPD, and XPG and Risk of Cutaneous Melanoma: a Case-Control Analysis Cancer Epidemiol. Biomarkers Prev., December 1, 2006; 15(12): 2526 - 2532. [Abstract] [Full Text] [PDF]

				Z. I. Nowecki, P. Rutkowski, A. Nasierowska-Guttmejer, and W. Ruka Survival Analysis and Clinicopathological Factors Associated With False-Negative Sentinel Lymph Node Biopsy Findings in Patients with Cutaneous Melanoma Ann. Surg. Oncol., December 1, 2006; 13(12): 1655 - 1663. [Abstract] [Full Text] [PDF]

				D. Becker, M. C. Mihm, S. M. Hewitt, V. K. Sondak, J. W. Fountain, and M. Thurin Markers and Tissue Resources for Melanoma: Meeting Report. Cancer Res., November 15, 2006; 66(22): 10652 - 10657. [Abstract] [Full Text] [PDF]

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				J. Rangel, S. Torabian, L. Shaikh, M. Nosrati, F. L. Baehner, C. Haqq, S. P.L. Leong, J. R. Miller III, R. W. Sagebiel, and M. Kashani-Sabet Prognostic Significance of Nuclear Receptor Coactivator-3 Overexpression in Primary Cutaneous Melanoma J. Clin. Oncol., October 1, 2006; 24(28): 4565 - 4569. [Abstract] [Full Text] [PDF]

				D. L. Morton, J. F. Thompson, A. J. Cochran, N. Mozzillo, R. Elashoff, R. Essner, O. E. Nieweg, D. F. Roses, H. J. Hoekstra, C. P. Karakousis, et al. Sentinel-node biopsy or nodal observation in melanoma. N. Engl. J. Med., September 28, 2006; 355(13): 1307 - 1317. [Abstract] [Full Text] [PDF]

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				K. Gao, D. L. Dai, M. Martinka, and G. Li Prognostic Significance of Nuclear Factor-{kappa}B p105/p50 in Human Melanoma and Its Role in Cell Migration. Cancer Res., September 1, 2006; 66(17): 8382 - 8388. [Abstract] [Full Text] [PDF]

				C. Li, Z. Liu, L.-E Wang, S. S. Strom, J. E. Lee, J. E. Gershenwald, M. I. Ross, P. F. Mansfield, J. N. Cormier, V. G. Prieto, et al. Genetic variants of the ADPRT, XRCC1 and APE1 genes and risk of cutaneous melanoma Carcinogenesis, September 1, 2006; 27(9): 1894 - 1901. [Abstract] [Full Text] [PDF]

				J. A. Campillo, J. A. Martinez-Escribano, M. R. Moya-Quiles, L. A. Marin, M. Muro, N. Guerra, A. Parrado, M. Campos, J. F. Frias, A. Minguela, et al. Natural Killer Receptors on CD8 T Cells and Natural Killer Cells from Different HLA-C Phenotypes in Melanoma Patients. Clin. Cancer Res., August 15, 2006; 12(16): 4822 - 4831. [Abstract] [Full Text] [PDF]

				M. S. Brady, K. Brown, A. Patel, C. Fisher, and W. Marx A Phase II Trial of Isolated Limb Infusion With Melphalan and Dactinomycin for Regional Melanoma and Soft Tissue Sarcoma of the Extremity Ann. Surg. Oncol., August 1, 2006; 13(8): 1123 - 1129. [Abstract] [Full Text] [PDF]