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A Population-Based Validation of the American Joint Committee on Cancer Melanoma Staging System

From The Melanoma Program of the Abramson Cancer Center of the University of Pennsylvania; Department of Biostatistics and Epidemiology; Department of Medicine; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; and Comprehensive Cancer Center, University of Alabama at Birmingham, AL

Address reprint requests to Phyllis A. Gimotty, PhD, Department of Biostatistics and Epidemiology, 631 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021; e-mail: pgimotty{at}cceb.upenn.edu

PURPOSE: A major revision of the American Joint Committee on Cancer (AJCC) stages for melanoma was implemented in 2002 after its validation in multinational cohorts including patients from cancer centers and cooperative groups. This staging system has not been validated in a US population-based cohort.

PATIENTS AND METHODS: We used 41,417 patients with primary invasive cutaneous melanoma diagnosed between 1988 and 2001 from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry to validate the revised AJCC staging system. Survival rates computed from stage-specific Kaplan-Meier curves (time to melanoma-specific death) were compared with the survival rates from 17,600 patients in the original AJCC validation study.

RESULTS: In the SEER cohort, 65% of reported melanomas were 1.00 mm in thickness and 8.7% were more than 4.00 mm compared with 39% and 10% in the AJCC cohort (P < .001), respectively. AJCC stages were able to discriminate among SEER patient groups with different prognosis. However, SEER survival rates were significantly higher than those in the AJCC study and notably so in patients with T1a lesions ( 1 mm without ulceration). This population-specific effect remained significant after controlling for lesion thickness in all substages except stage IIA.

CONCLUSION: Although this national population-based study validates the most recent revision of AJCC stages for melanoma, it emphasizes that survival rates are population specific and found them to be generally higher for SEER compared with AJCC patients. Population-specific survival rates should be used in study designs and decisions about patient-specific interventions.

Supported in part by Grant No. CA-093372 (M. Herlyn, principal investigator), SPORE on Skin Cancer.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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