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.

F i n a l V e r s i o n o f t h e A m e r i c a n J o i n t C o m m i t t e e o n C a n c e r S t a g i n g S y s t e m f o r C u t a n e o u s M e l a n o m aByMaterials 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. T HE AMERICAN JOINT Committee on Cancer (AJCC)has now formally approved the final version of a revised melanoma staging system, which is described herein, along with operational definitions. The final version is similar to the initial recommendations from the AJCC Melanoma Staging Committee published last year.1 Subsequent to the published recommendations, a number of clinicians made comments and recommendations to members of the AJCC Melanoma Staging Committee. In addition, a major database analysis of prognostic factors involving 17,600 patients from 13 cancer centers and organizations was performed to validate the original proposal.2 Results from the prognostics factors analyses, as well as input from melanoma clinicians, were used by the AJCC Melanoma Staging Committee to make final adjustments to the melanoma staging system, changes that largely impacted the stage grouping criteria. The AJCC Executive Committee has approved the final version of the melanoma staging system. It will become official with publication of the sixth edition of the AJCC Cancer Staging Manual in the year 2002.The AJCC Melanoma Staging Committee used the following guidelines to determine which criteria should be used in the tumor-node-metastasis (TNM) classification and the stage groupings. First, the staging system must be practical, reproducible, and applicable to the diverse needs of all medical disciplines. Second, the criteria must accurately reflect the biology of melanoma based on consistent outcome results of patients treated at multiple institutions from multiple countries. Third, the criteria used must be evidence-based and reflect the dominant prognostic factors cons...