Implications of the 2009 American Joint Committee on Cancer Melanoma Staging and Classification on Dermatologists and Their Patients

Abstract

The Melanoma Staging and Classification system was recently revised by the American Joint Committee on Cancer (AJCC) and implemented effective January 2010 with changes reflecting new prognostic data gleaned by the significantly larger patient population studied for the 7th edition. This newest analysis yields important long-term outcome data as many of the patients were followed for nearly 2 decades. Additions to edition 7 of the AJCC Melanoma Staging classification highlight several important prognostic factors, particularly the addition of mitotic rate for classifying thin melanomas, the presence of microtumor burden in lymph nodes for stage III disease, and elevated lactate dehydrogenase levels in patients with distant metastatic disease. Although the basic tumor-nodes-metastases (ie, TNM) cancer classification model remains unchanged in this newest edition, the current AJCC Melanoma Staging System has incorporated the latest prognostic data to accurately stratify patients into staging categories. It is important for clinicians and dermatopathologists to familiarize themselves with these changes so that patients are suitably managed and referred to medical and surgical oncologists when appropriate.

Impact of the 2009 (7th Edition) AJCC Melanoma Staging System in the Classification of Thin Cutaneous Melanomas

“…This study corroborates the importance of MR in thin melanomas as a risk factor for SLN metastasis and the role of SLNB in a subset of patients with thin melanomas [16, 22, 34, 41, 42]. All patients with positive SLNB were classified as T1b according to 2001 and 2009 staging systems.…”

Diagnosis and management of melanoma with regional lymph node metastases: a population‐based study in France

“…Although more frequent than ultrasonography, SLNB played a relatively limited role (29%) in the diagnosis of lymph node metastases. This result in France contrasts with data from other countries 4,21,30–32 . Among 3307 patients with regional metastases in the United States and Australia included in the 2009 American Joint Committee on Cancer (AJCC) prognostic study, the vast majority presented with micrometastases identified by SLNB.…”

A tenebrous tale: malignant melanoma of the oesophagus

“…To diagnose PME, there must be no prior history of melanoma 15. The prognosis is better for PME relative to secondary melanoma of the oesophagus 16. Staging is performed with CT TAP, fluorodeoxyglucose PET to detect the presence of locoregional and distant metastasis and MRI where indicated to detect bony or brain metastasis.…”