title: Final version of 2009 AJCC melanoma staging and classification.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Oncology and Dermatology, Johns Hopkins Medical Institutions, 600 N. Wolfe St, Osler 624, Baltimore, MD, 21287, USA. balchch@jhmi.edu
authors.forename: Charles M
authors.initials: CM
authors.lastname: Balch
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Seng-Jaw
authors.initials: SJ
authors.lastname: Soong
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Michael B
authors.initials: MB
authors.lastname: Atkins
authors.forename: David R
authors.initials: DR
authors.lastname: Byrd
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Buzaid
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Cochran
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: Shouluan
authors.initials: S
authors.lastname: Ding
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Keith T
authors.initials: KT
authors.lastname: Flaherty
authors.forename: Phyllis A
authors.initials: PA
authors.lastname: Gimotty
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.forename: Donald L
authors.initials: DL
authors.lastname: Morton
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Sober
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000145:classification* / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards; D012878:Skin Neoplasms / Q000145:classification* / Q000473:pathology; D015996:Survival Rate