Final version of 2009 AJCC melanoma staging and classification.
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.
Balch
Charles M
CM
Department of Surgery, Oncology and Dermatology, Johns Hopkins Medical Institutions, 600 N. Wolfe St, Osler 624, Baltimore, MD, 21287, USA. balchch@jhmi.edu
Gershenwald
Jeffrey E
JE
Soong
Seng-Jaw
SJ
Thompson
John F
JF
Atkins
Michael B
MB
Byrd
David R
DR
Buzaid
Antonio C
AC
Cochran
Alistair J
AJ
Coit
Daniel G
DG
Ding
Shouluan
S
Eggermont
Alexander M
AM
Flaherty
Keith T
KT
Gimotty
Phyllis A
PA
Kirkwood
John M
JM
McMasters
Kelly M
KM
Mihm
Martin C
MC
Morton
Donald L
DL
Ross
Merrick I
MI
Sober
Arthur J
AJ
Sondak
Vernon K
VK
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