Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Jeffrey E Gershenwald; Richard A Scolyer; Kenneth R Hess; Vernon K Sondak; Georgina V Long; Merrick I Ross; Alexander J Lazar; Mark B Faries; John M Kirkwood; Grant A McArthur; Lauren E Haydu; Alexander M M Eggermont; Keith T Flaherty; Charles M Balch; John F Thompson; for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform

doi:10.3322/caac.21409

Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

CA Cancer J Clin. 2017 Nov;67(6):472-492. doi: 10.3322/caac.21409. Epub 2017 Oct 13.

Authors

Jeffrey E Gershenwald¹, Richard A Scolyer^{2

3}, Kenneth R Hess⁴, Vernon K Sondak⁵, Georgina V Long⁶, Merrick I Ross⁷, Alexander J Lazar⁸, Mark B Faries⁹, John M Kirkwood¹⁰, Grant A McArthur¹¹, Lauren E Haydu¹², Alexander M M Eggermont¹³, Keith T Flaherty¹⁴, Charles M Balch¹⁵, John F Thompson¹⁶; for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform

Collaborators

for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform:
Jeffrey E Gershenwald, Richard A Scolyer, Michael B Atkins, Charles M Balch, Raymond L Barnhill, Karl Y Bilimoria, Antonio C Buzaid, David R Byrd, Alistair J Cochran, Alexander M M Eggermont, David E Elder, Mark B Faries, Keith T Flaherty, Claus Garbe, Julie M Gardner, Phyllis A Gimotty, Allan C Halpern, Lauren E Haydu, Kenneth R Hess, Timothy M Johnson, John M Kirkwood, Alexander J Lazar, Anne W M Lee, Georgina V Long, Grant A McArthur, Martin C Mihm Jr, Victor G Prieto, Merrick I Ross, Arthur J Sober, Vernon K Sondak, John F Thompson, Sandra L Wong, Keith A Delman, Mario Santinami, Andrea Maurichi, Eduardo Nagore, Mark B Faries, John F Thompson, Richard A Scolyer, Grant A McArthur, David E Gyorki, Michael Henderson, Alexander J Stratigos, Helen Gogas, Jeffrey E Gershenwald, Lauren E Haydu, Carlo Riccardo Rossi, Antonio Sommariva

Affiliations

¹ Professor of Surgery and Cancer Biology, Department of Surgical Oncology; Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX.
² Conjoint Medical Director, Melanoma Institute Australia; Clinical Professor, The University of Sydney, Sydney, New South Wales, Australia.
³ Senior Staff Pathologist, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁴ Professor, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁵ Chair, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL.
⁶ Conjoint Medical Director and Chair of Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁷ Professor of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁸ Professor of Pathology, Dermatology, and Translational Molecular Pathology; Director, Melanoma Molecular Diagnostics, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁹ Co-Director, Melanoma Program; Head, Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA.
¹⁰ Professor of Medicine, Dermatology, and Translational Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA.
¹¹ Executive Director, Victorian Comprehensive Cancer Center, Melbourne, Victoria, Australia.
¹² Manager, Clinical Data Management Systems, The University of Texas MD Anderson Cancer Center, Houston, TX.
¹³ Director General, Gustave Roussy Cancer Institute, Villejuif, France.
¹⁴ Director, Termeer Center for Targeted Therapy, Massachusetts General Hospital Cancer Center, Boston, MA.
¹⁵ Professor of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
¹⁶ Professor of Melanoma and Surgical Oncology, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Abstract

Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.

Keywords: American Joint Committee on Cancer (AJCC); TNM classification; melanoma; metastasis; pathology; prognosis; staging; survival.

MeSH terms

Humans
Lymphatic Metastasis
Melanoma / epidemiology
Melanoma / pathology*
Neoplasm Staging / standards*
Practice Guidelines as Topic
Registries
Skin Neoplasms / epidemiology
Skin Neoplasms / pathology*
Societies, Medical
United States / epidemiology

Abstract

MeSH terms

Grants and funding