Premium
The history and future of melanoma staging
Author(s) -
Thompson John F.,
Shaw Helen M.,
Hersey Peter,
Scolyer Richard A.
Publication year - 2004
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20082
Subject(s) - medicine , melanoma , cancer staging , stage (stratigraphy) , staging system , ajcc staging system , relevance (law) , adjuvant therapy , clinical trial , cancer , medical physics , oncology , paleontology , cancer research , political science , law , biology
The evolution and progressive refinement of an internationally accepted melanoma staging system over the last 50 years has resulted in much greater accuracy and increased utility, but the staging process has become more complex and less intuitive. This raises the question of whether melanoma staging should continue to develop with ever‐increasing levels of complexity, or whether attempts should be made to produce an alternative system that is simpler and more intuitive. The current, TNM‐based American Joint Committee on Cancer (AJCC) staging system for melanoma incorporates only some of the prognostic factors of proven significance. However, the information that is now available about these and other, well‐documented prognostic factors allows accurate prediction of an individual melanoma patient's prognosis using a computer‐generated estimate. Thus an alternative staging strategy that could be considered in the future would be to use such an estimate to obtain a numerical score for each patient, based on all available information agreed to be of prognostic relevance. A stage grouping could then be assigned on the basis of that score, according to previously determined score ranges for each stage and substage. The advantages of such a system would be that it would allow more reliable comparison of treatment results within and between institutions, and would provide more equivalent stratification groups for patients entering clinical trials of new therapies and those entering adjuvant therapy trials. A further advantage would be that because there would be a direct link between staging and prognostic estimate, such a system would be more readily able to be understood in an intuitive fashion. J. Surg. Oncol. 2004;86:224–235. © 2004 Wiley‐Liss, Inc.