Open AccessModifying the criteria of the American Joint Commission on Cancer staging system in melanoma
Author(s) -
Merrick Ross
Publication year - 1998
Publication title -
current opinion in oncology/current opinion in oncology, with cancerlit
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 95
eISSN - 1080-8140
pISSN - 1040-8746
DOI - 10.1097/00001622-199803000-00013
Subject(s) - medicine , melanoma , stage (stratigraphy) , staging system , cancer staging , lymph node , adjuvant therapy , lymph , cancer , oncology , neoplasm staging , radiology , surgery , pathology , cancer research , paleontology , biology
The currently used staging system in melanoma has not been significantly modified since 1988. While this four-stage system effectively stratifies patients into prognostic groups, additional discriminating criteria have been reported that is not presently incorporated in the staging system. The following additions and modifications are suggested based on a review of the recent literature: 1) for stage I and II patients, Clark's level of invasion is only predictive in patients with melanomas less than 1 mm, the best statistical fit for tumor thickness cutoffs are less than 1 mm, 1 to 2 mm, 2 to 4 mm, and greater than 4 mm, and ulceration should be included as part of the staging system; 2) in stage III patients, the presently used criteria of 3 cm in size needs to abandoned and replaced by the number of lymph nodes involved and the number of lymph node basins involved; and 3) local recurrence presenting as local metastases and satellite disease represent a biologic continuum of regional lymphatic dissemination and should both be classified in the stage III prognostic groups. These modifications, if accepted, should provide the ability to better stratify patients for future adjuvant therapy trials.