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Review
. 2011 Jan;20(1):1-17.
doi: 10.1016/j.soc.2010.09.007.

Staging and prognosis of cutaneous melanoma

Paxton V Dickson  1 , Jeffrey E Gershenwald
Affiliations
Review

Staging and prognosis of cutaneous melanoma

Paxton V Dickson et al. Surg Oncol Clin N Am. 2011 Jan.

Abstract

Staging of cutaneous melanoma continues to evolve through identification and rigorous analysis of potential prognostic factors. In 1998, the American Joint Committee on Cancer (AJCC) Melanoma Staging Committee developed the AJCC melanoma staging database, an international integrated compilation of prospectively accumulated melanoma outcome data from several centers and clinical trial cooperative groups. Analysis of this database resulted in major revisions to the TNM staging system reflected in the sixth edition of the AJCC Cancer Staging Manual published in 2002. More recently, the committee's analysis of an updated melanoma staging database, including prospective data on more than 50,000 patients, led to staging revisions adopted in the seventh edition of the AJCC Cancer Staging Manual published in 2009. This article highlights these revisions, reviews relevant prognostic factors and their impact on staging, and discusses emerging tools that will likely affect future staging systems and clinical practice.

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Figures

Figure 1
Figure 1
Survival curves from the 7th edition American Joint Committee on Cancer melanoma staging database comparing (A) the different T categories and (B) the stage groupings for stages I and II melanoma. Note that survival outcomes for patients with ulcerated tumors were remarkably similar to those of patients with nonulcerated tumors of the next highest T category. For patients with stage III disease, survival curves are shown comparing (C) the different N categories and (D) the stage groupings. Note in particular the marked heterogeneity in survival among these patients with stage III disease. From Balch CM, Gershenwald JE, Soong S, et al, Journal of Clinical Oncology 27(36): 6199-206, 2009; with permission.
Figure 2
Figure 2
Survival curves of 7,635 patients with metastatic melanoma at distant sites (stage IV) subgrouped by (A) the site of metastatic disease and (B) serum lactate dehydrogenase (LDH) levels. LDH values are not used to stratify patients. Curves in (A) are based only on site of metastasis. The number of patients is shown in parentheses. SQ, subcutaneous. From Balch CM, Gershenwald JE, Soong S, et al, Journal of Clinical Oncology 27(36): 6199-206, 2009, with permission.
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References

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