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Review
. 2018 Aug;18(8):775-784.
doi: 10.1080/14737140.2018.1489246.

The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care

Emily Z Keung  1 , Jeffrey E Gershenwald  1   2
Affiliations
Review

The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care

Emily Z Keung et al. Expert Rev Anticancer Ther. 2018 Aug.

Abstract

The eighth edition of the American Joint Committee on Cancer (AJCC) melanoma staging system was implemented in the United States on 1 January 2018. Areas covered: This article provides an overview of important changes in the eighth edition AJCC staging system from the seventh edition based on analyses of a large international melanoma database. The clinical implications of these changes for melanoma treatment are also discussed. Expert commentary: A standardized and contemporary cancer staging system that facilitates accurate risk stratification is essential to guide patient treatment. The eighth edition of the AJCC staging system is currently the most widely accepted approach to melanoma staging and classification at initial diagnosis.

Keywords: AJCC; American Joint Committee on Cancer; Melanoma; TNM; eighth edition; prognosis; staging.

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Conflict of interest statement

Declaration of interest

JE Gershenwald has served on advisory boards for Merck, Syndax, and Castle Biosciences, unrelated to the content of this article. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Comparison of AJCC seventh edition and AJCC eighth edition staging systems: melanoma-specific survival of patients with stage I and II melanoma by T subcategory. All patients with T1N0 melanoma were included. Patients with T2 to T4 melanoma were included only if they had negative sentinel lymph nodes. aWith permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:472–491.bWith permission from Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–6206.
Figure 2.
Figure 2.
Melanoma-specific survival by (A, B) N categories and (C) presence or absence of microsatellites, satellites, and/or in-transit metastases. With permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:472–491.
Figure 3.
Figure 3.
Comparison of AJCC seventh edition and AJCC eighth edition staging systems: melanoma-specific survival of patients by stage I and II subgroups. aWith permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:472–491.bWith permission from Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–6206.
Figure 4.
Figure 4.
Comparison of AJCC seventh edition and AJCC eighth edition staging systems: melanoma-specific survival of patients by stage III subgroups. aWith permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:472–491.bWith permission from Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–6206.
Figure 5.
Figure 5.
AJCC eighth edition pathological prognostic groups (TNM) for stage I to IV cutaneous melanoma. T0 – no evidence of primary tumor (e.g. unknown primary or completely regressed melanoma); Tis – melanoma in situ; TX – thickness cannot be assessed; NX – Regional nodes not assessed (e.g. SLN biopsy not performed, regional nodes previously removed for another reason). Exception: pathological N category is not required for T1 melanoma, use cN. *Pathological stage is IV for Any T, any N and M1 disease. aAdapted and used with permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:472–491.
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