Update on the melanoma staging system: The importance of sentinel node staging and primary tumor mitotic rate
- 19 August 2011
- journal article
- review article
- Published by Wiley in Journal of Surgical Oncology
- Vol. 104 (4), 379-385
- https://doi.org/10.1002/jso.21876
Abstract
The 7th Edition of the AJCC Staging Manual includes a detailed summary of melanoma staging and prognosis. The revisions are summarized in this article, along with details on two key aspects of melanoma staging: the incorporation of mitotic rate of the primary melanoma and the key role of the sentinel lymph node biopsy (SLNB) in determining accurate staging for clinically occult nodal metastases. Primary tumor mitotic rate was introduced as a major criterion for melanoma staging and prognosis that replaces the Clark's level of invasion, and is now proven to be an important independent adverse predictor of survival. Analysis of the AJCC melanoma staging database demonstrated a significant inverse correlation between primary tumor mitotic rate (histologically defined as mitoses/mm2) and survival. The use of SLNB reliably identifies melanoma patients with nodal micrometastases, enabling clinicians to identify patients with occult nodal metastases that would otherwise take months or years to become clinically palpable The number of nodal metastases was the most significant independent predictor of survival among all patients with stage III disease, including among patients with nodal micrometastases, and continues to be a primary criterion for defining Stage III melanoma. A clinical scoring system model and multivariate predictive tool under the auspices of the AJCC has led to a first-generation web-based predictive tool (www.melanomaprognosis.org). J. Surg. Oncol. 2011; 104:379–385.This publication has 29 references indexed in Scilit:
- Prognostic Significance of Mitotic Rate in Localized Primary Cutaneous Melanoma: An Analysis of Patients in the Multi-Institutional American Joint Committee on Cancer Melanoma Staging DatabaseJournal of Clinical Oncology, 2011
- The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I)Annals of Surgical Oncology, 2010
- Multivariate Analysis of Prognostic Factors Among 2,313 Patients With Stage III Melanoma: Comparison of Nodal Micrometastases Versus MacrometastasesJournal of Clinical Oncology, 2010
- Predicting Survival Outcome of Localized Melanoma: An Electronic Prediction Tool Based on the AJCC Melanoma DatabaseAnnals of Surgical Oncology, 2010
- Predictors of Occult Nodal Metastasis in Patients With Thin MelanomaArchives of Surgery, 2010
- Final Version of 2009 AJCC Melanoma Staging and ClassificationJournal of Clinical Oncology, 2009
- Targeted High-Resolution Ultrasound Is Not an Effective Substitute for Sentinel Lymph Node Biopsy in Patients With Primary Cutaneous MelanomaJournal of Clinical Oncology, 2009
- Method of biopsy and incidence of positive margins in primary melanoma.Annals of Surgical Oncology, 2007
- Sentinel-Node Biopsy or Nodal Observation in MelanomaNew England Journal of Medicine, 2006
- Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?Annals of Oncology, 2006