Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new dat...

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Published inCA: a cancer journal for clinicians Vol. 67; no. 6; pp. 472 - 492
Main Authors Gershenwald, Jeffrey E., Scolyer, Richard A., Hess, Kenneth R., Sondak, Vernon K., Long, Georgina V., Ross, Merrick I., Lazar, Alexander J., Faries, Mark B., Kirkwood, John M., McArthur, Grant A., Haydu, Lauren E., Eggermont, Alexander M. M., Flaherty, Keith T., Balch, Charles M., Thompson, John F., Atkins, Michael B., Barnhill, Raymond L., Bilimoria, Karl Y., Buzaid, Antonio C., Byrd, David R., Cochran, Alistair J., Elder, David E., Garbe, Claus, Gardner, Julie M., Gimotty, Phyllis A., Halpern, Allan C., Johnson, Timothy M., Lee, Anne W. M., Mihm Jr, Martin C., Prieto, Victor G., Sober, Arthur J., Wong, Sandra L., Delman, Keith A., Santinami, Mario, Maurichi, Andrea, Nagore, Eduardo, Gyorki, David E., Henderson, Michael, Stratigos, Alexander J., Gogas, Helen, Rossi, Carlo Riccardo, Sommariva, Antonio
Format Journal Article
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.11.2017
Subjects
American Joint Committee on Cancer (AJCC)
Cancer
Central nervous system
Clinical trials
Evidence-based medicine
Humans
L-Lactate dehydrogenase
Lactic acid
Lymph nodes
Lymphatic Metastasis
Medical prognosis
Melanoma
Melanoma - epidemiology
Melanoma - pathology
Metastases
Metastasis
Microsatellites
Neoplasm Staging - standards
pathology
Practice Guidelines as Topic
prognosis
Registries
Revisions
Satellites
Skin Neoplasms - epidemiology
Skin Neoplasms - pathology
Societies, Medical
staging
survival
TNM classification
United States - epidemiology
United States > US
pathology
American Joint Committee on Cancer (AJCC)
TNM classification
metastasis
survival
melanoma
prognosis
staging
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Summary:Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8‐1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA‐IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in‐transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor‐involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence‐based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472‐492. © 2017 American Cancer Society.
Bibliography:DISCLOSURES
https://cancerstaging.org/references-tools/deskreferences/Pages/8EUpdates.aspx
and/or the most current printing of the AJCC Cancer Staging Manual, 8th Edition.
The AJCC Melanoma Expert Panel (in alphabetical order): Michael B. Atkins, Charles M. Balch, Raymond L. Barnhill, Karl Y. Bilimoria, Antonio C. Buzaid, David R. Byrd, Alistair J. Cochran, Alexander M. M. Eggermont, David E. Elder, Mark B. Faries, Keith T. Flaherty, Claus Garbe, Julie M. Gardner, Jeffrey E. Gershenwald (Chair), Phyllis A. Gimotty, Allan C. Halpern, Lauren E. Haydu, Kenneth R. Hess, Timothy M. Johnson, John M. Kirkwood, Alexander J. Lazar, Anne W. M. Lee, Georgina V. Long, Grant A. McArthur, Martin C. Mihm, Victor G. Prieto, Merrick I. Ross, Richard A. Scolyer (Vice‐Chair), Arthur J. Sober, Vernon K. Sondak, John F. Thompson, and Sandra L. Wong.
Although the content of this article accurately reflects information in the first printing of the AJCC Cancer Staging Manual, 8th Edition, there have been some subsequent changes. We therefore refer readers interested in this topic to the AJCC web page on 8th Edition Updates and Corrections
The International Melanoma Database and Discovery Platform (in alphabetical order): Keith A. Delman, Mark B. Faries, Jeffrey E. Gershenwald (PI), Helen Gogas, David E. Gyorki, Lauren E. Haydu, Michael Henderson, Andrea Maurichi, Grant A. McArthur, Eduardo Nagore, Carlo Riccardo Rossi, Mario Santinami, Richard A. Scolyer, Antonio Sommariva, Alexander J. Stratigos, and John F. Thompson.
The first 3 authors contributed equally to this study.
This work was supported in part by the National Institutes of Health Specialized Program of Research Excellence (SPORE) Melanoma Grant P50 CA93459 (to The University of Texas MD Anderson Cancer Center); the National Institutes of Health/National Cancer Institute through The University of Texas MD Anderson Cancer Center Support Grant P30CA016672; a Melanoma Research Alliance Team Science Award; the generous philanthropic contributions to The University of Texas MD Anderson Melanoma Moon Shots Program; the Robert and Lynne Grossman Family Foundation; the Michael and Patricia Booker Melanoma Research Endowment; and the National Health and Medical Research Council of Australia, Melanoma Institute Australia, and the Medical Foundation of The University of Sydney. Jeffrey E. Gershenwald reports personal fees from Merck and Castle Biosciences outside the submitted work. Vernon K. Sondak reports personal fees from Merck, Genentech/Roche, Provectus Biopharmaceuticals, Bristol‐Myers Squibb, Novartis, Array, Polynoma, and Pfizer outside the submitted work. Georgina V. Long reports personal fees from Amgen, Bristol‐Myers Squibb, Novartis, Roche, Pierre Fabre, and Array Biopharma outside the submitted work. Merrick I. Ross reports personal fees and travel expenses/honorarium from Amgen and Merck and travel expenses/honorarium from Castle Biosciences, GlaxoSmithKline, and Provectus Biopharmaceuticals outside the submitted work. Mark B. Faries reports grants from the National Institutes of Health and personal fees from Novartis, Castle Biosciences, and Immune Design outside the submitted work. John M. Kirkwood reports grants from Prometheus; grants and personal fees from Merck; and personal fees from Bristol‐Myers Squibb, Novartis, Roche, Genentech, EMD Serono, and Array Biopharma outside the submitted work. Alexander M. M. Eggermont reports personal fees from Actelion, Agenus, Bristol‐Myers Squibb, GlaxoSmithKline, HalioDX, Incyte, ISA Pharmaceuticals, Merck Sharp & Dohme, Nektar, Novartis, Pfizer, and Sanofi outside the submitted work. John F. Thompson reports advisory board membership and honoraria from GlaxoSmithKline, Bristol‐Myers Squibb, and Provectus Pharmaceuticals outside the submitted work. Allan Halpern reports consulting fees from Canfield Scientific, Inc, DermTech, and SciBase; is on the Data and Saftey Monitoring Board for Janssen Research & Development, LLC and Quintiles; and is part of the Scientific Advisory Board of Caliber ID. Martin Mihm reports consulting fees from Novartis, Alnylam, and MelaSciences; and is part of the Advisory Board of Caliber ID and BioCoz. Michael Atkins reports consulting fees from Bristol Myers Squibb, Merck, Novartis, Genentech/Roche, Array, and Arduro. Antonio C. Buzaid reports contracted research and speakers bureau fees from Roche, Bristol‐Myers Squibb, Merck Sharp & Dohme, Pfizer, and Novartis. Helen Gogas reports consulting fees from Bristol‐Myers Squibb, Merck Sharp & Dohme, Roche, Amgen, and Novartis; and grants from Bristol‐Myers Squibb, Roche, Novartis. Alexander J. Stratigos reports consulting fees from LEO Pharma, Novartis, and Roche; and grants from Novartis, Roche. The remaining authors made no disclosures.
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ISSN:0007-9235
1542-4863
DOI:10.3322/caac.21409