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Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma

Authors
Antonio C Buzaid, MD
Jeffrey E Gershenwald, MD, FACS
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

In order to be useful, a staging system must be simple, practical, and accurately reflect the prognosis of the patients to whom it is being applied. Detailed analyses of large databases of patients presenting with newly diagnosed cutaneous melanoma have allowed the correlation of pathologic and clinical parameters with long-term outcome.

This information is incorporated into a staging system that was originally developed by the American Joint Committee on Cancer (AJCC) subsequently adopted by the International Union for Cancer Control (UICC). This tumor, node, metastasis (TNM) system relies upon assessments of the primary tumor (T), regional lymph nodes (N), and distant metastatic sites (M). The seventh (2010) edition of this staging system is based upon an analysis of over 38,900 patients with cutaneous melanoma from the AJCC Melanoma Staging Database [1,2].

The 2010 TNM staging system and other prognostic factors for cutaneous melanoma are discussed here. The approach to staging is reviewed separately. (See "Staging work-up and surveillance after treatment of melanoma".)

PROGNOSTIC FACTORS AFFECTING STAGING

Primary tumor (T) — The histopathologic factors incorporated into the 2010 TNM staging system are the thickness of the primary tumor (originally described by Breslow [3]), the presence or absence of ulceration of the overlying epithelium, and the mitotic rate [1,2]. The prognostic implications of these parameters were derived from the American Joint Committee on Cancer (AJCC) Melanoma Staging Database, which included over 27,000 patients who had clinically or pathologically localized melanoma (figure 1).

The thickness of the primary tumor (T) defines four categories (table 1):

                              

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 26 00:00:00 GMT+00:00 2016.
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