Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma
- Antonio C Buzaid, MD
Antonio C Buzaid, MD
- Centro Oncologico Antonio Ermirio de Moraes,
- BP de Sao Paulo, Brazil
- Steering Committee Member,
- Centro Oncológico do Hospital Israelita Albert Einstein,
- Sao Paulo, Brazil
- Jeffrey E Gershenwald, MD, FACS
Jeffrey E Gershenwald, MD, FACS
- Professor of Surgery and Cancer Biology
- The University of Texas MD Anderson Cancer Center
In order to be useful, a staging system must be simple, be 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 developed by the American Joint Committee on Cancer (AJCC) in collaboration with the Union for International 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 was based upon an analysis of over 38,900 patients with cutaneous melanoma from the AJCC Melanoma Staging Database [1,2]. The eighth edition was published at the end of 2016 and will formally go into effect at the beginning of 2018 . Nonetheless, clinicians may use the eighth edition melanoma staging system for patient care beginning in 2017.
The seventh edition AJCC melanoma staging system is presented here, along with key changes that will go into effect in the eighth edition AJCC melanoma staging system. Other significant prognostic factors for cutaneous melanoma are also presented here. The clinical approach to staging a newly diagnosed patient is reviewed separately. (See "Staging work-up and surveillance after treatment of melanoma".)
AJCC TNM STAGING
The tumor, node, metastasis (TNM) staging system is based upon an evaluation of the primary tumor (T), the regional lymph nodes (N), and the presence or absence of distant metastases (M). The information from TNM staging is then combined to classify patients into American Joint Committee on Cancer (AJCC) prognostic stage groups. (See 'Prognostic stage group' below.)
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- AJCC TNM STAGING
- Primary tumor (T)
- - Tumor thickness
- - Ulceration
- - Mitotic rate
- Lymphatic involvement (N)
- - Node classification
- - Microsatellite, satellite, and in transit metastases
- Distant metastases (M)
- PROGNOSTIC STAGE GROUP
- OTHER PROGNOSTIC FACTORS
- Anatomic location
- Pathologic factors
- Mutation status
- Circulating melanoma cells
- Serum S-100 protein
- Gene expression profiling and proteomics
- AMELANOTIC MELANOMA
- MELANOMA WITH UNKNOWN PRIMARY