Final version of the American Joint Committee on Cancer staging system forcutaneous melanoma

Purpose: To revise the staging system for cutaneous melanoma under the ausp ices of the American Joint Committee on Cancer (AJCC). Materials and Methods: The prognostic factors analysis described in the com panion publication (this issue), as well as evidence from the published lit erature, was used to assemble the tumor-node-metastasis criteria and stage grouping for the melanoma staging system. Results: Major changes include (1) melanoma thickness and ulceration but no t level of invasion to be used in the T category (except for T1 melanomas); (2) the number of metastatic lymph nodes rather than their gross dimension s and the delineation of clinically occult (ie, microscopic) versus clinica lly apparent (ie, macroscopic) nodal metastases to be used in the N categor y; (3) the site of distant metastases and the presence of elevated serum la ctic dehydrogenase to be used in the M category; (4) an upstaging of all pa tients with stage I, II, and III disease when a primary melanoma is ulcerat ed; (5) a merging of satellite metastases around a primary melanoma and in- transit metastases into a single staging entity that is grouped into stage III disease; and (6) a new convention for defining clinical and pathologic staging so as to take into account the staging information gained from intr aoperative lymphatic mapping and sentinel node biopsy. Conclusion: This revision will become official with publication of the sixt h edition of the AJCC Cancer Staging Manual in the year 2002. J Clin Oncol 19:3635-3648. (C) 2001 by American Society of Clinical Oncolog y.