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Staging and Classification of Melanoma

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Melanoma

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Abstract

Cutaneous melanoma is staged according to the TNM-based American Joint Committee of Cancer staging system. Primary tumor thickness (also termed Breslow thickness) and ulceration constitute the T (tumor) category and are important risk factors for survival in both localized and regionally advanced disease. The pathological status of the regional nodal basins is a powerful prognostic factor in cutaneous melanoma and comprises a major component of the N (nodal) category. Sentinel lymph node biopsy is a commonly employed staging technique to assess the status of the clinically negative regional nodal basin and contributes to N category assessment. Non-nodal regional metastases (e.g., satellites, microsatellites, and in-transit metastases) are also components of the N category and along with nodal status constitute stage III disease. Patients with distant (stage IV) disease constitute the M (metastasis) category and are categorized according to the site(s) of distant metastasis: skin/subcutaneous/distant nodal tissue, lung, non-pulmonary/non-CNS visceral, and central nervous system. Serum lactate dehydrogenase level is included in the M category and has been shown to be prognostically significant in patients with stage IV disease. Novel factors that evaluate the immunologic or molecular profile of primary melanoma, metastases, or host may further risk stratify patients beyond classic TNM-based staging. Clinical predictive models that account for multiple clinical and pathological factors may provide a more accurate approach to individualized risk assessment for a given patient and constitute an area of active focus and evolution.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael E. Egger & Jeffrey E. Gershenwald

  2. Department of Surgery, University of Louisville, Louisville, KY, USA

    Michael E. Egger

  3. Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald

  4. Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald

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  1. Michael E. Egger
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Correspondence to Jeffrey E. Gershenwald .

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  1. Louisiana State University, New Orleans, Louisiana, USA

    Adam I. Riker

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Egger, M.E., Gershenwald, J.E. (2018). Staging and Classification of Melanoma. In: Riker, A. (eds) Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-78310-9_5

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