Melanoma of the Skin

  • American Joint Committee on Cancer

Summary of Changes

Melanoma thickness and ulceration, but not level of invasion, are used in the T category (except for Tl melanomas).

The number of metastatic lymph nodes, rather than their gross dimensions and the delineation of clinical occult (i.e., “microscopic”) vs. clinically apparent (i.e., “macroscopic”) nodal metastases, are used in the N category.

The site of distant metastases and the presence of elevated serum lactic dehydrogenase (LDH) are used in the M category.

All patients with Stage I, II, or III disease are upstaged when a primary melanoma is ulcerated.

Satellite metastases around a primary melanoma and in-transit metastases have been merged into a single staging entity that is grouped into Stage IIIc disease.

A new convention for defining clinical and pathologic staging has been developed that takes into account the new staging information gained from intraoperative lymphatic mapping and sentinel node excision.


Cutaneous Melanoma Primary Melanoma Lymphatic Vessel Invasion Regional Metastasis Desmoplastic Melanoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    NCI Fact Book. Bethesda, MD, National Cancer Institute, 2000Google Scholar
  2. 2.
    Balch C, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, Urist MM, McMasters KM, Ross MI, Kirkwood JM, Atkins MB, Thompson JA, Coit DG, Byrd D, Desmond R, Zhang Y, Liu PY, Lyman GH, Morabito A: Prognostic factors analysis of 17,600 melanoma patients. Validation of the AJCC melanoma staging system. J Clin Oncol, 19:3622–3634, 2001PubMedGoogle Scholar
  3. 3.
    Balch C, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, Fleming ID, Gershenwald JE, Houghton A, Kirkwood JM, McMasters KM, Mihm MF, Morton DL, Reintgen DS, Ross MI, Sober AJ, Thompson JA, Thompson JF: Final version of the AJCC staging system for cutaneous melanoma. J Clin Oncol, 19:3635–3648, 2001PubMedGoogle Scholar
  4. 4.
    Balch CM, Buzaid AC, Atkins MB, et al: A new American Joint Committee on Cancer staging system for cutaneous melanoma. Cancer 88:1484–1491, 2000PubMedCrossRefGoogle Scholar
  5. 5.
    Buzaid AC, Ross MI, Balch CM, et al: Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol 15:1039–1051, 1997PubMedGoogle Scholar
  6. 6.
    Breslow A: Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 172:902–908, 1970PubMedCrossRefGoogle Scholar
  7. 7.
    Breslow A: Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg 182:572–575, 1975PubMedCrossRefGoogle Scholar
  8. 8.
    Balch CM, Murad TM, Soong SJ, et al: A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark’s and Breslow’s staging methods. Ann Surg 188:732–742, 1978PubMedCrossRefGoogle Scholar
  9. 9.
    Balch CM, Wilkerson JA, Murad TM, et al: The prognostic significance of ulceration of cutaneous melanoma. Cancer 45:3012–3017, 1980PubMedCrossRefGoogle Scholar
  10. 10.
    McGovern VJ, Shaw HM, Milton GW, et al: Ulceration and prognosis in cutaneous malignant melanoma. Histopathol-ogy 6:399–407, 1982CrossRefGoogle Scholar
  11. 11.
    Clark WH Jr, From L, Bernardino EA, Mihm MC: The histogenesis and biological behavior of primary human malignant melanoma of the skin. Cancer Research 29:705–727, 1969PubMedGoogle Scholar
  12. 12.
    Breslow A: Problems in the measurement of tumor thickness and level of invasion in cutaneous melanoma. Hum Pathol 8:1–2, 1977PubMedCrossRefGoogle Scholar
  13. 13.
    Breslow A: Tumor thickness in evaluating prognosis of cutaneous melanoma [letter]. Ann Surg 187:440, 1978PubMedCrossRefGoogle Scholar
  14. 14.
    Prade M, Sancho-Garnier H, Cesarini JP, et al: Difficulties encountered in the application of Clark classification and the Breslow thickness measurement in cutaneous malignant melanoma. Int J Cancer 26:159–163, 1980PubMedCrossRefGoogle Scholar
  15. 15.
    Lock-Andersen J, Hou-Jensen K, Hansen JP, et al: Observer variation in histological classification of cutaneous malignant melanoma. Scand J Plast Reconstr Surg Hand Surg 29:141–148, 1995PubMedCrossRefGoogle Scholar
  16. 16.
    Cascinelli N, Bufalino R, Marolda R, et al: Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol 12:175–80, 1986PubMedGoogle Scholar
  17. 17.
    Day CJ, Harrist T, Gorstein F, et al: Malignant melanoma: Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg 194:108–112, 1981PubMedCrossRefGoogle Scholar
  18. 18.
    Eton O, Legha SS, Moon TE, et al: Prognostic factors for survival of patients treated systemically for disseminated melanoma. J Clin Oncol 16:1103–1111, 1998PubMedGoogle Scholar
  19. 19.
    Keilholz U, Conradt C, Legha SS, et al: Results of interleu-kin-2-based treatment in advanced melanoma: A case record-based analysis of 631 patients. J Clin Oncol 16:2921–2929, 1998PubMedGoogle Scholar
  20. 20.
    Deichmann M, Benner A, Bock M, et al: S100-Beta, melanoma-inhibiting activity, and lactate dehydrogenase discriminate progressive from nonprogressive American Joint Committee on Cancer stage IV melanoma. J Clin Oncol 17:1891–1896, 1999PubMedGoogle Scholar
  21. 21.
    Agrawal S, Yao T-J, Coit DG: Surgery for melanoma metastatic to the gastrointestinal tract. Ann Surg Oncol 6:336–344, 1999PubMedCrossRefGoogle Scholar
  22. 22.
    Sirott M, Bajorin D, Wong G, et al: Prognostic factors in patients with metastatic malignant melanoma. A multivariate analysis. Cancer 72:3091–3098, 1993PubMedCrossRefGoogle Scholar
  23. 23.
    Franzke A, Probst-Kepper M, Buer J, et al: Elevated pretreatment serum levels of soluble vascular cell adhesion molecule 1 and lactate dehydrogenase as predictors of survival in cutaneous metastatic malignant melanoma. Brit J Cancer 78:40–45, 1998PubMedCrossRefGoogle Scholar
  24. 24.
    Cascinelli N, Zurrida S, Galimberti V, et al: Acral lentiginous melanoma. A histological type without prognostic significance. J Dermatol Surg Oncol 20:817–822, 1994PubMedCrossRefGoogle Scholar
  25. 25.
    McGovern VJ, Shaw HM, Milton GW, et al: Is malignant melanoma arising in a Hutchinson’s melanotic freckle a separate disease entity? Histopathology 4:235–242, 1980PubMedCrossRefGoogle Scholar
  26. 26.
    Kuchelmeister C, Schaumburg-Lever G, Garbe C: Acral cutaneous melanoma in Caucasians: clinical features, histopathology and prognosis in 112 patients. Br J Dermatol 143:275–280, 2000PubMedCrossRefGoogle Scholar
  27. 27.
    Urist MM, Balch CM, Soong SJ, et al: Head and neck melanoma in 534 clinical Stage I patients. A prognostic factors analysis and results of surgical treatment. Ann Surg 200:769–775, 1984PubMedCrossRefGoogle Scholar
  28. 28.
    Slingluff CL Jr, Vollmer R, Seigier HF: Acral melanoma: a review of 185 patients with identification of prognostic variables. J Surg Oncol 45:91–98, 1990PubMedCrossRefGoogle Scholar
  29. 29.
    Balch CM: Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol 8:400–414, 1992PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • American Joint Committee on Cancer
    • 1
  1. 1.Executive OfficeChicagoUSA

Personalised recommendations