ATS Merck CME Newsletter

Charles M. Balch, MD, Professor of Surgery, Oncology and Dermatology, Johns Hopkins Medicine, Baltimore, reviewed the current version of the melanoma staging as well as new data on staging and prognosis contained in the 2008 version of the American Joint Committee on Cancer (AJCC) Melanoma Staging Schema. The final version of the melanoma staging criteria are embargoed until May 2009 and implementation of the new version will not take place officially until January 2010. Therefore, this chapter will include the 6th edition version of melanoma staging as the primary reference and also describe those changes recommended by the Melanoma Staging Committee in 2008. The AJCC Melanoma Task Force used a collaborative database of 17,600 patients to redefine the staging classifications in 2001.1 During the past two years, 49,487 patients with Stages I, II, and III melanoma have been entered into the database to update the staging schema. Dr. Balch noted that 70% of melanoma patients present with T1 melanomas. In predicting survival by tumor thickness, the database shows that for patients with Stage I/II melanoma, those with T1 melanomas (0.01-0.50 mm) have a 10-year melanoma-specific survival rate of 95%, which goes down to 40% for those with T4 melanomas (> 8 mm). The updated staging classification data takes into account the impact of ulceration. In the T classification, the “a” category is nonulcerative melanoma and the “b” cate-