On January 1, the eighth and latest edition of the American Joint Committee on Cancer (AJCC)’s Melanoma Staging System officially went into effect. This highly anticipated periodic updating of the staging guidelines has considerable implications for communication among doctors and patients, selection of treatments and eligibility criteria for clinical trials.
With each iteration of the staging system, the database and analyses from which the guidelines derive have grown in size and intricacy. In the newest melanoma guidelines, the system has undergone multiple changes and increased significantly in complexity. We are therefore very grateful to Drs. Balch and Gershenwald, who have been primary developers and authors of the guidelines, and their coauthors, Drs. Keung and Halpern, for updating us in this issue of The Melanoma Letter. Together, they have prepared a synopsis of the considerable changes in the guidelines and explained the motivations for those changes. They have also presented examples exploring the implications for therapy, with an emphasis on surgical management of regional disease.
Given the centrality of staging in clinical communication and care, it is essential that we familiarize ourselves with the new system. Among the many changes, a few include a new approach to measuring and reporting primary tumor thickness, elimination of mitotic rate and LDH as staging factors (though they remain important prognostic factors) and expansion of N stage categories. Taken together, the changes reveal a lowest risk subset of stage III patients who surprisingly have a better overall prognosis than the highest risk subsets of stage II patients.
This latest reworking of the guidelines seeks to provide more accurate prognostication, inform better treatment decisions and improve the efficiency of clinical trials. These goals can be met only if we, the user community, master the challenges of the new system. We thank the authors for helping us to do so.
Allan C. Halpern, MD • Editor-in-Chief
Ashfaq A. Marghoob, MD • Associate Editor