Table 3.
Differences between the previous (2002) and the current (2009) versions of the AJCC melanoma staging system
| Factor | 2002 Criteria | 2009 Criteria | Comments |
|---|---|---|---|
| Thickness | Primary determinant of T staging; thresholds of 1.0,2.0,4.0 mm | Same | Correlation of metastatic risk is a continuous variable |
| Level of invasion | Used only for defining T1 melanomas | No longer used | Clark levels IV or V may be used in rare instances as a criterion for defining T1b melanoma only if mitotic rate cannot be determined in a nonulcerated melanoma |
| Ulceration | Included as a second determinant of T and N staging | Same | Signifies a locally advanced lesion; dominant prognostic factor for grouping Stage I,II and III |
| Mitotic rate per mm2 | Not used | Used for categorizing T1 melanoma | Mitosis ≥ /mm2 used as a primary determinant for defining T1b melanoma |
| Satellite metastases | In N category | Same | Merged with in transit lesions |
| Immunochemical detection of nodal metastases | Not allowed | Allowed | Must include at least one melanoma-specific marker (e.g., HMB-45, Melan-A, MART 1) |
| 0.2 mm threshold of defined N-positive disease | Implied | No lower threshold of staging N-positive disease | |
| Number of Nodal metastases | Dominant determinant of N Staging | Same | Thresholds of 1 vs 2–3 vs. > 4 nodes |
| Metastatic "volume" | Included as a second determinant of N staging | Same | Clinically occult ("microscopic") vs. clinically apparent ("macroscopic") nodal volume |
| Lung metastases | Separate category as M1b | Same | Has a somewhat better prognosis than other visceral metastases |
| Elevated serum LDH | Included as a second determinant of M staging | Same | Recommend a second confirmatory LDH if elevated |
| Clinical vs. pathologic staging | Sentinel node results incorporated into definition of pathologic staging | Large variability in outcome between clinical and pathological staging; sentinel node staging encouraged for standard patient care and should be required prior to entry into clinical trials |
From Balch CM: Melanoma of the Skin. In Edge SB, Byrd DR, Compton CC, et al (eds): AJCC Cancer Staging Manual ed 7th. New York: Springer Verlag, 2009; with permission.