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Dermatopathology: Practical & Conceptual July - September 2002
Flawed Concept: Staging of Melanoma: A Critique in Historical Perspective
Bradley Bakotic, D.O.
A. Bernard Ackerman, M.D.
Systems of Staging in Chronologic Sequence: L.V. Ackerman and Delgato (1947)
American Joint Committee on Cancer (1962–1965)
McNeer and Das Gupta (1964)
M.D. Anderson Cancer Center (1976)
American Joint Committee on Cancer (1977)
Union Internationale Contre Le Cancer (1978)
American Joint Committee on Cancer (1983)
American Joint Committee on Cancer and Union Internationale Contre le Cancer (1988, 1992, 1997)
American Joint Committee on Cancer (2000, 2001)
“Evolution” in Staging is Paralleled by Devolution in Critical Thought
Since the staging of melanoma first was proposed over 55 years ago, numerous methods for accomplishing that desideratum have been published. Exhaustive studies have been undertaken in an attempt to correlate various clinical features and histopathologic findings on one hand with prognosis on the other. With the advent of each new system for staging came new parameters and new ways of interpreting those already in use. Although staging may be worthwhile for permitting analysis statistically of modalities for treatment, some authors have advocated staging as a means of assessing prognosis.
What follows is a review of systems of staging that in little more than half a century have been suggested for melanoma and a critique of those systems for the purpose of illuminating the subject for physicians charged with managing patients in whom that malignant neoplasm of melanocytes came into being.
Prior to addressing the matter of staging of melanoma, it is useful to take note of the definition of "staging" as it is given in
Dorland's Illustrated Medical Dictionary.
The statement reads as follows: "Staging: 1. the determination of distinct phases or periods in the course of a disease, the life history of an organism or any biological process. 2. the classification of neoplasms according to the extent of the tumor."
Despite the striking differences among systems of staging, all of them have in common an attempt to divide metastatic melanoma into distinct phases, that is, stages, based on where metastases have become manifest.
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