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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.
Abstract
Introduction
Systems of Staging in Chronologic Sequence: L.V. Ackerman and Delgato (1947)
Sylven (1949)
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
References
SEE ALSO
-
melanoma
-
metastatic melanoma
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McNeer and Das Gupta (1964)
Stage I. Localized melanoma without metastases to distant or regional lymph nodes
Primary melanoma untreated or removed within 1 month
Locally metastatic or recurrent melanoma
Multiple primary melanomas
Stage II. Metastasis confined to regional lymph nodes
Primary melanoma present with simultaneous metastasis
Primary melanoma controlled with subsequent metastasis
Locally recurrent melanoma with metastasis
Unknown primary with metastasis
Stage III. Disseminated melanoma
Organic [sic] and/or multiple lymphatic metastasis, and/or
Multiple cutaneous and/or subcutaneous metastasis
Although some students of the subject, like Gershenwald
et al.,
7
gave McNeer and Das Gupta credit for having introduced a three-tier system of staging for melanoma, the fact is that the system of McNeer and Das Gupta differed little from the one proposed by Sylven 15 year earlier. Like Sylven, McNeer and Das Gupta used the same basic criteria for each of their three Stages, that is, I—local disease, II—lymph node metastasis, and III—distant metastasis. Moreover, like Sylven, nearby cutaneous metastases (satellite metastases) were said to be indicative of a relatively good prognosis (Stage I).
Subsequently, the AJCC applied the TNM system directly to staging of melanoma. A profound shortcoming of the system as it was utilized for melanoma involved the "T" component of it. For staging of carcinomas, those < 2 cm were designated T1, 2 to < 5 cm T2, and 5 cm or greater T3. Because
in situ
melanoma may expand within surface epithelium for a diameter of several centimeters and still have no potential for metastasis, this system was flawed patently and, therefore, never deserved to be adopted.
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