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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
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melanoma
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metastatic melanoma
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American Joint Committee on Cancer (1983)
Five years after the UICC system was proclaimed, the AJCC proposed a revision of its own system for staging melanoma.
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A major change was moving patients with in-transit metastases to a higher stage (III/IV), thereby endowing that phenomenon with a worse prognosis than had been attributed to it before. In prior systems, in-transit metastases were assigned to Stage I or II, the implication of that being rather favorable prognosis. The revised system of the AJCC was constructed in this way:
Stage IA. Localized melanoma <0.75 mm thick or < level II
Stage IB. Localized melanoma >0.75 to 1.50 mm thick or level III
Stage IIA. Localized melanoma >1.50 to 4.00 mm thick or level IV
Stage IIB. Localized melanoma >4.00 mm thick or level V
Stage III. Lymph node metastases to one regional basin or < 5 mm in-transit metastases without nodal disease
Stage IV. Advanced regional disease (defined as more than one regional lymph node basin, regional lymph nodes > 5 mm or fixed, > 5 mm in-transit metastases at least 2 cm from the primary lesion) or any distant metastasis
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