What is the most current system for staging melanoma?

The current and preferred staging system for melanoma is that of the American Joint Commission on Cancer (AJCC) from 2009. It is based on the TNM (tumor, lymph node, metastasis) system, which allows the assessment of patients based on the thickness of the primary tumor and whether lymph node or other metastases are present. Staging and survival rates for cutaneous melanoma are summarized in Table 45-1.

Balch CM, Gershenwald JE, Soong SJ, et al: Final version of the 2009 AJCC Melanoma Staging and Classification, J Clin Oncol 27:6199–6206, 2009.

Table 45-1. 2009 AJCC Stage Groupings and 5-Year Survival for Primary Cutaneous Melanoma *
	STAGE		TUMOR		NODE		METASTASES		5-YEAR SURVIVAL
	0		Tis		N0		M0		99.5%–100%
	IA		T1a		N0		M0		97%–99%
	IB		T1b, 2a		N0		M0		90%-92%
	IIA		T2b, 3a		N0		M0		78%–82%
	IIB		T3b, 4a		N0		M0		68%–71%
	IIC		T4b		N0		M0		53%–56%
	IIIA		T1–4a		N1a–2a		M0		78%
	IIIB		T1–4b		N1a–2b		M0		50%–68%
	IIIC		T1–4b		N1b–3		M0		27%–52%
	IV		Any T		Any N		M1a–c		9%–18% †
	* Range reflects the prognostic impact of tumor burden (micrometastasis versus macrometastasis), number of nodes involved, and whether there was extracapsular extension. Patients with in-transit metastases/satellite lesions without metastatic lymph nodes are classified as N2c. † Range reflects the prognostic impact of lung metastasis and/or elevated lactate dehydrogenase (LDH). AJCC, American Joint Committee on Cancer. Data from Greene FL, Page DL, Fleming ID, et al, editors: AJCC cancer staging manual, ed 7, New York, 2009, Springer Verlag.