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Review
. 2020 Sep 1;112(9):875-885.
doi: 10.1093/jnci/djaa012.

Clinicopathological Features, Staging, and Current Approaches to Treatment in High-Risk Resectable Melanoma

Emily Z Keung  1 , Jeffrey E Gershenwald  1   2   3
Affiliations
Review

Clinicopathological Features, Staging, and Current Approaches to Treatment in High-Risk Resectable Melanoma

Emily Z Keung et al. J Natl Cancer Inst. .

Abstract

The incidence of melanoma in the United States has been increasing over the past several decades. Prognosis largely depends on disease stage, with 5-year melanoma-specific survival ranging from as high as 99% in patients with stage I disease to less than 10% for some patients with stage IV (distant metastatic) disease. Fortunately, in the last 5-10 years, there have been remarkable treatment advances for patients with high-risk resectable melanoma, including approval of targeted and immune checkpoint blockade therapies. In addition, results of recent clinical trials have confirmed the importance of sentinel lymph node biopsy and continue to refine the approach to regional lymph node basin management. Lastly, the melanoma staging system was revised in the eighth edition AJCC Cancer Staging Manual, which was implemented on January 1, 2018. Here we discuss these changes and the clinicopathological features that confer high risk for locoregional and distant disease relapse and poor survival. Implications regarding the management of melanoma in the metastatic and adjuvant settings are discussed, as are future directions for neoadjuvant therapies.

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Figures

Figure 1.
Figure 1.
AJCC 8th edition pathological prognostic groups (TNM) for stage I to III cutaneous melanoma*†. NX = Regional nodes not assessed (eg, SLN biopsy not performed, regional nodes previously removed for another reason); SLN = sentinel lymph node; T0 = no evidence of primary tumor (eg, unknown primary or completely regressed melanoma); Tis = melanoma in situ; TX = thickness cannot be assessed. Exception: pathological N category is not required for T1 melanomas, use cN. *Pathological stage is IV for any T, any N, and M1 disease. †Adapted and used with permission of the American Joint Committee on Cancer (AJCC), Chicago, IL. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing (Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma of the skin. In: Amin AB, Edge SB, Greene, FL, et al. eds. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017:563–585).
Figure 2.
Figure 2.
Melanoma-specific survival (MSS) according to T subcategory and mitotic rate (MR) for patients with stage I and II melanoma and according to stage I–III subgroups from the eighth edition International Melanoma Database.* MSS according to (A) T subcategory and (B) MR for patients with stage I and II melanoma, and according to (C) stage I–II subgroup and (D) stage III subgroup. *Adapted and used with permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition Cancer Staging Manual. CA Cancer J Clin. 2017; 67:472–492. 2017 John Wiley & Sons, Inc.
Figure 3.
Figure 3.
Melanoma-specific survival according to presence of in-transit or satellite disease from the eighth edition International Melanoma Database.* *Adapted and used with permission from Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition Cancer Staging Manual. CA Cancer J Clin. 2017; 67:472–492. 2017 John Wiley & Sons, Inc.
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