@article{3108196,
    title = "Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual",
    author = "Gershenwald, J.E. and Scolyer, R.A. and Hess, K.R. and Sondak, V.K. and Long, G.V. and Ross, M.I. and Lazar, A.J. and Faries, M.B. and Kirkwood, J.M. and McArthur, G.A. and Haydu, L.E. and Eggermont, A.M.M. and Flaherty, K.T. and Balch, C.M. and Thompson, J.F. and Atkins, M.B. and Barnhill, R.L. and Bilimoria, K.Y. and Buzaid, A.C. and Byrd, D.R. and Cochran, A.J. and Elder, D.E. and Garbe, C. and Gardner, J.M. and Gimotty, P.A. and Halpern, A.C. and Johnson, T.M. and Lee, A.W.M. and Mihm Jr, M.C. and Prieto, V.G. and Sober, A.J. and Wong, S.L. and Delman, K.A. and Santinami, M. and Maurichi, A. and Nagore, E. and Gyorki, D.E. and Henderson, M. and Stratigos, A.J. and Gogas, H. and Rossi, C.R. and Sommariva, A. and for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform",
    journal = "CA: A Cancer Journal for Clinicians",
    year = "2017",
    volume = "67",
    number = "6",
    pages = "472-492",
    publisher = "Wiley-Blackwell",
    issn = "0007-9235, 1542-4863",
    doi = "10.3322/caac.21409",
    keywords = "lactate dehydrogenase, Article;  cancer classification;  cancer prognosis;  cancer staging;  central nervous system metastasis;  evidence based medicine;  human;  lactate dehydrogenase blood level;  lymph node;  lymph node metastasis;  melanoma;  metastasis;  metastatic melanoma;  microsatellite marker;  mitosis rate;  priority journal;  tumor volume;  ulcer;  cancer staging;  medical society;  melanoma;  pathology;  practice guideline;  register;  Skin Neoplasms;  standards;  United States, Humans;  Lymphatic Metastasis;  Melanoma;  Neoplasm Staging;  Practice Guidelines as Topic;  Registries;  Skin Neoplasms;  Societies, Medical;  United States",
    abstract = "Answer questions and earn CME/CNE. To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society. © 2017 American Cancer Society"
}