Analysis of the change in the staging of the T according to the manual of the American Joint Committee on Cancer. How does our patient management change?
Cross-sectional study
DOI:
https://doi.org/10.47196/da.v26i1.2064Keywords:
Melanoma, Staging, Mitotic index, Breslow, AJCCAbstract
Background: In the 8th edition of the cancer staging manual of the American Joint Committee on Cancer (AJCC), important changes were made in the T, N and M categories. When the 8th guideline of the AJCC came into effect, not only was the T stage modified, but also the indication for sentinel lymph node biopsy (SLNB).
The most significant changes in staging included: the exclusion of the mitotic index (MI) as a determinant of the T category and the change of the threshold of tumor thickness to discriminate a T1a (<0.8 mm without ulceration) from a T1b (≥ 0.8 mm).
Objective: To compare the initial staging of thin melanomas according to the criteria used in the 7th edition, with the one that would have been used according to the current AJCC recommendations, with special focus on MI.
Design and methods: Observational, cross-sectional study, carried out through the collection of data from medical records from January 1, 2000 to December 31, 2017.
Results: There were 131 thin melanomas included, 28 of which would have had changes in their staging. When considering the modified threshold for tumor thickness, 22 T1a melanomas would be classified as T1b.Among 20 thin melanomas with a MI ≥1, only 6 had an indication for SLNB solely due to the MI criterion and would be now classified as T1a.Two of these did not undergo SLNB because they rejected the procedure, and in the remaining 4, there were no SLN metastasis.
Conclusions: Nowadays, 28 of our patients would have differences in the indication for SLNB: 22 would be considered to be at greater risk of lymph node metastasis and would be candidates for screening. The other 6 patients would no longer have an indication for this procedure due to the low probability of clinically occult metastases, which seems to concur with the negative result of SLNB in the 4 patients who underwent the procedure.
References
I. The American Cancer Society medical and editorial content team. Key Statistics for Melanoma Skin Cancer. Disponible en http://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html#references. [Consultado octubre 2019]
II. Gershenwald JE, Scolyer RA, Hess KR, et ál. 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.
III. Balch CM, Gershenwald JE, Soong SJ, Thompson JF,et ál. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 2009;27:6199-206.
IV. Faries MB, Thompson JF, Cochran AJ, et ál. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017;376:2211‐2222.
V. Seth R, Messersmith H, Kaur V, et ál. Systemic Therapy for Melanoma: ASCO Guideline [publicado en línea antes de la impresión, 31 de marzo de 2020]. J Clin Oncol 2020; JCO2000198. doi:10.1200/JCO.20.00198.
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