Cytopathology Fellow Alexandra Balaban, MD, Dermatopathology Fellow Kasey McCollum, MD, MPH, and Associate Professor of Dermatology and Pathology Rami-Al-Rohil, MBBS, have published a paper titled “A Proposed Staging Model That Outperforms the American Joint Committee on Cancer Eighth Edition Staging System” in the October 2024 edition of The American Journal of Surgical Pathology (AJCC).
The paper proposes a new staging system for stage-3 melanoma that does not rely on information from the complete lymph node dissection (CLND), a procedure that is optional due to National Comprehensive Cancer Network guidelines. Foregoing a CLND spares patients numerous comorbidities such as infection, lingering pain, and nerve dysfunction. However, without information from the CLND, a subset of patients would be under-staged, potentially leading to suboptimal adjuvant therapy, clinical care, and prognostication.
Their model eliminates the need for a CLND for accurate prognostication. It also performs at least as well as the current staging system for predicting melanoma-specific survival if information from a complete lymph node dissection is present, and better than the current AJCC eighth edition staging system if information from the complete lymph node dissection is absent. The model performs better than the AJCC eighth edition staging system for predicting metastasis-free, and locoregional- and distant-metastasis-free survival, regardless of whether information from the complete lymph node dissection is included. Read the paper here.