ASO Author Reflections: Extracapsular Spread in Melanoma Lymphadenopathy: Prognostic Implications, Classification, and Management

Excerpt

The current American Joint Committee on Cancer (AJCC) classification system for stage III cutaneous melanoma is heterogeneous, with 5-year melanoma-specific survival rates ranging from 88% for stage IIIA disease to 24% for stage IIID disease. Currently, the stage III classification not only incorporates data from the N stage, but also qualifies T data from the primary tumour such as Breslow thickness and ulceration status. This takes into account the fact that the risk of distant spread and subsequent death from melanoma for the stage III group is dependent on the risk of hematogenous spread from a deeply invading primary tumour, in addition to the disease burden of the metastatic nodes. Extracapsular spread (ECS), a well-known risk factor for locoregional recurrence in melanoma patients with macrometastatic disease, is associated with a poor prognosis.1‐3 Although ECS is a biomarker for poor prognosis, it is not included in the current AJCC classification system. …