Nomograms and Staging in Melanoma: New Tools for Better Predicting Outcomes

Excerpt

Predicting outcomes for patients diagnosed with primary melanoma, as with any cancer, has several important utilities, including patient counseling, therapeutic decision making, designing and interpreting clinical trials, and optimizing health outcome assessments. Melanoma, more so than many other cancers, has lent itself to the development of predictive models initially based on microstaging methods, such as tumor depth using Breslow thickness and Clark level of invasion, and, more recently, to detecting micrometastases with the sentinel lymph node biopsy technique. In addition, a number of other factors have been associated with varying degrees of prognostic significance that reflect either patient-related factors (such as age, sex, site, or lymphatic drainage pattern) or tumor-related factors (such as ulceration, regression, vertical growth phase, mitotic rate, lymphovascular invasion, tumor-infiltrating lymphocytes, satellitosis, or perineural invasion). What has proven quite challenging, however, has been how to develop a useful staging system that tries to incorporate these multiple factors in a fashion that uses reliable and independent predictors of survival outcome and accurate prognostic modeling in the least invasive way possible. …