Mitotic figures and the evolving staging of melanoma

Abstract

The seventh edition of the American Joint Committee on Cancer (AJCC)'s staging manual identified tumor thickness, ulceration, and mitotic figures as important adverse prognostic factors for survival. Identification of a single mitosis prompted staging of a tumor as T1b and prompted consideration of sentinel lymph node biopsy (SLNB). Careful review of survival data has shown that the identification of mitotic figures in melanoma is not an independent variable but linked to thickness and ulceration. The updated eighth edition of the AJCC's cancer staging manual reflects this understanding by stratifying thin melanomas by depth of invasion and ulceration rather than including mitotic rate.

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