Eigentler Thomas K, Radny Peter, Kamin Anne, Weide Benjamin, Caroli Ulrich M, Garbe Claus
Sektion Dermatologische Onkologie, Universitätshautklinik der Eberhard-Karls-Universität Tübingen.
J Dtsch Dermatol Ges. 2005 Aug;3(8):592-8. doi: 10.1111/j.1610-0387.2005.05051.x.
A new AJCC/UICC staging classification of malignant melanoma was published in 2001 and has been in use since then. Compared to the TNM classification used for the previous 15 years, the new classification contains fundamental changes. The classification of the primary tumor is now based on newly defined classes for Breslow's tumor thickness (0 - 1.0 mm; 1.01 - 2.0 mm, 2.01 - 4.0 mm; > 4.0 mm). Histopathologically diagnosed ulceration is the second prognostic factor in primary melanoma and its presence leads to upstaging into the next higher T category. Clark level of invasion is now only relevant for tumors up to 1 mm thick; levels IV and V are also reasons for upstaging. Classification of regional lymph node metastasis distinguishes between microscopic metastasis only as detected with sentinel lymph node biopsy and clinically detectable macroscopic metastasis. Additionally, the number of metastatic nodes and the presence of satellite and in-transit metastasis are prognostic factors for classification of regional lymph node metastasis. In distant metastasis, the kind of organ involvement has a role for classification (only skin and lymph nodes vs. lung vs. other organs) and an elevated LDH value leads to upstaging. A critical analysis of data of the German Central Malignant Melanoma Registry did not confirm the strong role of histopathological ulceration of the primary tumor in all T- and N-stages. Furthermore, there is an inconsistency of the classification as stage IIC displays a significantly worse prognosis as compared to stage IIIA. In spite of these drawbacks the new staging classification should used particularly in clinical trials in order to make data internationally comparable.
2001年发表了一种新的美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）恶性黑色素瘤分期分类方法，自那时起一直在使用。与过去15年使用的TNM分类相比，新分类有根本性变化。原发性肿瘤的分类现在基于对Breslow肿瘤厚度新定义的类别（0 - 1.0毫米；1.01 - 2.0毫米，2.01 - 4.0毫米；> 4.0毫米）。组织病理学诊断的溃疡是原发性黑色素瘤的第二个预后因素，其存在会导致分期升至下一个更高的T类别。Clark浸润水平现在仅与厚度达1毫米的肿瘤相关；IV级和V级也是分期升高的原因。区域淋巴结转移的分类区分仅通过前哨淋巴结活检检测到的微小转移和临床上可检测到的宏观转移。此外，转移淋巴结的数量以及卫星灶和移行转移的存在是区域淋巴结转移分类的预后因素。在远处转移中，器官受累的类型对分类有作用（仅皮肤和淋巴结、肺或其他器官），乳酸脱氢酶（LDH）值升高会导致分期升高。对德国中央恶性黑色素瘤登记处数据的批判性分析未证实原发性肿瘤的组织病理学溃疡在所有T期和N期的重要作用。此外，分类存在不一致之处，因为II期C显示出比III期A明显更差的预后。尽管有这些缺点，但新的分期分类尤其应在临床试验中使用，以便使数据具有国际可比性。
