Prognostic factors in patients with localized primary cutaneous melanoma

The clinical and histopathological characteristics that predict the outcomes of patients with melanoma have been studied for more than four decades. Increasingly more melanoma patients are being included in prospectively collected databases and our understanding of the biology of melanoma is improving. Therefore, the melanoma staging system is constantly being revised. The currently valid American Joint Committee on Cancer (AJCC) staging system for melanoma has been in place since early 2010 and is crucial for the determination of appropriate treatment, follow-up, and evaluating the risk of recurrence. Staging of a localized primary melanoma is based on the histopathological characteristics of the tumor: Breslow tumor thickness, mitotic rate, and presence or absence of ulceration. The Clark level of invasion is no longer recommended as a staging criterion. When mitotic rate is taken into consideration, it is no longer an independent prognostic factor. Other important and independent adverse predictors of primary cutaneous melanoma survival that are not part of the AJCC staging system are the age and sex of the patient and the anatomic location of the primary tumor. These factors, combined with the melanoma's histopathological features, could predict an individual patient's prognosis more precisely than the AJCC staging system currently in use.