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Related Concept Videos

Tumor Progression02:07

Tumor Progression

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Tumor progression is a phenomenon where the pre-formed tumor acquires successive mutations to become clinically more aggressive and malignant. In the 1950s, Foulds first described the stepwise progression of cancer cells through successive stages.
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...
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Related Experiment Video

Updated: May 5, 2026

Evaluation of Tumor-infiltrating Leukocyte Subsets in a Subcutaneous Tumor Model
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Tumor-infiltrating lymphocyte scoring improves progression risk prediction in stage II melanoma: A retrospective

George Adigbli1, Benedict Reed2, Bhavika Khera2

  • 1Translational Research Immunology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Department of Plastic Surgery, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.

Journal of the American Academy of Dermatology
|March 23, 2025
PubMed
Summary

The American Joint Committee on Cancer staging is suboptimal for predicting melanoma progression. Tumor-infiltrating lymphocyte (TIL) scoring improves risk stratification for stage II melanoma patients, identifying those who may benefit from immunotherapy.

Keywords:
AJCC stagingadjuvant immunotherapybiomarkercancer prognosiscancer stagingimmunologymelanomaoncologypathologypersonalized medicineprognostic factorprogression riskprogression-free survival (PFS)retrospective cohort studyrisk stratificationsentinel lymph node (SLN)skin cancerstage II melanomasurgical oncologytumor-infiltrating lymphocyte (TIL)

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Area of Science:

  • Oncology
  • Dermatology
  • Immunology

Background:

  • The American Joint Committee on Cancer (AJCC) eighth edition substaging may not accurately predict melanoma progression.
  • Current AJCC staging risks overtreating low-risk stage IIB/IIC melanoma patients and undertreating high-risk stage IIA patients.
  • The prognostic value of tumor-infiltrating lymphocytes (TILs) in stage II melanoma is not well-defined.

Purpose of the Study:

  • To assess the predictive capabilities of AJCC eighth edition substaging for melanoma progression.
  • To evaluate tumor-infiltrating lymphocyte (TIL) scoring as a predictor of progression in stage II melanoma.
  • To determine if TIL scoring can improve risk stratification beyond AJCC substages.

Main Methods:

  • Retrospective cohort study involving 366 sentinel lymph node-negative stage II melanoma patients.
  • Data collected from four UK hospitals between 2004 and 2017.
  • Long-term follow-up to assess melanoma progression and survival outcomes.

Main Results:

  • Twenty-three percent of melanomas progressed during the median 9.5-year follow-up.
  • TIL scoring independently predicted progression risk and progression-free survival.
  • Non-brisk TILs, found in 80% of progressing tumors, indicated high risk, reclassifying stage IIA patients similarly to stage IIB/IIC patients with brisk/absent TILs.

Conclusions:

  • AJCC eighth edition substaging demonstrates limited ability to predict stage II melanoma progression.
  • TIL scoring offers enhanced risk stratification across AJCC substages.
  • TIL scoring presents a cost-effective method for identifying stage II melanoma patients who could benefit from adjuvant immunotherapies.