[TNM classification of melanoma : Evolution and limitations]

The incidence of melanoma is increasing, accounting for the majority of deaths related to skin cancer. The TNM classification has served as the foundation for staging and treatment decisions for decades.

This review critically analyzes the historical development of the TNM classification of melanoma and systematically outlines its limitations in the context of current molecular pathological findings.

A narrative literature review was conducted considering AJCC editions 1-8 and current studies on prognostic biomarkers, gene expression profiles, and circulating tumor DNA.

The TNM classification shows significant limitations: some stage III patients have a more favorable prognosis than stage II patients, biologically distinct melanoma subtypes are not adequately considered, and immunological parameters and mitotic rate are absent from the current edition. Gene expression profiling and circulating tumor DNA analyses enable more precise risk stratification than purely clinicopathological parameters.

Integration of molecular and immunological biomarkers into future classification systems is necessary to enable individualized therapeutic decision-making.