The alarming increase in the incidence of malignant melanoma<sup>59 Parker S.L., Tong T., Bolden S. , e al. Cancer Statistics, 1996. CA–A Cancer Journal for Clinicians 1996 ;  46 (1) : 5-28  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> has been paralleled by the evolution of new and more accurate approaches to staging and treatment. The dominant prognostic variables help in the design of clinical research trials involving adjuvant therapy as well as surgery. Identifying the dominant prognostic variables also allows the results of surgical treatment options and adjuvant therapy to be evaluated against the natural course of the disease. With accurate prognostic indicators, the treating physician is able to present to the melanoma patient reliable information regarding his or her future survival and outcome. Equally as important, the availability of accurate prognostic factor analysis will allow patients to make rational decisions concerning their participation in various treatment regimens and clinical trials.

If useful comparisons between treatment centers and data bases are to be made, a uniform and practical classification and staging system must exist and be widely adopted. The 1992 American Joint Committee on Cancer (AJCC) pTNM staging system is used in this review whenever possible (Table 1). With this staging classification, localized disease without regional nodal involvement is defined as stage I and II, depending on the tumor thickness of the primary melanoma. Regional lymph node involvement and/or in-transit metastasis is defined as stage III, and systemic metastatic disease is defined as stage IV.<sup>1 American Joint Committee on Cancer Manual for Staging of Cancer Philadelphia: JB Lippincott (1988).  139

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