Several clinicopathological factors have been identified as influencing outcome and survival in patients with CMM. The most important prognostic determinants in localized disease are the tumor thickness and the presence of ulceration. In the subgroup of thin tumors (< 1.0 mm), the level of invasion represents the most important prognosticator. In regional disease, the most significant independent predictors of survival are the number of metastatic nodes, the nodal tumor burden, and the presence of ulceration. In distant disease, the most important independent prognosticators are the site of metastatic involvement, the serum LDH level, and the number of metastases. Accordingly, the 2002 AJCC melanoma staging system represents an incorporation of the most recent prognostic data. In the future, further advances in diagnostic and staging techniques (eg, imaging and molecular staging) will undoubtedly lead to new and more accurate prognostic information.
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