Progress but not enough: the 2009 (7th) revision of the American Joint Committee on Cancer (AJCC) for melanoma staging and classification.

In 2009 the American Joint Committee on Cancer (AJCC) examined for the first time the mitotic rate of the primary melanoma as a new covariate in a revised staging and classification system. In a multifactorial analysis mitotic rate was the second most powerful predictor of survival after tumour thickness, reaffirming the findings of earlier studies. Analyses demonstrated a highly significant correlation between increasing mitotic rate and declining survival rates. Despite these findings some of the intrinsic weaknesses of the 2001 staging and classification system for melanoma remain apparent in the 7th revision of 2009 and are discussed in this paper.