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The following is a summary of “Tumor-Infiltrating Lymphocyte Scoring Improves Progression Risk Prediction in Stage II Melanoma: A Retrospective Cohort Study,” published in the March 2025 issue of Journal of the American Academy of Dermatology by Adigbli et al. 

The AJCC 8th edition substaging was found to be limited in predicting melanoma progression, potentially leading to imbalanced treatment selection for stage II melanoma.  

Researchers conducted a retrospective study to examine AJCC substaging and tumor-infiltrating lymphocyte (TIL) scoring as predictors of progression in stage II melanoma.  

They analyzed 366 sentinel lymph node (SLN[-]) individuals with stage II melanoma from 4 hospitals in the UK (2004–2017) and conducted long-term follow-up.  

The results showed that 23% of melanomas progressed during a median follow-up of 9.5 years. Among these, 41.5% were stage IIA, 41.5% were stage IIB, and 17.1% were stage IIC. The TIL scoring independently predicted progression risk, with non-brisk TILs associated with higher risk compared to brisk TILs (OR 0.298, P =0.009) and absent TILs (OR 0.436, P =0.049). Non-brisk TILs were present in 80% of tumors that progressed, indicating a high-risk feature and TIL scoring stratified individuals into high- and low-risk groups across substages, with stage IIA individuals having non-brisk TILs showing similar 5-year progression-free survival (PFS) to stage IIB/IIC individuals with absent or brisk TILs.  

Investigators concluded the TIL scoring outperforms AJCC 8th edition substaging in predicting stage II melanoma progression, offering enhanced risk stratification and potentially identifying patients who would benefit from adjuvant immunotherapies more cost-effectively. 

Source: jaad.org/article/S0190-9622(25)00509-2/fulltext