The predictive accuracy of the traditional staging system is based on disease progression as a tumour cell-autonomous process, but it fails to incorporate the effects of the host immune response.,A precise analysis of the immune component of the tumour microenvironment by computer-based analysis may be essential to managing patients better, opening the road to an expertise in this new emerging field.,The Immunoscore as a new possible approach in the classification of cancer, designated TNM-Immune, studied in colon cancer patients with predictive and prognostic value.,This new scoring system is derived from the immune contexture, and is based on the numeration of lymphocyte populations, both in the core of the tumour and in the invasive margin of tumours.,The Immunoscore demonstrated to be quantitative, reproducible and robust.,The usefulness of Immunoscore in advanced melanoma cancer patients has been as well demonstrated; the correlation of marker expression profile with clinical outcome is ongoing.,More recently, the Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery.,A multivariable Cumulative “Suppression Index” scoring system has been also studied in Oral Squamous Cell Carcinoma patients: it evaluates both the tumor and stromal microcompartments at the invasive margin and summarizes them into the score, providing an accurate stratification, independent of stage, tumour classification.,The introduction of Immunoscore requires a redefinition of the Laboratory system according to the LEAN Management process, which has been already implemented in referral research labs.,The definition and test of hundreds of biomarkers, in the tumour contexture represents a definitive scientific progression.,However, there is still a need of substantial body of work to reach the end of the tunnel to assure a personalize treatment.
Melanoma accounts for the majority of skin cancer deaths.,It has over thirty different subtypes.,Different races have been observed to differ in multiple aspects of melanoma.,SEER (Surveillance, Epidemiology, and End Results) data on six major subtypes, namely melanoma in situ (MIS), superficial spreading melanoma (SSM), nodular melanoma (NM), lentigo maligna melanoma (LMM), acral lentiginous melanoma malignant (ALM), and malignant melanoma NOS (NOS), were analyzed.,The racial groups studied included NHW (non-Hispanic white), HW (Hispanic white), Black, and Asian/PI (Pacific Islanders).,Univariate and multivariate analysis was conducted to quantify racial differences in patients’ characteristics, incidence, treatment, and survival.,Significant racial differences are observed in patients’ characteristics.,For all subtypes except for ALM, NHWs have the highest incidence rates, followed by HWs, while Blacks have the lowest.,For ALM, HWs have the highest rate, followed by NHWs.,In stratified analysis, interaction between gender and race is observed.,For the first five subtypes and localized and regional NOS, the dominating majority of patients had surgery, while for distant NOS, the distribution of treatment is more scattered.,Significant racial differences are observed for distant ALM and NOS.,For MIS, SSM, NM, LMM, and ALM, there is no significant racial difference in survival.,For NOS, significant racial differences in survival are observed for the localized and regional stages, with NHWs having the best and Blacks having the worst five-year survival rates.,Racial differences exist for the six major melanoma subtypes in the U.S.,More data collection and analysis are needed to fully describe and interpret the differences across racial groups and across subtypes.