1
|
Zhu T, Zong C, Li Y, Jia S, Shi H, Tian H, Rao Y, Zhang X, Ge S, Fan X, Li Y, Jia R, Xu S. High-risk histopathologic features in local advanced conjunctival melanoma. Acta Ophthalmol 2024; 102:e851-e861. [PMID: 38420891 DOI: 10.1111/aos.16662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/11/2024] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To identify high-risk histopathologic and molecular features of local recurrence, nodal metastasis, distant metastasis (DM) and disease-specific death (DSD) in conjunctival melanoma (CoM). METHODS Ninety patients with pathologically diagnosed CoM between 2008 and 2023 were enrolled. Immunohistochemistry staining of BRAFV600E, NRASQ61R, CD117, PD-1 and PD-L1 was performed in 65 and 45 patients, respectively. Cox regression and Kaplan-Meier survival analysis were conducted to identify risk factors for local recurrence, nodal metastasis, DM and DSD. RESULTS Pathologically, ulceration (hazard ratio [HR]: 3.170; 95% CI: 1.312-7.659; p = 0.01) and regression (HR: 3.196; 95% CI: 1.094-9.335; p = 0.034) were risk factors for DM. Tumour thickness ≥ 4 mm (HR: 4.889; 95% CI: 1.846-12.946; p = 0.001) and regression (HR: 4.011; 95% CI: 1.464-10.991; p = 0.007) were risk factors for DSD. For patients with tumour thickness < 4 mm, the presence of ulceration indicated a higher risk of nodal metastasis (log-rank p = 0.0011), DM (log-rank p = 0.00051) and DSD (log-rank p = 0.02). Patients with regression (+)/tumour-infiltrating lymphocytes (TILs) (+) had a higher risk for DM (log-rank p = 0.011) and DSD (log-rank p = 0.0032). Molecularly, the positive rate of BRAFV600E, NRASQ61R, CD117, PD-1 and PD-L1 was 40.00% (26/65), 43.08% (28/65), 70.77% (46/65), 46.67% (21/45) and 28.89% (13/45), respectively. Positive BRAFV600E was identified as an independent risk factor for DM (HR: 2.533; 95% CI: 1.046-6.136, p = 0.039). The expression level of BRAFV600E was positively correlated with vascular invasion (p = 0.01), as well as the expression levels of PD-1 (p = 0.038) and PD-L1 (p = 0.049). CONCLUSIONS Tumour thickness ≥ 4 mm, ulceration, the coexistence of regression and TILs, and positive BRAFV600E were risk factors for poor prognosis of CoM patients. Besides, expression level of BRAFV600E was positively correlated with the expression levels of PD-1 and PD-L1.
Collapse
Affiliation(s)
- Tianyu Zhu
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Zong
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongyun Li
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shichong Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanhan Shi
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Tian
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Zhang
- Department of Implant Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Li
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiqiong Xu
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Vargas GM, Shafique N, Xu X, Karakousis G. Tumor-infiltrating lymphocytes as a prognostic and predictive factor for Melanoma. Expert Rev Mol Diagn 2024; 24:299-310. [PMID: 38314660 PMCID: PMC11134288 DOI: 10.1080/14737159.2024.2312102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Tumor-infiltrating lymphocytes (TILs) have been investigated as prognostic factors in melanoma. Recent advancements in assessing the tumor microenvironment in the setting of more widespread use of immune checkpoint blockade have reignited interest in identifying predictive biomarkers. This review examines the function and significance of TILs in cutaneous melanoma, evaluating their potential as prognostic and predictive markers. AREAS COVERED A literature search was conducted on papers covering tumor infiltrating lymphocytes in cutaneous melanoma available online in PubMed and Web of Science from inception to 1 December 2023, supplemented by citation searching. This article encompasses the assessment of TILs, the role of TILs in the immune microenvironment, TILs as a prognostic factor, TILs as a predictive factor for immunotherapy response, and clinical applications of TILs in the treatment of cutaneous melanoma. EXPERT OPINION Tumor-infiltrating lymphocytes play a heterogeneous role in cutaneous melanoma. While they have historically been associated with improved survival, their status as independent prognostic or predictive factors remains uncertain. Novel methods of TIL assessment, such as determination of TIL subtypes and molecular signaling, demonstrate potential for predicting therapeutic response. Further, while their clinical utility in risk-stratification in melanoma treatment shows promise, a lack of consensus data hinders standardized application.
Collapse
Affiliation(s)
| | - Neha Shafique
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Blanc F, Bertho N, Piton G, Leplat JJ, Egidy G, Bourneuf E, Vincent-Naulleau S, Prévost-Blondel A. Deciphering the immune reaction leading to spontaneous melanoma regression: initial role of MHCII + CD163 - macrophages. Cancer Immunol Immunother 2023; 72:3507-3521. [PMID: 37526660 PMCID: PMC10576715 DOI: 10.1007/s00262-023-03503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
The human cutaneous metastatic melanoma is the deadliest skin cancer. Partial, or less frequently complete spontaneous regressions could be observed, mainly mediated by T cells. Nevertheless, the underlying mechanisms are not fully unraveled. We investigated the first events of the immune response related to cancer regression in Melanoma-bearing Libechov Minipigs (MeLiM), a unique swine model of cutaneous melanoma that regresses spontaneously. Using a multiparameter flow cytometry strategy and integrating new clinical and histological criteria of the regression, we show that T cells and B cells are present only in the late stages, arguing against their role in the initial destruction of malignant cells. NK cells infiltrate the tumors before T cells and therefore might be involved in the induction of the regression process. Myeloid cells represent the main immune population within the tumor microenvironment regardless of the regression stage. Among those, MHCII+ CD163- macrophages that differ phenotypically and functionally compared to other tumor-associated macrophages, increase in number together with the first signs of regression suggesting their crucial contribution to initiating the regression process. Our study supports the importance of macrophage reprogramming in humans to improve current immunotherapy for metastatic melanoma.
Collapse
Affiliation(s)
- Fany Blanc
- INSERM, U1016, Institut Cochin, 75014, Paris, France.
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France.
- CEA, DSV/iRCM/SREIT/LREG, 78350, Jouy-en-Josas, France.
| | - Nicolas Bertho
- Université Paris-Saclay, INRAE, VIM, 78350, Jouy-en-Josas, France
- INRAE, Oniris, BIOEPAR, 44300, Nantes, France
| | - Guillaume Piton
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France
- CEA, DSV/iRCM/SREIT/LREG, 78350, Jouy-en-Josas, France
| | - Jean-Jacques Leplat
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France
- CEA, DSV/iRCM/SREIT/LREG, 78350, Jouy-en-Josas, France
| | - Giorgia Egidy
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France
| | - Emmanuelle Bourneuf
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France
- CEA, DSV/iRCM/SREIT/LREG, 78350, Jouy-en-Josas, France
- Laboratoire de Cancérologie Expérimentale, CEA/DRF/IBFJ/IRCM, 92265, Fontenay-Aux-Roses, France
- Université Paris Cité, Paris, France
| | - Silvia Vincent-Naulleau
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350, Jouy-en-Josas, France
- CEA, DSV/iRCM/SREIT/LREG, 78350, Jouy-en-Josas, France
- Plateforme animalerie, CEA/DRF/IBFJ/IRCM, 92265, Fontenay-Aux-Roses, France
- Bureau des Etudes Biomédicales chez l'Animal, CEA/DRF/BEBA, 92265, Fontenay-Aux-Roses, France
| | - Armelle Prévost-Blondel
- INSERM, U1016, Institut Cochin, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- CNRS, UMR8104, Paris, France.
| |
Collapse
|
4
|
Hoskins S, Vale SM, Moshiri AS. Acute regression of a melanocytic neoplasm. J Cutan Pathol 2023; 50:869-872. [PMID: 37448109 DOI: 10.1111/cup.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 07/15/2023]
Abstract
Immune-mediated regression of melanocytic neoplasms is predominantly lymphocytic, driven by CD8+ anti-tumoral T-cells and, rarely, natural killer cells. Histopathologic features of regression include effacement of the epidermis, replacement of tumor cells by a fibrotic stroma, varying degrees of chronic inflammation (usually lymphocytes) and melanophages, as well as vascular ectasia and angioplasia. The understanding of regression and the complex immune response in melanoma has led to the development of targeted immunotherapy in melanoma. Here, we report a case of near-complete regression of a melanocytic neoplasm associated with neutrophilic and eosinophilic inflammation, suggesting a non-traditional pathway of regression that has yet to be explored.
Collapse
Affiliation(s)
- Sidney Hoskins
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Spencer M Vale
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ata S Moshiri
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
5
|
Regression in cutaneous melanoma: histological assessment, immune mechanisms and clinical implications. Pathology 2023; 55:227-235. [PMID: 36639333 DOI: 10.1016/j.pathol.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
Tumour regression is an immunologically driven process that results in complete or partial disappearance of tumour cells. This can be observed in histological sections as replacement of tumour cells with fibrosis, angiogenesis, and a variable inflammatory infiltrate. In primary cutaneous melanoma, the prognostic significance of regression has been debated for decades, in part because inconsistent histological criteria are used in prognostication studies. It is broadly accepted that CD8+ T lymphocytes are the primary effectors of the anti-tumour response, but the interplay between melanoma and the immune system is complex, dynamic, and incompletely understood. Sustained progress in unravelling the pathogenesis of melanoma regression has led to the identification of therapeutic targets, culminating in the development of immune checkpoint inhibitors for the management of advanced disease. Modern techniques allow for high-resolution spatial analyses of the tumour microenvironment. Such studies may lead to better understanding of the immune drivers of melanoma regression, thereby facilitating the search for new prognostic and predictive biomarkers to assist clinical decision-making.
Collapse
|
6
|
Dong D, Wang W, Wang H, Chen L, Liu T. The expression pattern of immune-related genes and characterization of tumor immune microenvironment: predicting prognosis and immunotherapeutic effects in cutaneous melanoma. World J Surg Oncol 2022; 20:303. [PMID: 36138406 PMCID: PMC9502579 DOI: 10.1186/s12957-022-02767-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Increasing evidences have revealed the tumor immune microenvironment not only has vital impacts on the origin, progression, and metastasis of tumors significantly but also influences the response to immunotherapy. Nonetheless, to date, the well-rounded expression pattern of immune-related genes in cutaneous melanoma and the comprehensive characterization of tumor immune microenvironment remain not clearly elucidated. Method We comprehensively evaluated the well-rounded expression pattern of immune-related genes of 686 patients with cutaneous melanoma based on immune-related genes with prognostic value and systematically correlated the expression pattern of these genes with the comprehensive characterization of tumor immune microenvironment. The IRGscore was constructed to quantify immunological function of individual using principal component analysis algorithms. Result Three distinct immune subtypes were determined with obvious survival differences. Melanoma patients with high IRGscore was characterized by comprehensive suppression of immune function, showing much poorer prognosis and efficacy for immunotherapy, while the low IRGscore means the robust activation of immune function and the better effect of immunotherapy, which may be responsible for a better prognosis. Besides, the prognostic ability of IRGscore was further validated by the independent dataset of stomach cancers. Furthermore, the predictive effect of immunotherapeutic benefits of IRGscore was demonstrated by the independent dataset of melanoma patients accepting immunotherapy and another predictive model for immunotherapy. Conclusion IRGscore could serve as an independent immunotherapeutic and prognostic predictor, thereby facilitating the identification of appropriate candidates with cutaneous melanoma for immunotherapy and the formulation of individualized therapeutic approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02767-z.
Collapse
Affiliation(s)
- Dong Dong
- Department of Plastic and Aesthetic Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Wei Wang
- Department of Plastic and Aesthetic Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Heng Wang
- Department of Plastic and Aesthetic Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Liang Chen
- Department of Plastic and Aesthetic Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Tianyi Liu
- Department of Plastic and Aesthetic Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
| |
Collapse
|
7
|
Amalinei C, Grigoraș A, Lozneanu L, Căruntu ID, Giușcă SE, Balan RA. The Interplay between Tumour Microenvironment Components in Malignant Melanoma. Medicina (B Aires) 2022; 58:medicina58030365. [PMID: 35334544 PMCID: PMC8953474 DOI: 10.3390/medicina58030365] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022] Open
Abstract
Malignant melanoma has shown an increasing incidence during the last two decades, exhibiting a large spectrum of locations and clinicopathological characteristics. Although current histopathological, biochemical, immunohistochemical, and molecular methods provide a deep insight into its biological behaviour and outcome, melanoma is still an unpredictable disease, with poor outcome. This review of the literature is aimed at updating the knowledge regarding melanoma’s clinicopathological and molecular hallmarks, including its heterogeneity and plasticity, involving cancer stem cells population. A special focus is given on the interplay between different cellular components and their secretion products in melanoma, considering its contribution to tumour progression, invasion, metastasis, recurrences, and resistance to classical therapy. Furthermore, the influences of the specific tumour microenvironment or “inflammasome”, its association with adipose tissue products, including the release of “extracellular vesicles”, and distinct microbiota are currently studied, considering their influences on diagnosis and prognosis. An insight into melanoma’s particular features may reveal new molecular pathways which may be exploited in order to develop innovative therapeutic approaches or tailored therapy.
Collapse
|
8
|
Histological regression in melanoma: impact on sentinel lymph node status and survival. Mod Pathol 2021; 34:1999-2008. [PMID: 34247192 DOI: 10.1038/s41379-021-00870-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/08/2022]
Abstract
Regression in melanoma is an immunological phenomenon that results in partial or complete replacement of the tumor with variably vascular fibrous tissue, often accompanied by pigment-laden macrophages and chronic inflammation. In some cases, tumor-infiltrating lymphocytes (TILs) may represent the earliest phase of this process. The prognostic significance of regression has long been a matter of debate, with inconsistent findings reported in the literature to date. This study sought to determine whether regression in primary cutaneous melanomas predicted sentinel lymph node (SLN) status and survival outcomes in a large cohort of patients managed at a single centre. Clinical and pathological parameters for 8,693 consecutive cases were retrieved. Associations between regression and SLN status, overall survival (OS), melanoma-specific survival (MSS) and recurrence-free survival (RFS) were investigated using logistic and Cox regression. Histological evidence of regression was present in 1958 cases (22.5%). Regression was significantly associated with lower Breslow thickness, lower mitotic rate, and absence of ulceration (p < 0.0001). Multivariable analysis showed that regression in combination with TILs independently predicted a negative SLN biopsy (OR 0.33; 95% C.I. 0.20-0.52; p < 0.0001). Patients whose tumors showed both regression and TILs had the highest 10-year OS (65%, 95% C.I. 59-71%), MSS (85%, 95% C.I. 81-89%), and RFS (60%, 95% C.I. 54-66%). On multivariable analyses, the concurrent presence of regression and TILs independently predicted the lowest risk of death from melanoma (HR 0.69; 95% C.I. 0.51-0.94; p = 0.0003) as well as the lowest rate of disease recurrence (HR 0.71; 95% C.I. 0.58-0.85; p < 0.0001). However, in contrast, in the subgroup analysis of Stage III patients, the presence of regression predicted the lowest OS and RFS, with MSS showing a similar trend. Overall, these findings indicate a prognostically favorable role of regression in primary cutaneous melanoma. However, in Stage III melanoma patients, regression may be a marker of more aggressive disease.
Collapse
|
9
|
Tonella L, Pala V, Ponti R, Rubatto M, Gallo G, Mastorino L, Avallone G, Merli M, Agostini A, Fava P, Bertero L, Senetta R, Osella-Abate S, Ribero S, Fierro MT, Quaglino P. Prognostic and Predictive Biomarkers in Stage III Melanoma: Current Insights and Clinical Implications. Int J Mol Sci 2021; 22:4561. [PMID: 33925387 PMCID: PMC8123895 DOI: 10.3390/ijms22094561] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 01/19/2023] Open
Abstract
Melanoma is one of the most aggressive skin cancers. The 5-year survival rate of stage III melanoma patients ranges from 93% (IIIA) to 32% (IIID) with a high risk of recurrence after complete surgery. The introduction of target and immune therapies has dramatically improved the overall survival, but the identification of patients with a high risk of relapse who will benefit from adjuvant therapy and the determination of the best treatment choice remain crucial. Currently, patient prognosis is based on clinico-pathological features, highlighting the urgent need of predictive and prognostic markers to improve patient management. In recent years, many groups have focused their attention on identifying molecular biomarkers with prognostic and predictive potential. In this review, we examined the main candidate biomarkers reported in the literature.
Collapse
Affiliation(s)
- Luca Tonella
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Valentina Pala
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Renata Ponti
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Marco Rubatto
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Giuseppe Gallo
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Luca Mastorino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Gianluca Avallone
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Martina Merli
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Andrea Agostini
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Paolo Fava
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Luca Bertero
- Department of Oncology, Pathology Unit, University of Turin, 10126 Turin, Italy; (L.B.); (R.S.); (S.O.-A.)
| | - Rebecca Senetta
- Department of Oncology, Pathology Unit, University of Turin, 10126 Turin, Italy; (L.B.); (R.S.); (S.O.-A.)
| | - Simona Osella-Abate
- Department of Oncology, Pathology Unit, University of Turin, 10126 Turin, Italy; (L.B.); (R.S.); (S.O.-A.)
| | - Simone Ribero
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Maria Teresa Fierro
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, 10126 Turin, Italy; (V.P.); (R.P.); (M.R.); (G.G.); (L.M.); (G.A.); (M.M.); (A.A.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| |
Collapse
|
10
|
Tas F, Erturk K. Coexistence of regression and tumor infiltrating lymphocytes is associated with more favorable survival in melanoma. J Cancer Res Clin Oncol 2021; 147:2721-2729. [PMID: 33611652 DOI: 10.1007/s00432-021-03565-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Melanoma is one of the highly immunogenic malignancies, and histological regression (HR) and tumor infiltrating lymphocytes (TILs) represent early signs of activation of the immune system against primary melanoma. In this study we aimed to investigate the potential roles of HR and TILs on survival, as combined or separately. METHODS A total of 916 cutaneous melanomas were analyzed retrospectively. RESULTS Only minority of the lesions had HR (25.1%) and they were associated with males (p = 0.002), axial localization (p = 0.0001), non-nodular histopathology (p = 0.0001), thin Breslow depth (p = 0.01) and nevus-associated melanoma (p = 0.03). Those with TILs (48.4%) were found in association with lower Clark levels (p = 0.003), thin tumor thicknesses (p = 0.001), lower mitotic rates (p = 0.02), BRAF mutation (p = 0.03), absence of neurotropism (p = 0.03), involvement of lymph node (p = 0.0001) and relapse of disease (p = 0.04). A significant relationship was found between HR and TILs (p = 0.01). TILs were independently associated with favorable RFS (p = 0.02), whereas no relationship was observed between HR and RFS (p = 0.2). A marked favorable survival advantage was noted in the group with HR (+)/TILs (+) compared to other groups with HR (-)/TILs (-) (p = 0.007), only HR (+) and only TILs (+). Both HR (p = 0.05) and TILs (p = 0.04) were correlated with favorable OS rates. Moreover, HR (+) /TILs (+) patients had more favorable OS than other groups with HR (-)/TILs (-) (p = 0.002), only HR (+) and only TILs (+). CONCLUSION Only HR (+) and only TILs (+) subgroups separately were found to be associated with favorable survivals in melanoma. Furthermore, coexistence of HR and TILs, HR (+)/TILs (+) subgroup, had more favorable survival rates compared to only HR (+) and only TILs (+) subgroups.
Collapse
Affiliation(s)
- Faruk Tas
- Institute of Oncology, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Kayhan Erturk
- Department of Medical Oncology, Koc University, Istanbul, Turkey
| |
Collapse
|
11
|
Jairath NK, Farha MW, Jairath R, Harms PW, Tsoi LC, Tejasvi T. Prognostic value of intratumoral lymphocyte-to-monocyte ratio and M0 macrophage enrichment in tumor immune microenvironment of melanoma. Melanoma Manag 2020; 7:MMT51. [PMID: 33318782 PMCID: PMC7727784 DOI: 10.2217/mmt-2020-0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Skin cutaneous melanoma is characterized by significant heterogeneity in its molecular, genomic and immunologic features. Whole transcriptome RNA sequencing data from The Cancer Genome Atlas of skin cutaneous melanoma (n = 328) was utilized. CIBERSORT was used to identify immune cell type composition, on which unsupervised hierarchical clustering was performed. Analysis of overall survival was performed using Kaplan–Meier estimates and multivariate Cox regression analyses. Membership in the lymphocyte:monocytelow, monocytehigh and M0high cluster was an independently poor prognostic factor for survival (HR: 3.03; 95% CI: 1.12–8.20; p = 0.029) and correlated with decreased predicted response to immune checkpoint blockade. In conclusion, an M0-macrophage-enriched, lymphocyte-to-monocyte-ratio-low phenotype in the primary melanoma tumor site independently characterizes an aggressive phenotype that may differentially respond to treatment.
Collapse
Affiliation(s)
- Neil K Jairath
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark W Farha
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ruple Jairath
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lam C Tsoi
- Department of Computational Medicine & Bioinformatics, Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
12
|
Cioplea M, Nichita L, Georgescu D, Sticlaru L, Cioroianu A, Nedelcu R, Turcu G, Rauta A, Mogodici C, Zurac S, Popp C. FOXP3 in Melanoma with Regression: Between Tumoral Expression and Regulatory T Cell Upregulation. J Immunol Res 2020; 2020:5416843. [PMID: 33274240 PMCID: PMC7683174 DOI: 10.1155/2020/5416843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022] Open
Abstract
Cutaneous melanoma is a significant immunogenic tumoral model, the most frequently described immune phenomenon being tumor regression, as a result of the interaction of tumoral antigens and stromal microenvironment. We present a retrospective cohort study including 52 cases of melanoma with regression. There were evaluated correlations of the most important prognostic factors (Breslow depth and mitotic index) with FOXP3 expression in tumor cells and with the presence of regulatory T cells and dendritic cells in the tumoral stroma. FOXP3 expression in tumor cells seems an independent factor of poor prognosis in melanoma, while regression areas are characterized by a high number of dendritic cells and a low number of regulatory T cells. FOXP3 is probably a useful therapeutical target in melanoma, since inhibition of FOXP3-positive tumor clones and of regulatory T cells could eliminate the ability of tumor cells to escape the immune defense of the host.
Collapse
Affiliation(s)
- Mirela Cioplea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | - Luciana Nichita
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | - Daniela Georgescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Colentina University Hospital, Hematology Department, Bucharest, Romania
| | - Liana Sticlaru
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | | | - Roxana Nedelcu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriela Turcu
- Colentina University Hospital, Dermatology Department, Bucharest, Romania
| | - Alin Rauta
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | - Cristian Mogodici
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | - Sabina Zurac
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| | - Cristiana Popp
- Colentina University Hospital, Pathology Department, Bucharest, Romania
| |
Collapse
|
13
|
Porcellato I, Brachelente C, Cappelli K, Menchetti L, Silvestri S, Sforna M, Mecocci S, Iussich S, Leonardi L, Mechelli L. FoxP3, CTLA-4, and IDO in Canine Melanocytic Tumors. Vet Pathol 2020; 58:42-52. [PMID: 33021155 DOI: 10.1177/0300985820960131] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite promising immunotherapy strategies in human melanoma, there are few studies on the immune environment of canine melanocytic tumors. In humans, the activation of immunosuppressive cell subpopulations, such as regulatory T cells (Tregs) that express forkhead box protein P3 (FoxP3), the engagement of immunosuppressive surface receptors like cytotoxic T lymphocyte antigen (CTLA-4), and the secretion of molecules inhibiting lymphocyte activation, such as indoleamine-pyrrole 2,3-dioxygenase (IDO), are recognized as immunoescape mechanisms that allow tumor growth and progression. The aim of our study was to investigate the expression of these immunosuppression markers in canine melanocytic tumors and to postulate their possible role in melanoma biology and progression. Fifty-five formalin-fixed, paraffin-embedded canine melanocytic tumors (25 oral melanomas; 20 cutaneous melanomas; 10 cutaneous melanocytomas) were selected to investigate the expression of FoxP3, CTLA-4, and IDO by immunohistochemistry and RT-qPCR (real-time quantitative polymerase chain reaction). All of the tested markers showed high gene and protein expression in oral melanomas and were differently expressed in cutaneous melanomas when compared to their benign counterpart. IDO expression was associated with an increased hazard of death both in univariable and multivariable analyses (P < .05). FoxP3 protein expression >6.9 cells/HPF (high-power field) was an independent predictor of death (P < .05). CTLA-4 gene and protein expressions were associated with a worse prognosis, but only in the univariable analysis (P < .05). FoxP3, CTLA-4, and IDO likely play a role in canine melanoma immunoescape. Their expression, if supported by future studies, could represent a prognostic tool in canine melanoma and pave the way to future immunotherapeutic approaches in dogs.
Collapse
Affiliation(s)
| | | | | | - Laura Menchetti
- 9309University of Perugia, Perugia, Italy.,Department of Agricultural and Food Sciences (DISTAL), University of Bologna
| | | | | | | | | | | | | |
Collapse
|
14
|
Sabbatino F, Scognamiglio G, Liguori L, Marra A, Anniciello AM, Polcaro G, Dal Col J, Caputo A, Peluso AL, Botti G, Zeppa P, Ferrone S, Pepe S. Peritumoral Immune Infiltrate as a Prognostic Biomarker in Thin Melanoma. Front Immunol 2020; 11:561390. [PMID: 33117345 PMCID: PMC7550791 DOI: 10.3389/fimmu.2020.561390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Thin melanomas are tumors less than 1 mm thick according to Breslow classification. Their prognosis is in most cases excellent. However, a small subset of these tumors relapses. These clinical findings emphasize the need of novel prognostic biomarkers to identify this subset of tumors. Characterization of tumor immune microenvironment (TIME) is currently investigated as a prognostic and predictive biomarker for cancer immunotherapy in several solid tumors including melanoma. Here, taking into account the limited availability of tumor tissues, by characterizing some of the characteristics of TIME such as number of infiltrating lymphocytes, HLA class I antigen and PD-L1 expression, we show that number of infiltrating CD8+ and FOXP3+ T cells as well as CD8+/FOXP3+ T cell ratio can represent a useful prognostic biomarker in thin melanoma. Although further investigations in a larger patient cohort are needed, these findings have potential clinical significance since they can be used to define subgroups of thin melanoma patients who have a worse prognosis and might need different treatment modalities.
Collapse
Affiliation(s)
- Francesco Sabbatino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Oncology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori, IRCSS, “Fondazione G. Pascale”, Naples, Italy
| | - Luigi Liguori
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Antonio Marra
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology, Milan, Italy
| | - Anna Maria Anniciello
- Pathology Unit, Istituto Nazionale Tumori, IRCSS, “Fondazione G. Pascale”, Naples, Italy
| | - Giovanna Polcaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Jessica Dal Col
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Alessandro Caputo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Pathology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
| | - Anna Lucia Peluso
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Pathology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
| | - Gerardo Botti
- Scientific Direction, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Pio Zeppa
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Pathology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
| | - Soldano Ferrone
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Stefano Pepe
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
- Oncology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Salerno, Italy
| |
Collapse
|
15
|
Osella-Abate S, Vignale C, Annaratone L, Nocifora A, Bertero L, Castellano I, Avallone G, Conti L, Quaglino P, Picciotto F, Senetta R, Papotti MG, Cassoni P, Ribero S. Microenvironment in cutaneous melanomas: a gene expression profile study may explain the role of histological regression. J Eur Acad Dermatol Venereol 2020; 35:e35-e38. [PMID: 32580236 DOI: 10.1111/jdv.16784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022]
Affiliation(s)
- S Osella-Abate
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - C Vignale
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - L Annaratone
- Pathology Division, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Nocifora
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - L Bertero
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - I Castellano
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - G Avallone
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - L Conti
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - P Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - F Picciotto
- Dermatologic Surgery Section, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - R Senetta
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - M G Papotti
- Department of Oncology, Pathology Unit, University of Turin, Turin, Italy
| | - P Cassoni
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - S Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| |
Collapse
|
16
|
Histological regression in primary melanoma and drug-related immune reaction towards metastatic melanoma: Are they associated?? Med Hypotheses 2020; 143:110019. [PMID: 32645656 DOI: 10.1016/j.mehy.2020.110019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
Abstract
Histologic regression has recently been associated with a more favorable prognosis in primary melanoma. historically this immune phenomenon was described as a negative prognostic factor able to substage the true Breslow thickness. Since many years we have assisted to the appearance of vitiligo in metastatic melanoma patients. This has been considered one of the explanations of the immunogenicity of this disease, as inducing a strong immune reaction against cancer cells able to kill normal melanocytes even far from the metastatic lesions, This vitiligo like reaction has been seen even stronger in patients treated with immune and target therapy. The three phenomena involve the same pattern of lymphocytes. The association between the three can explain the better prognosis of the patients with primary melanoma with histological regression as well as the longer survival of the vitiligo like immune reaction in metastatic melanoma patients.
Collapse
|
17
|
Ribero S, Torres-Navarro I, Botella-Estrada R. Tumour-infiltrating lymphocyte and histological regression in primary melanoma. Arch Dermatol Res 2020; 313:63-64. [PMID: 32382813 DOI: 10.1007/s00403-020-02089-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - I Torres-Navarro
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - R Botella-Estrada
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
- Dermatology, Universitat de València, Valencia, Spain
| |
Collapse
|
18
|
Nakamura Y. The Role and Necessity of Sentinel Lymph Node Biopsy for Invasive Melanoma. Front Med (Lausanne) 2019; 6:231. [PMID: 31696119 PMCID: PMC6817613 DOI: 10.3389/fmed.2019.00231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a widely accepted procedure for melanoma staging and treatment. The development of lymphatic mapping and SLNB, which was first introduced in 1992, has enabled surgeons to detect microscopic nodal metastases and stage-negative regional nodal basins with low morbidity. SLNB has also facilitated the selective application of regional lymph node dissection for patients with microscopic nodal metastases, enabling unnecessary lymph node dissection. In contrast, recent major randomized phase III trials (DeCOG-SLT and MSLT–II trial) compared the clinical benefit of early completion lymph node dissection with observation after detecting microscopic nodal disease. The results of those studies indicated that there was no significant difference in the survival between the two groups, although regional control was superior after early completion lymph node dissection compared to that obtained after observation. Thus, the role and value of early completion lymph node dissection worldwide are currently very limited for patients with microscopic nodal disease. However, the use of SLNB is still controversial. In addition, the recent approval of adjuvant therapy using novel agents, such as anti-programmed death-1 antibodies, and molecular targeted therapeutics may influence the skipping of complete lymph node dissection in patients with micrometastatic nodal disease in a real-world setting. Furthermore, modern neoadjuvant therapy, which is now under investigation, may have the potential to change the surgical procedure used for nodal disease. Herein, we describe the current role and value of SLNB and completion lymph node dissection and discuss the major controversies as well as the favorable future outlook.
Collapse
Affiliation(s)
- Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|