1
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Asato MA, Moraes-Neto FA, Moraes MPDT, Ocanha-Xavier JP, Alencar Marques ME, Xavier-Junior JCC. Macroscopic tumor dimension, sentinel lymph node outcome, and survival analysis among cutaneous melanoma. Int J Dermatol 2024; 63:765-772. [PMID: 38217520 DOI: 10.1111/ijd.17024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/12/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Cutaneous melanoma is characterized by a high risk of metastasis to distant organs and a substantial mortality rate. For planning treatment and assessing outcomes, the Breslow micrometric measurement is critical. The tumor macroscopic dimension is not considered a prognostic parameter in cutaneous melanoma, although there are studies showing that tumor size is an independent prognostic factor for melanoma-specific survival. Therefore, this study aimed to evaluate the macroscopic dimension of melanoma and other known prognostic factors (i.e., Breslow index, mitoses, regression, and ulceration) as predictors of sentinel lymph node outcome and survival outcome. METHODS We performed a retrospective cross-sectional study of 227 melanoma lesions subjected to sentinel lymph node biopsy at two Brazilian referral centers. RESULTS On univariate analysis, there was a statistically significant correlation between the largest macroscopic tumor dimension and the sentinel lymph node result (P = 0.001); however, on multivariate analysis considering all evaluated parameters, there was no significant difference between the sentinel lymph node result and the tumor macroscopic dimension (P = 0.2689). Regarding melanoma-specific survival, the macroscopic dimension showed no significant correlation (P = 0.4632) in contrast to Breslow's dimension (P < 0.0001). CONCLUSION The Breslow thickness was the only significant factor related to both the sentinel lymph node outcome and melanoma specific survival among the evaluated variables.
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Affiliation(s)
- Marcel A Asato
- School of Medicine, The Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- School of Medicine, São Paulo State University, Botucatu, Brazil
| | | | | | | | | | - Jose Candido C Xavier-Junior
- School of Medicine, São Paulo State University, Botucatu, Brazil
- School of Medicine, Centro Universitário Unisalesiano Auxilium, Araçatuba, Brazil
- Pathology Institute of Araçatuba, Araçatuba, Brazil
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2
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Namubiru P, Dalleywater W, Lashin S, Elsheikh S. Can angiotropism and lymphovascular invasion refine the current cutaneous melanoma staging system? J Cutan Pathol 2024; 51:288-298. [PMID: 38100196 DOI: 10.1111/cup.14561] [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: 03/05/2023] [Revised: 09/29/2023] [Accepted: 10/30/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Several prognostic factors for primary cutaneous melanoma (PCM) have been identified, and these predict metastasis and survival, to a certain extent. We sought to determine the frequency of angiotropism (AT) and lymphovascular invasion (LVI) in PCM and the relationship between AT, LVI, and other clinicopathological parameters and patient's prognosis. METHODS This study included 538 cases of PCM diagnosed between 2003 and 2016. It comprised 246 females and 292 males whose clinicopathological variables were evaluated with respect to LVI and AT using univariate and multivariate analyses. Overall survival (OS) was assessed by Kaplan-Meier (KM) analysis and Cox regression multivariate analysis. RESULTS AT occurred more frequently than LVI. Ulceration, mitotic rate, and Breslow thickness were found to be highly associated with both LVI and AT (p < 0.01). All LVI+ cases had AT, with a significant positive correlation (p < 0.01). Both AT and LVI predicted lymph node (LN) metastasis (odds ratio [OR] = 1.47, 1.12, respectively). Multivariate analysis showed LN metastasis, Breslow thickness, LVI, and AT as predictors of OS. LVI and AT independently predicted adverse OS by Cox regression analysis (hazard ratio [HR] = 1.66, 1.49, respectively) and with KM survival analysis. CONCLUSION AT is a marker for angiotropic extravascular migratory tumor spread (angiotropic EVMM), and LVI is a marker for intra-lymphovascular tumor spread. Both predict poor prognosis. Given its ease of detection, AT could be adopted as a histologpathological feature in the routine assessment of primary cutaneous malignant melanoma cases.
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Affiliation(s)
- Patricia Namubiru
- Faculty of Medicine and Health Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - William Dalleywater
- Cellular Pathology Department, Nottingham University Hospital, Nottingham, UK
| | - Shaimaa Lashin
- Dermatology Department, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Somaia Elsheikh
- Cellular Pathology Department, Nottingham University Hospital, Nottingham, UK
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
- Histopathology Department, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
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Tan SX, Chong S, Rowe C, Galbraith J, Dight J, Zhou C, Malt M, Smithers BM, Khosrotehrani K. Lymphatic expression of the proliferation marker Ki67 is linked to sentinel node positivity, recurrence and mortality in primary cutaneous melanoma. Exp Dermatol 2024; 33:e15041. [PMID: 38433382 DOI: 10.1111/exd.15041] [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: 08/03/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Lymphangiogenesis is a precursor to lymphovascular invasion, and may therefore signal a higher risk of metastasis and mortality in primary cutaneous melanoma. This retrospective longitudinal study aimed to evaluate whether emergent lymphangiogenesis, as measured through co-expression of endothelial proteins with the proliferation marker Ki67, was associated with poorer prognosis in a cohort of patients with single primary cutaneous melanoma. We screened all patients with a single locally invasive primary cutaneous melanoma who received sentinel lymph node biopsy at a tertiary dermatology centre in Brisbane, Australia between 1994 and 2007. Primary melanoma sections were stained via Opal multiplex immunofluorescence, and categorized according to the presence of Ki67 within either CD31+ or D2-40+ endothelial cells. Multivariate Cox regression modelling was used to evaluate associations between endothelial Ki67 positivity and clinical outcomes, with adjustment for age, sex, Breslow depth, ulceration, and anatomical location. Overall, 264 patients were available for analysis, with a median follow-up duration of 7.1 years. The presence of D2-40+ /Ki67+ co-expression was associated with greater melanoma-specific mortality (adjusted hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.33-3.10; p = 0.001) and recurrence (adjusted HR: 1.70; 95% CI: 1.33-3.10; p = 0.001) relative to absence. CD31+ /Ki67+ co-expression was not prognostic in this cohort. Lymphatic proliferation, as measured through D2-40+ /Ki67+ co-expression, predicted greater melanoma-specific mortality and recurrence in this cohort of primary cutaneous melanoma.
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Affiliation(s)
- Samuel X Tan
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sharene Chong
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Casey Rowe
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jack Galbraith
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - James Dight
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Chenhao Zhou
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose Malt
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Bernard Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Frazer Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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4
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Jarell A, Gastman BR, Dillon LD, Hsueh EC, Podlipnik S, Covington KR, Cook RW, Bailey CN, Quick AP, Martin BJ, Kurley SJ, Goldberg MS, Puig S. Optimizing treatment approaches for patients with cutaneous melanoma by integrating clinical and pathologic features with the 31-gene expression profile test. J Am Acad Dermatol 2022; 87:1312-1320. [PMID: 35810840 DOI: 10.1016/j.jaad.2022.06.1202] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many patients with low-stage cutaneous melanoma will experience tumor recurrence, metastasis, or death, and many higher staged patients will not. OBJECTIVE To develop an algorithm by integrating the 31-gene expression profile test with clinicopathologic data for an optimized, personalized risk of recurrence (integrated 31 risk of recurrence [i31-ROR]) or death and use i31-ROR in conjunction with a previously validated algorithm for precise sentinel lymph node positivity risk estimates (i31-SLNB) for optimized treatment plan decisions. METHODS Cox regression models for ROR were developed (n = 1581) and independently validated (n = 523) on a cohort with stage I-III melanoma. Using National Comprehensive Cancer Network cut points, i31-ROR performance was evaluated using the midpoint survival rates between patients with stage IIA and stage IIB disease as a risk threshold. RESULTS Patients with a low-risk i31-ROR result had significantly higher 5-year recurrence-free survival (91% vs 45%, P < .001), distant metastasis-free survival (95% vs 53%, P < .001), and melanoma-specific survival (98% vs 73%, P < .001) than patients with a high-risk i31-ROR result. A combined i31-SLNB/ROR analysis identified 44% of patients who could forego sentinel lymph node biopsy while maintaining high survival rates (>98%) or were restratified as being at a higher or lower risk of recurrence or death. LIMITATIONS Multicenter, retrospective study. CONCLUSION Integrating clinicopathologic features with the 31-GEP optimizes patient risk stratification compared to clinicopathologic features alone.
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Affiliation(s)
- Abel Jarell
- Northeast Dermatology Associates, PC, Portsmouth, New Hampshire
| | | | - Larry D Dillon
- Surgical Oncology & General Surgery, Colorado Springs, Colorado
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, Missouri
| | - Sebastian Podlipnik
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Kyle R Covington
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Robert W Cook
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas.
| | | | - Ann P Quick
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Brian J Martin
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Sarah J Kurley
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | | | - Susana Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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Barricklow Z, DiVincenzo MJ, Angell CD, Carson WE. Ulcerated Cutaneous Melanoma: A Review of the Clinical, Histologic, and Molecular Features Associated with a Clinically Aggressive Histologic Phenotype. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:1743-1757. [PMID: 36065342 PMCID: PMC9440663 DOI: 10.2147/ccid.s372287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/02/2022] [Indexed: 12/05/2022]
Abstract
The presence of ulceration in melanoma is associated with poor clinical outcomes and is the third most powerful predictor of survival in the AJCC Melanoma Staging System after tumor thickness and mitotic activity. The aggressive biological behavior associated with ulceration has been hypothesized to be the result of an intrinsic biological attribute that favors dissemination and presents locally with the loss of epidermal integrity. Among the features of ulcerated melanoma, many show promise as potential prognostic tools, markers of differential immunogenicity and indicators of oncogenic drivers of invasion and metastasis. The incidence of ulcerated melanoma is greater in males, increases with age and with systemic inflammatory risk factors (diabetes, smoking, low vitamin D, elevated body mass index). Patients with ulcerated primary tumors seem to exclusively benefit from adjuvant interferon (IFN) therapy, which is likely the consequence of an altered tumor microenvironment. When ulceration is present, there is a higher density of macrophages and dendritic cells and enhanced expression of pro-inflammatory cytokines, such as IL-6. There is also an increased expression of proteins involved in tumor antigen presentation in ulcerated melanomas. Histologically, vascular density, vasculogenic mimicry and angiotropism are all significantly correlated with ulceration in melanoma. The presence of ulceration is associated with reduced protein expression of E-cadherin and PTEN and elevated levels of N-cadherin and the matrix metalloproteinases. Differential microRNA expression also holds promise as a potential prognostic biomarker of malignancy and disease spread within the setting of ulceration. However, the molecular and cellular differences associated with the ulcerated state are complex and further study will aid in determining how these differences can be harnessed to improve care for patients with melanoma.
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Affiliation(s)
- Zoe Barricklow
- The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio, State University, Columbus, OH, USA
| | - Mallory J DiVincenzo
- The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio, State University, Columbus, OH, USA
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA
| | - Colin D Angell
- The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio, State University, Columbus, OH, USA
| | - William E Carson
- The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio, State University, Columbus, OH, USA
- Correspondence: William E Carson, The Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA, Tel +1 614 293-6306, Fax +2 614 293-3465, Email
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Straker RJ, Krupp K, Sharon CE, Thaler AS, Kelly NJ, Chu EY, Elder DE, Xu X, Miura JT, Karakousis GC. Prognostic Significance of Primary Tumor-Infiltrating Lymphocytes in a Contemporary Melanoma Cohort. Ann Surg Oncol 2022; 29:5207-5216. [PMID: 35301610 PMCID: PMC9704356 DOI: 10.1245/s10434-022-11478-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prognostic impact of tumor-infiltrating lymphocytes (TILs) on outcomes and treatment efficacy for patients with melanoma in the contemporary era remains poorly characterized. METHODS Consecutive patients who underwent wide excision and sentinel lymph node biopsy for cutaneous melanoma 1 mm thick or thicker at a single institution were identified (2006-2019). The patients were stratified based on primary tumor TIL status as brisk (bTILs), non-brisk (nbTILs), or absent (aTILs). Associations between patient factors and outcomes were analyzed using multivariable analysis. RESULTS Of the 1017 patients evaluated, 846 (83.2 %) had primary TILs [nbTILs (n = 759, 89.7 %) and bTILs (n = 87, 10.3 %)]. In the multivariable analysis, the patients with any type of TILs had higher rates of regression [odds ratio (OR), 1.86; p = 0.016], lower rates of acral lentiginous histology (OR, 0.22; p < 0.001), and lower rates of SLN positivity (OR, 0.64; p = 0.042) than those without TILs. The multivariable analysis found no association between disease-specific survival and bTILs [hazard ratio (HR), 1.04; p = 0.927] or nbTILs (HR, 0.89; p = 0.683). An association was found between bTILs and recurrence-free survival (RFS) advantage [bTILs (HR 0.46; p = 0.047), nbTILs (HR 0.71; p = 0.088)], with 5-year RFS rates of 84 % for bTILs, 71.8 % for nbTILs, and 68.4 % for aTILs (p = 0.044). For the 114 immune checkpoint blockade (ICB)-naïve patients who experienced a recurrence treated with ICB therapy, no association was observed between progression-free survival and bTILs (HR, 0.64; p = 0.482) or nbTILs (HR, 0.58; p = 0.176). CONCLUSIONS The prognostic significance of primary TILs in the contemporary melanoma era appears complex. Further studies characterizing the phenotype of TILs and their association with regional metastasis and responsiveness to ICB therapy are warranted.
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Affiliation(s)
- Richard J Straker
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Hospital of the University of Pennsylvania, 4 Maloney, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Katharine Krupp
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cimarron E Sharon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra S Thaler
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas J Kelly
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John T Miura
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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7
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Straker RJ, Taylor LA, Neuwirth MG, Sinnamon AJ, Shannon AB, Abbott J, Miura JT, Chu EY, Xu X, Karakousis GC. Optimizing Detection of Lymphatic Invasion in Primary Cutaneous Melanoma With the Use of D2-40 and a Paired Melanocytic Marker. Am J Dermatopathol 2022; 44:21-27. [PMID: 34231497 PMCID: PMC8671172 DOI: 10.1097/dad.0000000000002018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Dual immunohistochemical (IHC) staining with D2-40 and S100 improves detection of lymphatic invasion (LI) in primary cutaneous melanoma. However, limited data exist evaluating this technique using other melanocytic markers, and thus, the optimal marker for detection of LI is unestablished. To address this knowledge gap, a case-control study was performed comparing melanoma specimens from 22 patients with known lymphatic spread (LS) with a control group of 11 patients without LS. Specimens underwent dual IHC staining with D2-40 and MART-1, SOX-10, and S100 to evaluate for LI. Receiver operating characteristic analysis was used to estimate each stain's accuracy for detection of LI. The LS group was more likely to be ≥65 years (P = 0.04), have a tumor thickness of ≥1 mm (P < 0.01), and have ulcerated tumors (P = 0.02). Detection of LI with D2-40/MART-1 significantly correlated with LS (P = 0.03), and the D2-40/MART-1 stain was most accurate for LI based on receiver operating characteristic curve analysis (area under the curve [AUC] 0.705) in comparison with D2-40/SOX-10 (AUC 0.575) and D2-40/S100 (AUC 0.633). These findings suggest that MART-1 may be the optimal melanocytic marker to combine with D2-40 for detection of LI in melanoma. Further studies are needed to determine the utility of routinely performing these stains for histopathologic analysis of melanoma.
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Affiliation(s)
- Richard J. Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Laura A. Taylor
- Department of Dermatology, University of Louisville, Louisville, KY
| | | | | | - Adrienne B. Shannon
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - James Abbott
- Department of Dermatology, University of Utah, Salt Lake City, UT
| | - John T. Miura
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Emily Y. Chu
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Giorgos C. Karakousis
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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8
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Bayram A, Ozturk Sari S, Ozluk Y, Tas F, Buyukbabani N. Multiple combinations of melanocytic and vascular endothelial markers enhance the detection rate of lymphovascular invasion in cutaneous melanoma. J Cutan Pathol 2021; 48:472-478. [PMID: 32935876 DOI: 10.1111/cup.13874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is believed to be the mechanism by which melanoma cells can disseminate to regional lymph nodes and distant sites and may be predictive of adverse outcome. Lymphovascular invasion often difficult to detect on hematoxylin-eosin (HE) stained sections, are readily identified with dual immunohistochemistry (IHC) for melanocytic and vascular markers. METHODS A total of 100 primary cutaneous malignant melanoma cases that had a Breslow thickness of 1-4 mm and lacked LVI by conventional HE assessment were included. We compared the LVI detection rates of double staining for CD31/S100 and CD34/S100, and D2-40/S100, and examined the association of LVI with clinical outcomes. RESULTS The dual immunohistochemical positivity for CD31/S100, CD34/S100, and D2-40/S100 were 40(40%), 17(17%) and 35(35%), respectively. On multivariate analysis, LVI was an independent predictor of SLN status. Multivariate analysis revealed that LVI and male gender were independent risk factors for overall survival. CONCLUSIONS The recognition of LVI is improved by dual IHC and predicts SLN metastasis. The detection of LVI using dual IHC, especially by a combination of CD31/S100 and D2-40/S100 is a useful step that inclusion should be recommended in basic evaluation parameters for cutaneous melanoma.
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Affiliation(s)
- Aysel Bayram
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Sule Ozturk Sari
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Yasemin Ozluk
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Faruk Tas
- Institute of Oncology, University of Istanbul, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
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9
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Rajović M, Jaukovic L, Kandolf Sekulovic L, Radulovic M, Petrov N, Mijuskovic Z, Stepic N, Nikolic Z. Regional Lymph Node Metastases in Cutaneous Melanoma: A Single-Center Analysis from Southeast Europe. Scand J Surg 2021; 110:498-503. [PMID: 33586532 DOI: 10.1177/1457496921992936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Sentinel lymph node biopsy is the standard of care for nodal staging in clinically node-negative melanoma patients. Our goal was to present 10-year results of sentinel lymph node biopsy at our institution and to evaluate the clinicopathologic factors as potential predictors of sentinel lymph node and non-sentinel lymph node metastatic involvement in patients with cutaneous melanoma. METHODS We have analyzed clinicopathologic and lymphoscintigraphic characteristics in 420 patients with cutaneous melanoma who underwent sentinel lymph node biopsy between 2010 and 2019. In addition, we have examined the results of group of patients with positive sentinel lymph node biopsy undergoing complete lymph node dissection. RESULTS The overall detection rate of sentinel lymph node biopsies was 97.1%, of which 18.8% was metastatic. Drainage to one regional basin was seen in 345 patients (83.1%) and to multiple drainage regions in 71 patients (17%). In-transit lymph nodes were detected in 20 patients. On univariate logistic regression analysis, male gender, primary tumor thickness with nodular histology, acral location, presence of ulceration, and the number of nodes harvested were significantly associated with sentinel lymph node biopsy status (p < 0.05). On multivariate analysis, the Breslow thickness was the only independent predictor of sentinel lymph node biopsy status. The metastases in non-sentinel lymph node found in 26 patients with positive sentinel lymph node (35.6%) correlated on univariate, as well as on multivariate logistic regression, with tumor subtype and number of sentinel lymph node harvested. CONCLUSION In addition to the well-established primary tumor thickness as a predictor of sentinel lymph node biopsy positivity, we observed acral location and nodular melanoma subtype to significantly enhance the risk of metastases in sentinel lymph node(s). Primary tumor histology and number of nodes harvested were the only statistically significant variables predicting the non-sentinel lymph node status on multivariate analysis. Lymphoscintigraphy imaging characteristics were not significantly associated with sentinel lymph node status.
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Affiliation(s)
- M Rajović
- Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - L Jaukovic
- Institute of Nuclear Medicine, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - L Kandolf Sekulovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - M Radulovic
- Institute of Nuclear Medicine, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - N Petrov
- Center of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia
| | - Z Mijuskovic
- Department of Dermatology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - N Stepic
- Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Z Nikolic
- Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
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10
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Hawryluk EB, Moustafa D, Bartenstein D, Brahmbhatt M, Cordoro K, Gardner L, Gauthier A, Grossman D, Gupta D, Hunt RD, Jen M, Kao PC, Kruse LL, Lawley LP, London WB, Mansour D, O'Haver JA, Phung T, Pope E, Price HN, Rogers T, Shah SD, Wolner Z, Huang J, Marghoob AA. A retrospective multicenter study of fatal pediatric melanoma. J Am Acad Dermatol 2020; 83:1274-1281. [DOI: 10.1016/j.jaad.2020.06.1010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
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11
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Jung JM, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Lymphatic invasion in acral and non-acral melanoma: a comparative, clinicoprognostic study of primary cutaneous melanoma according to tumour site. Pathology 2020; 52:670-675. [PMID: 32819739 DOI: 10.1016/j.pathol.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022]
Abstract
There have been limited studies comparing the clinical significance of lymphatic invasion in melanoma according to tumour site. The objective of this study was to evaluate the impact of lymphatic invasion on the clinicoprognostic features of acral and non-acral melanoma. Clinical and histopathological features and survival outcomes of 532 patients with acral melanoma or non-acral melanoma in the database of the Asan Medical Center, Korea, were retrospectively evaluated according to the presence of lymphatic invasion. Lymphatic invasion was significantly more common in acral melanoma than non-acral melanoma. In acral melanoma, lymphatic invasion was significantly associated with a higher frequency of lymph node involvement and advanced stages, but not associated with Breslow thickness or visceral dissemination. By contrast, lymphatic invasion in non-acral melanoma was significantly associated with a higher rate of visceral involvement, deeper Breslow thickness, as well as a higher rate of lymph node involvement and advanced stages. When acral melanoma and non-acral melanoma both with lymphatic invasion were compared, Breslow thickness was significantly shallower and vertical growth phase was significantly less common in acral melanoma. Meanwhile, visceral involvement was significantly more frequent in non-acral melanoma than acral melanoma. In conclusion, lymphatic invasion was more common in acral melanoma than non-acral melanoma and occurred in acral melanoma cases with relatively thin Breslow thickness, suggesting acral melanoma is lymphotropic.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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12
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Pathology-based Biomarkers Useful for Clinical Decisions in Melanoma. Arch Med Res 2020; 51:827-838. [PMID: 32950263 DOI: 10.1016/j.arcmed.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
The dramatic recent advances in therapy of melanoma require a more personalized and precise diagnostic approach to aid in clinical decisions. Tissue-based biomarkers in pathology have diagnostic, prognostic and predictive relevance. Herein we review the most commonly used pathology-based biomarkers in melanoma. Most of these biomarkers are evaluated through immunohistochemistry (IHC) or fluorescent in situ hybridization (FISH) performed on formalin fixed paraffin embedded tissue (FFPE), and are widely available in clinical pathology laboratories. We describe the utility of MART1/Ki67, p16, PRAME, markers of lymphovascular invasion (D2-40, CD31, D2-40/MITF, CD31/SOX-10), BRAF V600E, NRAS, KIT, BAP1, ALK, NTRK, PD-L1, TERT, PTEN, iNOS, and MMR proteins (MLH1, MSH2, MSH6, PMS2) in the evaluation of melanoma specimens. Correct interpretation and awareness of the significance of these biomarkers is crucial for pathologists, dermatologists, and oncologists who take care of melanoma patients.
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13
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Bellomo D, Arias-Mejias SM, Ramana C, Heim JB, Quattrocchi E, Sominidi-Damodaran S, Bridges AG, Lehman JS, Hieken TJ, Jakub JW, Pittelkow MR, DiCaudo DJ, Pockaj BA, Sluzevich JC, Cappel MA, Bagaria SP, Perniciaro C, Tjien-Fooh FJ, van Vliet MH, Dwarkasing J, Meves A. Model Combining Tumor Molecular and Clinicopathologic Risk Factors Predicts Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. JCO Precis Oncol 2020; 4:319-334. [PMID: 32405608 PMCID: PMC7220172 DOI: 10.1200/po.19.00206] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose More than 80% of patients who undergo sentinel lymph node (SLN) biopsy have no nodal metastasis. Here we describe a model that combines clinicopathologic and molecular variables to identify patients with thin and intermediate thickness melanomas who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis. Patients and Methods Genes with functional roles in melanoma metastasis were discovered by analysis of next generation sequencing data and case control studies. We then used PCR to quantify gene expression in diagnostic biopsy tissue across a prospectively designed archival cohort of 754 consecutive thin and intermediate thickness primary cutaneous melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. A penalized maximum likelihood estimation algorithm was used to train logistic regression models in a repeated cross validation scheme to predict the presence of SLN metastasis from molecular, clinical and histologic variables. Results Expression of genes with roles in epithelial-to-mesenchymal transition (glia derived nexin, growth differentiation factor 15, integrin β3, interleukin 8, lysyl oxidase homolog 4, TGFβ receptor type 1 and tissue-type plasminogen activator) and melanosome function (melanoma antigen recognized by T cells 1) were associated with SLN metastasis. The predictive ability of a model that only considered clinicopathologic or gene expression variables was outperformed by a model which included molecular variables in combination with the clinicopathologic predictors Breslow thickness and patient age; AUC, 0.82; 95% CI, 0.78-0.86; SLN biopsy reduction rate of 42% at a negative predictive value of 96%. Conclusion A combined model including clinicopathologic and gene expression variables improved the identification of melanoma patients who may forgo the SLN biopsy procedure due to their low risk of nodal metastasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mark A Cappel
- Mayo Clinic, Jacksonville, FL, USA.,Gulf Coast Dermatopathology Laboratory, Tampa, FL, USA
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14
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Hyams DM, Cook RW, Buzaid AC. Identification of risk in cutaneous melanoma patients: Prognostic and predictive markers. J Surg Oncol 2019; 119:175-186. [PMID: 30548543 PMCID: PMC6590387 DOI: 10.1002/jso.25319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/15/2018] [Indexed: 12/23/2022]
Abstract
New therapeutic modalities for melanoma promise benefit in selected individuals. Efficacy appears greater in patients with lower tumor burden, suggesting an important role for risk-stratified surveillance. Robust predictive markers might permit optimization of agent to patient, while low-risk prognostic markers might guide more conservative management. This review evaluates protein, gene, and multiplexed marker panels that may contribute to better risk assessment and improved management of patients with cutaneous melanoma.
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Affiliation(s)
- David M. Hyams
- Desert Surgical Oncology, Eisenhower Medical CenterRancho MirageCalifornia
| | - Robert W. Cook
- R&D and Medical Affairs, Castle Biosciences, IncFriendswoodTexas
| | - Antonio C. Buzaid
- Oncology Center, Hospital Israelita Albert EinsteinSão PauloBrazil
- Centro Oncológico Antonio Ermírio de Moraes, Beneficência Portuguesa de São PauloSão PauloBrazil
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15
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Jaukovic L, Rajović M, Kandolf Sekulovic L, Radulovic M, Stepic N, Mijuskovic Z, Petrov N, Ajdinovic B. Time to Procedure, Nuclear Imaging and Clinicopathological Characteristics as Predictive Factors for Sentinel Lymph Node Metastasis in Cutaneous Melanoma: A Single-Center Analysis. Ann Plast Surg 2018; 81:80-86. [PMID: 29762449 DOI: 10.1097/sap.0000000000001465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sentinel lymph node (SLN) biopsy is a widely accepted staging procedure for cutaneous melanoma patients who are at risk of clinically occult nodal metastases. Numerous predictive factors for regional lymph node metastases have been identified; however, few have been found to be reproducibly significant. Also, the role of blue dye in identification was questioned in recent trials. Time to procedure was also found to be predictive of SLN positivity, but this was not confirmed in other studies. In our study, predictive factors for metastatic involvement of SLN were analyzed, together with the role of addition blue dye in imaging on detection rate and false-negative SLN rate. An impact of time interval to procedure on the rate of SLN positivity was also explored. METHODS Data analysis was done in 362 cutaneous melanoma patients who underwent lymphoscintigraphy and SLN biopsy at our institution from 2010 to 2016, with a median follow-up of 29 months (1-98 months). To delineate the relation of each variable (demographical, time to procedure, and clinical and pathological variables, as well as the presence of in-transit nodes, the number of draining basins, and SLN localization on scintigraphy) with positive SLN status, we used univariate logistic regression with odds ratios representing effect size. RESULTS Metastatic involvement SLN was found in 67 (18.8%) of 356 patients. Detection rate was similar with or without further intraoperative SLN identification with blue dye (98.8% vs 98.17%, P > 0.05). Time to procedure was not associated with higher SLN positivity rate (P > 0.05). In univariate analysis, Breslow thickness (P < 0.001), primary ulceration lesion (P = 0.001), and lymphovascular invasion (P = 0.006) were strongly correlated with SLN positivity, as well as the site of primary tumor (P = 0.024), tumor-infiltrating lymphocytes (TILs) (P = 0.021), and sex (P = 0.026). In multivariate analysis, Breslow thickness and TILs were found to be significant independent predictors of SLN status (P < 0.05). CONCLUSIONS Addition of blue dye did not improve SLN detection rate; time to procedure was not found to be associated with higher SLN biopsy positivity rates. Breslow thickness and TILs, as a marker of immune response to tumor, were consistently found to be significant independent predictors of SLN status.
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Affiliation(s)
| | | | | | | | | | | | - Nenad Petrov
- Institute of Pathology and Forensic Medicine Interdisciplinary Melanoma Team, Military Medical Academy, Belgrade, Serbia
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16
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Nurdjaja V, Yozu M, Mathy JA. Essential Components of Melanoma Histopathological Reporting: The Surgical Oncologist's Perspective. J Skin Cancer 2018; 2018:9838410. [PMID: 29854464 PMCID: PMC5954935 DOI: 10.1155/2018/9838410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/10/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
Abstract
Histopathological reporting plays a critical role in guiding the surgical oncologist's management plan in treatment of primary cutaneous melanoma. The International Collaboration on Cancer Reporting (ICCR) espouses various components of structured histopathological reporting as "essential" or "recommended." From a surgical oncologist's perspective, we discuss the clinical relevance of each essential component, as well as prognostic and treatment implications with regard to treatment planning.
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Affiliation(s)
- Vinka Nurdjaja
- University of Auckland School of Medicine, Auckland, New Zealand
| | - Masato Yozu
- Histopathology Department, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Jon A. Mathy
- University of Auckland School of Medicine, Auckland, New Zealand
- Plastic Surgery Unit, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
- New Zealand Melanoma Institute, Auckland, New Zealand
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17
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Moy AP, Mochel MC, Muzikansky A, Duncan LM, Kraft S. Lymphatic invasion predicts sentinel lymph node metastasis and adverse outcome in primary cutaneous melanoma. J Cutan Pathol 2017; 44:734-739. [PMID: 28555886 DOI: 10.1111/cup.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) metastasis is a powerful predictor of survival in primary cutaneous melanoma. Lymphatic invasion (LI) may correlate with increased risk of SLN metastasis. Intralymphatic metastases, often difficult to detect on hematoxylin and eosin (H&E) stained sections, are readily identified with dual immunohistochemistry for melanocytic and lymphatic markers. METHODS We used dual S100/D240 immunohistochemistry to detect LI in 125 melanomas from patients who underwent SLN biopsy and correlated LI with melanoma staging parameters and disease status. RESULTS Dual immunohistochemistry allowed for the identification of LI in 33 cases (26%), compared to only 2% on H&E stained sections. Melanomas with LI showed greater thickness, higher mitotic rate and more frequent ulceration. Eleven of 33 cases with LI (33%) and 10 of 92 cases without LI (11%) were associated with a positive SLN (P = .006). More patients without LI were disease-free at last follow-up (80%) than patients with LI (50%; P = .002); LI was significantly associated with decreased progression-free survival. CONCLUSION The detection of LI is improved by dual immunohistochemistry and predicts SLN metastasis. The presence of LI may impact therapeutic planning in melanoma, such as the decision to perform a SLN biopsy.
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Affiliation(s)
- Andrea P Moy
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark C Mochel
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Stefan Kraft
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
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18
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Hayashi T, Furukawa H, Kitamura T, Shichinohe R, Murao N, Oyama A, Funayama E, Maeda T, Yamamoto Y. Review and proposal of regional surgical management for melanoma: revisiting of integumentectomy and incontinuity dissection in treatment of skin melanoma. Int J Clin Oncol 2017; 22:569-576. [PMID: 28064397 DOI: 10.1007/s10147-016-1085-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Past studies showed that integumentectomy and incontinuity could be effective procedures in the surgical management of melanoma patients. The present study reports on the historical background of these procedures. In addition, we analyze the ICG assisted integumentectomy and incontinuity techniques and algorithms that we had created when performing this procedure. METHOD In accordance with our algorithm, we performed ICG assisted integumentectomy/incontinuity procedures on 17 patients with stage III melanomas between 2008 and 2016. We also investigated the locoregional recurrence rate in a control group comprising 60 patients at stage III without using the algorithm. RESULTS The former group exhibited a tendency of locoregional recurrence rate suppression. Melanoma cells in the dissected intervening tissue were microscopically identified in 2 out of 17 cases. CONCLUSIONS Our ICG assisted integumentectomy or incontinuity procedures could be effective in controlling locoregional recurrence rates in melanoma cases. Moreover, our method can be generally applied because the dissection is only performed within the lymphatic pathway region identified using indocyanine green.
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Affiliation(s)
- Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo, 060-8586, Japan.
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Takashi Kitamura
- Department of Plastic and Reconstructive Surgery, Obihiro-Kosei General Hospital, Nishi 6, Minami 8, Obihiro, 080-0016, Japan
| | - Ryuji Shichinohe
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Akihiko Oyama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Emi Funayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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19
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Magno RJ, Perper M, Eber AE, Cervantes J, Verne SH, Tsatalis J, Nouri K. Cells to Surgery Quiz: May 2017. J Invest Dermatol 2017; 137:e55. [PMID: 30477723 DOI: 10.1016/j.jid.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J Magno
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Perper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ariel E Eber
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sebastian H Verne
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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20
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Moy AP, Duncan LM, Kraft S. Lymphatic invasion and angiotropism in primary cutaneous melanoma. J Transl Med 2017; 97:118-129. [PMID: 27991909 DOI: 10.1038/labinvest.2016.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022] Open
Abstract
Access of melanoma cells to the cutaneous vasculature either via lymphatic invasion or angiotropism is a proposed mechanism for metastasis. Lymphatic invasion is believed to be a mechanism by which melanoma cells can disseminate to regional lymph nodes and to distant sites and may be predictive of adverse outcomes. Although it can be detected on hematoxylin- and eosin-stained sections, sensitivity is markedly improved by immunohistochemistry for lymphatic endothelial cells. Multiple studies have reported a significant association between the presence of lymphatic invasion and sentinel lymph node metastasis and survival. More recently, extravascular migratory metastasis has been suggested as another means by which melanoma cells can spread. Angiotropism, the histopathologic correlate of extravascular migratory metastasis, has also been associated with melanoma metastasis and disease recurrence. Although lymphatic invasion and angiotropism are not currently part of routine melanoma reporting, the detection of these attributes using ancillary immunohistochemical stains may be useful in therapeutic planning for patients with melanoma.
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Affiliation(s)
- Andrea P Moy
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Lyn M Duncan
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kraft
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, MA, USA
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21
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Zenga J, Nussenbaum B, Cornelius LA, Linette GP, Desai SC. Management Controversies in Head and Neck Melanoma. JAMA FACIAL PLAST SU 2017; 19:53-62. [DOI: 10.1001/jamafacial.2016.1038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Lynn A. Cornelius
- Department of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Gerald P. Linette
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Shaun C. Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins University School of Medicine, Bethesda, Maryland
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22
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Desch A, Gebhardt C, Utikal J, Schneider SW. D-dimers in malignant melanoma: Association with prognosis and dynamic variation in disease progress. Int J Cancer 2016; 140:914-921. [PMID: 27813063 DOI: 10.1002/ijc.30498] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023]
Abstract
Malignant cells elicit a chronic hemostatic activation in disease progress. This procoagulant activity does not only bear a risk for thromboembolism but also facilitates tumor growth and dissemination. An elevated plasma D-dimer level indicates an activated coagulation and fibrinolysis. In this study, the association of D-dimer levels with clinicopathological parameters and patients outcome in melanoma was investigated analyzing in total 533 melanoma patients retrospectively. Using the cut-off point of 0.6 mg/L D-dimer 145 of the total 533 patients (27.2%) were identified with elevated plasma D-dimer levels. This increased D-dimer level positively correlated with tumor thickness (p = 0.0003), lymph node invasion (p = 0.0004) and metastatic state (p <0.0001). To assess the association of D-dimer levels with progression-free survival (PFS) and overall survival (OS), long-rank test and the Cox proportional hazard model was performed. Univariate analyses revealed that elevated D-dimer levels were significantly associated with decreased PFS (HR:2.89, 95% CI (2.07-7.56), p < 0.0001) and OS (HR:2.22, 95% CI (1.06-4.57), p = 0.035). Moreover, multivariate analyses identified elevated D-dimer levels being associated with poor disease outcome (PFS:HR:2.47, 95% CI (1.23-4.98), p = 0.012; OS:HR:2.01, 95% CI (0.09-4.45), p = 0.087). Additionally, D-dimer levels were significantly increased in terminal stage patients when comparing plasma levels 0-8 versus 24-48 weeks before death (p = 0.0003). In summary, this study presents multiple evidence that elevated D-dimer levels in melanoma patients associate with poor prognosis and therefore plasma levels of D-dimers could reveal a more aggressive phenotype of melanoma and may guide the management of anti-melanoma treatment including the concept of an anti-coagulatory therapy in tumor patients.
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Affiliation(s)
- Anna Desch
- Experimental Dermatology, Department of Dermatology, Venereology, and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Christoffer Gebhardt
- Department of Dermatology, Venereology, and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany.,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Utikal
- Department of Dermatology, Venereology, and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany.,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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23
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Tas F, Erturk K. Histological lymphovascular invasion is associated with nodal involvement, recurrence, and survival in patients with cutaneous malignant melanoma. Int J Dermatol 2016; 56:166-170. [DOI: 10.1111/ijd.13405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/09/2016] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Faruk Tas
- Institute of Oncology; University of Istanbul; Istanbul Turkey
| | - Kayhan Erturk
- Institute of Oncology; University of Istanbul; Istanbul Turkey
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24
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Tatti O, Gucciardo E, Pekkonen P, Holopainen T, Louhimo R, Repo P, Maliniemi P, Lohi J, Rantanen V, Hautaniemi S, Alitalo K, Ranki A, Ojala PM, Keski-Oja J, Lehti K. MMP16 Mediates a Proteolytic Switch to Promote Cell-Cell Adhesion, Collagen Alignment, and Lymphatic Invasion in Melanoma. Cancer Res 2015; 75:2083-94. [PMID: 25808867 DOI: 10.1158/0008-5472.can-14-1923] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 03/16/2015] [Indexed: 12/13/2022]
Abstract
Lymphatic invasion and accumulation of continuous collagen bundles around tumor cells are associated with poor melanoma prognosis, but the underlying mechanisms and molecular determinants have remained unclear. We show here that a copy-number gain or overexpression of the membrane-type matrix metalloproteinase MMP16 (MT3-MMP) is associated with poor clinical outcome, collagen bundle assembly around tumor cell nests, and lymphatic invasion. In cultured WM852 melanoma cells derived from human melanoma metastasis, silencing of MMP16 resulted in cell-surface accumulation of the MMP16 substrate MMP14 (MT1-MMP) as well as L1CAM cell adhesion molecule, identified here as a novel MMP16 substrate. When limiting the activities of these trans-membrane protein substrates toward pericellular collagen degradation, cell junction disassembly, and blood endothelial transmigration, MMP16 supported nodular-type growth of adhesive collagen-surrounded melanoma cell nests, coincidentally steering cell collectives into lymphatic vessels. These results uncover a novel mechanism in melanoma pathogenesis, whereby restricted collagen infiltration and limited mesenchymal invasion are unexpectedly associated with the properties of the most aggressive tumors, revealing MMP16 as a putative indicator of adverse melanoma prognosis.
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Affiliation(s)
- Olga Tatti
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Translational Cancer Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Gucciardo
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirita Pekkonen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Tanja Holopainen
- Translational Cancer Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Louhimo
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pauliina Repo
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pilvi Maliniemi
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Rantanen
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sampsa Hautaniemi
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari Alitalo
- Translational Cancer Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annamari Ranki
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi M Ojala
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland. Finnish Cancer Institute, Helsinki, Finland
| | - Jorma Keski-Oja
- Translational Cancer Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Lehti
- Research Programs Unit, Genome-Scale Biology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Finnish Cancer Institute, Helsinki, Finland.
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25
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Aung PP, Leone D, Feller JK, Yang S, Hernandez M, Yaar R, Singh R, Helm T, Mahalingam M. Microvessel density, lymphovascular density, and lymphovascular invasion in primary cutaneous melanoma-correlation with histopathologic prognosticators and BRAF status. Hum Pathol 2015; 46:304-12. [PMID: 25537974 DOI: 10.1016/j.humpath.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 02/01/2023]
Abstract
The relationship between microvessel density (MVD), lymphovascular density (LVD), and lymphovascular invasion (LVI) in primary cutaneous melanoma (PCM) remains unclear. Given this, a total of 102 PCMs were assessed for MVD (vascular endothelial growth factor receptor 2 and Endocan), LVD (D2-40), and LVI (immunostaining with D2-40/S-100 and hematoxylin and eosin); tumoral S-100A13, vascular endothelial growth factor receptor 2, and Endocan; and BRAF status. LVD was associated with MVD (P = .01). MVD was higher in PCMs with depth greater than or equal to 2 mm and ulceration (P = .04, .05), whereas LVD was higher in PCMs with depth greater than or equal to 2 mm and mitoses (P = .03, .02). After adjusting for MVD and LVD, only ulceration was associated with LVI (P < .02). A BRAF mutation was seen in 30.4% cases, and when present, both LVD and host response (P = .0008 and .04, respectively) were significantly associated with MVD. Immunostaining with S-100A13 was noted in 99% of cases and a significant association noted only with ulceration (P = .05). Immunostaining increased LVI positivity (46.5% versus 4.9% by hematoxylin and eosin, P < .0001). MVD and LVD are not associated with LVI, appear to be closely related with each other, and are associated with select markers of poor prognosticative value. The association between a host response and LVD and MVD in PCMs with a BRAF mutation suggests that they exhibit potential for strategizing immunotherapies.
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Affiliation(s)
- Phyu Phyu Aung
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118.
| | - Dominick Leone
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118.
| | - John Kyle Feller
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118.
| | - Shi Yang
- Department of Pathology, Boston University School of Medicine, Boston, MA 02118.
| | - Marier Hernandez
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX 75390.
| | - Ron Yaar
- Aurora Diagnostics, Greensboro, NC 27408.
| | - Rajendra Singh
- Departments of Dermatology and Pathology, Mt Sinai School of Medicine, New York, NY 10029.
| | - Thomas Helm
- Department of Dermatology, State University of New York at Buffalo, Buffalo, NY 14203.
| | - Meera Mahalingam
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118.
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Maurichi A, Miceli R, Camerini T, Mariani L, Patuzzo R, Ruggeri R, Gallino G, Tolomio E, Tragni G, Valeri B, Anichini A, Mortarini R, Moglia D, Pellacani G, Bassoli S, Longo C, Quaglino P, Pimpinelli N, Borgognoni L, Bergamaschi D, Harwood C, Zoras O, Santinami M. Prediction of survival in patients with thin melanoma: results from a multi-institution study. J Clin Oncol 2014; 32:2479-85. [PMID: 25002727 DOI: 10.1200/jco.2013.54.2340] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. PATIENTS AND METHODS Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. RESULTS Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). CONCLUSION Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.
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Affiliation(s)
- Andrea Maurichi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece.
| | - Rosalba Miceli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Tiziana Camerini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Luigi Mariani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberto Patuzzo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Ruggeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gianfranco Gallino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Elena Tolomio
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gabrina Tragni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Barbara Valeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Andrea Anichini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Mortarini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Moglia
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Giovanni Pellacani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Sara Bassoli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Caterina Longo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Pietro Quaglino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Nicola Pimpinelli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Lorenzo Borgognoni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Bergamaschi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Catherine Harwood
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Odysseas Zoras
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Mario Santinami
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
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Xu X, Gimotty PA, Guerry D, Karakousis G, Elder DE. Lymphatic invasion as a prognostic biomarker in primary cutaneous melanoma. Methods Mol Biol 2014; 1102:275-86. [PMID: 24258984 PMCID: PMC4918087 DOI: 10.1007/978-1-62703-727-3_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Melanoma has a propensity for lymph node metastasis. However, the incidence of lymphatic invasion detected by histology alone in primary melanoma is disproportionately low in comparison to the incidence of positive sentinel lymph nodes (SLN). With the discovery of lymphatic endothelial cell markers, such as podoplanin and LYVE-1, lymphatic vessels can be reliably detected in formalin-fixed paraffin-embedded (FFPE) tissues. There is a now consensus that lymphatic invasion detected by immunohistochemical stains in primary melanoma is much more common than previously reported by histological examination alone. Immunohistochemical stains show that lymphangiogenesis and lymphatic invasion in primary melanoma may occur intratumorally or peritumorally, and lymphatic invasion is common across the range of tumor thicknesses in primary vertical growth phase (VGP) melanomas. A number of studies have shown that lymphatic invasion in primary melanoma is associated with a positive sentinel lymph node biopsy and a worse clinical outcome. Although not currently a part of the standard of care for staging of melanoma, the detection of lymphatic invasion in primary melanoma using immunohistochemical markers may be helpful in planning of therapy in some cases and may find a routine role in primary melanoma microscopic attributes in future.
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Affiliation(s)
- Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of University of Pennsylvania, Philadelphia, PA, USA
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Egger ME, Stepp LO, Callender GG, Quillo AR, Martin RCG, Scoggins CR, Stromberg AJ, McMasters KM. Outcomes and prognostic factors in superficial spreading melanoma. Am J Surg 2013; 206:861-7; discussion 867-8. [PMID: 24124662 DOI: 10.1016/j.amjsurg.2013.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prognostic factors and risk factors for positive sentinel lymph node (SLN) biopsy results are important to identify in superficial spreading melanoma (SSM). METHODS A single-center database and a prospective clinical trial database were reviewed for all patients with diagnoses of SSM. Logistic regression, Kaplan-Meier survival analysis, and univariate and multivariate Cox models were used. RESULTS A total of 1,643 patients with SSM were identified. Independent risk factors for positive SLN biopsy results were Breslow thickness (BT) ≥2.0 mm, age <60 years, and presence of ulceration. BT ≥2.0 mm, ulceration, lymphovascular invasion, and positive SLN and positive non-SLN biopsy results were independent risk factors for worse disease-free survival. Independent overall survival risk factors included BT ≥2.0 mm, age ≥60 years, ulceration, nonextremity tumor location, lymphovascular invasion, and positive SLN biopsy results. CONCLUSIONS BT, ulceration, lymphovascular invasion, and SLN and non-SLN status are important risk factors for SSM.
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Affiliation(s)
- Michael E Egger
- Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY 40202, USA
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Is ulceration in cutaneous melanoma just a prognostic and predictive factor or is ulcerated melanoma a distinct biologic entity? Curr Opin Oncol 2012; 24:137-40. [DOI: 10.1097/cco.0b013e32834fcb0d] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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