Tumor cell migration involved in metastases is a tightly regulated, nonrandom process. Chemokines have been identified as critical molecules guiding cell migration. We performed a prospective study to analyze a possible association between the expression of chemokine receptors CXCR3 and CXCR4 by primary melanoma and clinical outcome. Forty primary melanomas were available for analysis; 57% of the tumors expressed CXCR3 and 35% expressed CXCR4 by melanoma cells. At initial diagnosis, 5 patients had subclinical lymph node involvement and after a median follow-up time of 32 months, 2 additional patients developed regional lymph node metastases and 5 patients developed distant metastases. The expression of CXCR4, but not CXCR3, by melanoma cells in primary lesions was significantly associated with the presence of ulceration, increased tumor thickness, a greater risk of developing regional and distant metastases and a higher mortality rate. Our study underscores the value of CXCR4 expression as a useful marker for predicting outcome in patients with localized melanoma. In addition, our findings support that, among chemokine receptors, CXCR4 might be an appropriate therapeutic target for adjuvant therapy in patients at risk for metastatic disease. ' 2005 Wiley-Liss, Inc.Key words: melanoma; chemokine receptors; clinical significanceThe incidence of cutaneous melanoma has steeply increased in the last decade.1 The most important prognostic factors of the primary tumor include depth of invasion 2 and presence of ulceration.3,4 Roughly 20% of patients will develop metastases that are the main cause of death. The mechanisms involved in metastasis are not completely understood. The capability of a tumor clone to metastasize depends on its ability to disrupt the basal membrane, migrate, proliferate and survive to allow progressive growth at distant sites. The development of metastases implies a stepwise and organ-specific process. Tumor cell migration to target organs is achieved by a chemotactic response to certain molecules. Chemokines comprise a group of key molecules involved in migration of different cell lineages. They constitute a family of small proteins that are classified based on the specific cysteine motifs in their amino acid sequence. [5][6][7] Through their interaction with G-proteincoupled receptors, chemokines mediate many physiologic and pathologic processes involving cell migration. [5][6][7] Tumor cells might employ similar mechanisms to migrate to specific organs as do leukocytes and other cell types through the expression of certain chemokine receptors.8 Current evidence supports a strong role for chemokines in the complex process of metastasis.9 Moreover, chemokines have been identified as angiogenic factors that promote tumor cell growth and progression. The chemokines most thoroughly studied in melanoma are CXCL1, CXCL2 and CXCL8. The increased expression of CXCL1 and CXCL2 (previously known as melanoma growth stimulatory activity alpha and beta, respectively) in melanoma lesions correlates with tu...