Prognostic factors in localized invasive cutaneous melanoma: high value of mitotic rate, vascular invasion and microscopic satellitosis

Abstract

The aim of this study was to determine independent clinical and pathological prognostic factors for overall and disease-free survival in Spanish melanoma patients. Eight hundred and twenty-three patients with localized melanoma and complete clinical and pathological information were evaluated. The age at diagnosis, gender, location, tumour thickness, invasion level, ulceration, histological subtype, inflammatory infiltrate, mitotic rate, vascular invasion, microscopic satellitosis, regression and cell type were all included. Univariate and multivariate Cox regression analyses were performed for overall and disease-free survival. Gender, histological subtype, tumour thickness, invasion level, ulceration, inflammatory infiltrate, microscopic satellitosis, vascular invasion and mitotic rate were related to overall and disease-free survival in univariate analysis. Age and location were only related to disease-free survival. Only tumour thickness, vascular invasion and gender exhibited independent significance for overall survival in multivariate analysis. For disease-free survival, tumour thickness, location, mitotic rate, vascular invasion and microscopic satellitosis were the sole independent factors. It can be concluded that the Breslow thickness remains the most significant prognostic factor for the survival of patients with localized cutaneous melanoma. Our results support the inclusion of microscopic satellitosis and vascular invasion in the current American Joint Committee on Cancer (AJCC) staging system, although further studies evaluating their separate influence are needed. Mitotic rate is confirmed as an objective and independent predictor of disease-free survival for melanoma patients that should be considered in further revisions of the mentioned staging system.

Lymphatic invasion and angiotropism in primary cutaneous melanoma

“…Additional studies have also shown an association between lymphatic invasion and both disease-free survival (DFS) and OS. 13,24 Rose et al 24 also demonstrated that patients with lymphatic invasion in greater than one vascular channel had a worse DFS as compared to those with only one involved vascular channel. Despite these findings, a number of additional studies showed no association between the detection of lymphatic invasion in primary melanomas and survival (Table 1).…”

“…In a multicenter study, Egger et al 12 evaluated melanomas 41.0 mm in thickness from 2183 patients and reported lymphovascular invasion in 7.8% of cases, as detected on H&E-stained sections. Nagore et al 13 identified lymphatic invasion in 5.7% (47/823) of melanomas (see Table 1 for an overview of studies).…”

Guidelines of care for the management of primary cutaneous melanoma

“…of metastatic nodes and presence or absence of intralymphatic metastases (in transit or satellite) Note: N1-3 and a-c subcategories assigned as shown below: J AM ACAD DERMATOL VOLUME 65, NUMBER 5 the lesion must be included. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The clinical information in the pathology report should contain the type of surgical procedure performed (ie, biopsy intenteexcisional or incisional) and size of the lesion. Additional optional, but desirable, clinical information include ABCDE criteria, dermatoscopic features, a clinical photograph, and the presence or absence of macroscopic satellitosis.…”

Lymphangioinvasion in routine H&E staining is strongly associated with poor clinical outcome in lymph node-negative cutaneous melanoma patients

“…Its pro- www.fhc.viamedica.pl gnostic significance was postulated, although not always unanimously, in melanoma [3][4][5][6][7] and multiple other cancer types, e.g. lung [8], breast [9,10], cervical [11,12], ovarian [13], gastric [14], colorectal [15,16], prostate [17] or bladder [18] cancers.…”