Relationship between sentinel lymph node status and regression of primary malignant melanoma

Abstract

The prognostic significance of spontaneous regression of primary melanoma is a controversial issue. Studies on sentinel lymph node status and circulating tumour cells may represent a step towards a better understanding. The clinical details of 269 melanoma patients who underwent sentinel lymph node biopsy were analysed. Correlation was sought between the parameters of the primary tumour, particularly tumours showing a partial intermediate level of regression, and sentinel lymph node status. The presence of circulating tumour cells was studied by reverse transcription-polymerase chain reaction for tyrosinase messenger RNA preoperatively in 94 patients. Of the examined tumours, 27.8% showed histological features of a partial intermediate level of regression. Regressive tumours were localized predominantly on the trunk (P=0.006), were significantly thinner (P<0.0000) and were less frequently ulcerated (P=0.003) than tumours without regression. Moreover, the majority of regressive melanomas were of the superficial spreading type (P<0.0000) and their sentinel node status was more favourable (P=0.026). We demonstrated the presence of circulating tumour cells in five of 26 (19.2%) regressive and 19 of 68 (29.4%) non-regressive tumours. The difference was not significant (P=0.32). By multivariate analysis, however, the Breslow thickness and ulceration of the primary tumour were predictors of the sentinel lymph node status, in agreement with literature data. A partial intermediate level of regression of the primary tumour did not affect unfavourably the sentinel lymph node status in our study. We failed to demonstrate a significant relationship between the presence of circulating tumour cells and either primary tumour regression or the sentinel lymph node status.

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

“…7,72,[74][75][76]78,[100][101][102][103] On the other hand, additional studies have suggested that regression indicates a favorable outcome (Table 3). 3,[104][105][106][107][108] Thus, the prognostic significance of regression in primary melanoma has been controversial for many years. In the next section, we discuss some of the most relevant published studies with respect to melanoma recurrence, lymph node metastasis, and survival.…”

“…2,4,7,76,82 Yet other studies have reported that the presence of regression may be associated with negative SLN status. 3,85,98,[105][106][107] Moreover, in a recent meta-analysis of 14 studies that included 10 098 patients with melanoma of various stages, Ribero et al 13 demonstrated that regression was associated with lower rates of SLN positivity.…”

Lymphatic invasion detected by D2-40/S-100 dual immunohistochemistry does not predict sentinel lymph node status in melanoma

“…Breslow thickness remains the most consistent predictor of sentinel lymph node metastases, but other parameters such as ulceration, age, location, angiolymphatic invasion, regression, small cell melanoma histology, and clinical tumor palpability may also be predictive. 15,19,[22][23][24][25][26][27][28][29][30][31][32][33][34] Tumor lymphangiogenesis is an active area of investigation in melanoma and other cancers and is postulated to be a fruitful area for therapeutic targets. 35 Excellent reviews are available discussing tumor lymphangiogenesis and melanoma metastasis.…”

Estudo da espessura da regressão como fator prognóstico nos melanomas cutâneos finos

“…Alguns estudos mostraram que MCFs com regressão representam um grupo com alto risco de metástases (4,7,13,14,26,28) ,enquanto outros não demonstraram relação entre estes fatores (12,19,20,21,27,32) . Também tem sido sugerido que tal influência negativa seria mais relevante entre os MCFs do que entre os melanomas espessos, sendo a regressão relacionada com alguns casos de metástases em melanomas in situ (MIS) (6,12,14) .…”

“…Alguns autores mostraram aparente associação entre presença de regressão espontânea e comportamento biológico mais agressivo, com grande divergência nos resultados (12,19,20,21,27,32) . O que pode explicar tal divergência são as diferentes metodologias utilizadas.…”