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Lymphatic invasion in cutaneous melanoma is associated with sentinel lymph node metastasis |
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| Authors: | Katie Doeden Zhihai Ma Balasubramanian Narasimhan Susan M. Swetter Michael Detmar and Soheil S. Dadras |
| Affiliation: | Department of Pathology;, Department of Statistics;and Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, CA, USA;, Dermatology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA,;and Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland |
| Abstract: | Background: Sentinel lymph node (SLN) metastasis is a major determinant for staging, prognostication and clinical management of patients with cutaneous melanoma. However, the role of lymphatic vs. vascular invasion (VI) for SLN spread remains unclear. Methods: We compared the frequency of lymphatic invasion (LI) vs. VI in melanoma sections from 94 patients with a mean three-year clinical follow up using immunostains for the lymphatic endothelial markers D2-40 (podoplanin) and LYVE-1 and the panvascular marker CD31. Results: LI occurred more frequently than VI (16 vs. 3%, respectively, p = 0.001) and correlated with higher American Joint Committee on Cancer stage at diagnosis (p = 0.0004). In a univariate analysis, LI was strongly associated with SLN metastasis (p = 0.008), independent of tumor thickness. In a multivariate analysis, LI was not a significant risk factor for SLN metastasis. The presence of intratumoral lymphatics (ITLs) was associated with distant metastasis, whereas VI was rare and did not correlate with SLN or distant metastasis. A combination of LI and ITL had higher positive and negative predictive values for the risk of developing SLN metastasis compared with routine histology and VI. Conclusion: Detection of LI in the primary tumor may aid in identifying melanoma patients with the propensity to develop SLN metastasis. |
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