Early metastases in regional lymph nodes and prognosis of malignant melanoma. Histological and clinical examinations in 104 lymphadenectomized patients

Cutaneous malignant melanoma in West Yorkshire: II. A prospective study of recurrence and prediction of lymph nodal metastasis

One hundred and fifty patients with cutaneous malignant melanoma, in clinical stage I at diagnosis, were studied prospectively to determine the lymph nodal metastatic pattern of the disease, and to find that combination of clinical and pathological variables best predictive of the probability of its occurrence when combined in a linear logistic regression equation based upon a model by Cox. Details of the general pattern of melanoma recurrence are included to provide a necessary background to the nodal metastatic study. Of 66 patients showing melanoma recurrence in 48 (19 males and 29 females) it took the form of lymph nodal metastasis. Of these 50% showed lymph nodal metastasis within 1.1 years of the primary operation and 90% within 3.8 years. Nineteen clinical and pathological variables were tested for association with lymph nodal metastasis, 15 of which showed a significant association and in 7 of these the association was highly significant (P less than or equal to 0.0001). All 19 variables were included in the logistic regression analysis, 6 being selected as providing the best regression 'goodness of fit' and of these 'maximum tumour thickness (Breslow' and 'sex' emerged as the dominant variables. It is concluded that the analysis described provides surgeons, oncologists, and pathologists with a practical method to assess the likelihood in an individual patient of melanoma recurrence to regional lymph nodes. This should enable surgery or other adjunctive therapeutic regimens to be selected at an early stage.

Microstages in malignant melanoma--the basis for an elective lymph node dissection

Our experience has shown that an increasing depth of invasion of the primary tumor is connected with a higher incidence of regional lymph node metastases. The incidence of subsequent metastases or recurrences is compared retrospectively for two groups: (1) 175 patients with elective dissection and (2) 33 patients with excision only. All patients suffered from high-risk melanomas of clinical stage I. The frequency of subsequent metastases was 21% (N = 36) for the first group and 46% (N = 15) for the second group (p less than or equal to 0.01). The 5-year survival rate (Berkson-Gage) of patients with high-risk melanomas and secondaries is 41% for the patient group (N = 27) in which elective dissection was performed and 21% for patients with therapeutic dissection (N = 52). The results speak for the elective dissection in cases of high-risk melanomas.

Comparative histological studies of regional lymph nodes of 201 melanoma patients. (Microscopic features in relation to individual age, site, and metastatic spread)

Since May 1968 a total of 2.108 regional lymph nodes (l.n.) dissected from 201 melanoma patients (86 axillary, 107 groin, and 8 neck) have become available for study. The purpose was to detect histological differences between the l.n. of 134 patients lacking and those of 67 patients exhibiting l.n. metastases, histologically verified in 104 of 706 nodes. The main finding is a more than six-fold increase in number and an eleven-fold increase in total area (evaluated by a microscope micrometer) of germinal centers in the lymph follicles of patients with, as compared to those without, l.n. metastases (P less than or equal to 0.05). Paracortical areas were found to be diminished in 56.7% of cases with metastatic spread. Accumulations of plasma cells were mainly seen in the nodes of elderly patients (48.4%) and of those exhibiting regional metastases (47.8%). The observation of numerous and dilated blood vessels in the interfollicular regions noticeably corresponded to the occurrence of lymphatic metastases (P less than or equal to 0.01), suggesting a "tumor angiogenic factor". A negative correlation with metastatic involvement was found as to histiocytosis of marginal sinuses and with respect to the observed fibrinoid hyalinosis of pulp vessels (P less than or equal to 0.01). The marked hyperplasia of lymph node B-lymphocyte regions as opposed to diminished T-lymphocyte areas prevailing in cases with metastatic melanoma is in accord with findings of humoral immunologic blocking activity and impaired T-cell response in advanced malignant melanoma.