Skip to main content

Advertisement

Log in

Are Locoregional Cutaneous Metastases in Melanoma Predictable?

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: In-transit metastases and satellite lesions are manifestations of locoregional cutaneous recurrence that are characteristic of malignant melanoma. They are the result of tumor cell emboli entrapped in the dermal lymphatics between the primary tumor and the regional lymph node basin. Histopathological features of lymphatic invasion were investigated to determine the possibility of predicting locoregional cutaneous metastases in melanoma patients.

Methods: In a prospective study, 258 patients with clinical stage I melanoma underwent wide local excision and sentinel node biopsy. Nodal metastases were found in 53 (21%) patients. Of 29 patients (11.2%) who had developed recurrences to date, 17 (6.6%) had locoregional cutaneous metastases. All surgical specimens were examined with particular attention to histopathological signs of lymphatic vascular invasion or microscopic satellites.

Results: Unequivocal signs of lymphatic invasion were observed in 14 of 258 patients (5.4%), and 13 (93%) of these patients subsequently developed in-transit metastases, after a median interval of 10 months. The primary melanoma was located on the extremities in seven patients. The median Breslow thickness was 2.5 mm, and 5 showed ulceration. In 244 of 258 patients (94.6%), there were no signs of lymphatic invasion. To date, only four patients (1.6%) have had a locoregional cutaneous recurrence, occurring after a median interval of 29 months. All four of these patients had ulcerative melanomas on an extremity, with a median thickness of 4.0 mm. The presence of lymphatic invasion was significantly related to early locoregional cutaneous relapse (P _ .0001).

Conclusions: Locoregional cutaneous recurrence appears to be highly predictable in the presence of histopathological signs of lymphatic invasion. Lymphatic invasion is an important prognostic parameter and should be included as a stratification criterion when selecting patients for adjuvant (locoregional) therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Singletary SE, Balch CM. Recurrent regional metastases and their management. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong S-J, eds. Cutaneous Melanoma. London: JB Lippincott, 1992:427–435.

    Google Scholar 

  2. Calabro A, Singletary SE, Balch CM. Patterns of relapse in 1001 consecutive patients with melanoma nodal metastases. Arch Surg 1989;124:1051–1055.

    Google Scholar 

  3. Singletary SE, Tucker SL, Boddie AW. Multivariate analysis of prognostic factors in regional cutaneous metastases of extremity melanoma. Cancer 1988;61:1437–1440.

    Google Scholar 

  4. Pijpers R, Borgstein PJ, Meijer S, Hoehstra OS, van Hattum LH, Teule GJJ. Sentinel node biopsy in melanoma patients: dynamic lymphoscintigraphy followed by intraoperative gamma probe and vital dye guidance. World J Surg 1997;21:788–793.

    Google Scholar 

  5. Cascinelli N, Bufalino R, Marolda R, et al. Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol 1986;12:175–180.

    Google Scholar 

  6. Gilchrist KW, Gilbert E, Metter G, Powers D. Importance of microscopic vascular invasion in primary cutaneous malignant melanoma. Surg Gynecol Obstet 1977;145:559–561.

    Google Scholar 

  7. Schmoeckel C, Bockelbrink A, Bockelbrink H, Koutsis J, Braun-Falco O. Low- and high-risk malignant melanoma. I. Evaluation of clinical and histological prognosticators in 585 cases. Eur J Cancer Clin Oncol 1983;19:227–235.

    Google Scholar 

  8. Schmoeckel C, Bockelbrink A, Bockelbrink H, Braun-Falco O. Low- and high-risk malignant melanoma. II. Multivariate analyses for a prognostic classification. Eur J Cancer Clin Oncol 1983;19:237–243.

    Google Scholar 

  9. Larsen TE, Grude TH. A retrospective histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I. Acta Path Microbiol Scand 1979;87:131–138.

    Google Scholar 

  10. Johnson OK, Emrich LJ, Karakousis CP, Rao U, Greco WR. Comparison of prognostic factors for survival and recurrence in malignant melanoma of the skin, clinical stage I. Cancer 1985;55:1107–1117.

    Google Scholar 

  11. Day CL, Harrist TJ, Gorstein F, et al. Malignant melanoma. Prognostic significance of “microscopic satellites” in the reticular dermis and subcutaneous fat. Ann Surg 1981;194:108–112.

    Google Scholar 

  12. León P, Daly JM, Synnestvedt M, Schultz DJ, Elder DE, Clark WH. The prognostic implications of microscopic satellites in patients with clinical stage I melanoma. Arch Surg 1991;126:1461–1468.

    Google Scholar 

  13. Karakousis CP, Choe KJ, Holyoke ED. Biologic behavior and treatment of intransit metastases of melanoma. Surg Gynecol Obstet 1980;150:29–32.

    Google Scholar 

  14. Roses DF, Harris MN, Rigel D, Carrey Z, Friedman R, Kopf AW. Local and in-transit metastases following definitive excision for primary cutaneous malignant melanoma. Ann Surg 1983;198:65–69.

    Google Scholar 

  15. Wong JH, Cagle LA, Kopald KH, Swisher SG, Morton DL. Natural history and selective management of in transit melanoma. J Surg Oncol 1990;44:146–150.

    Google Scholar 

  16. Lee Y-TM. Loco-regional primary and recurrent melanoma. III. Update of natural history and non-systemic treatments (1980–1987). Cancer Treatment Rev 1988;15:135–162.

    Google Scholar 

  17. Schraffordt-Koops H, Kroon BBR, Oldhoff J, Hoekstra HJ. Controversies concerning adjuvant regional isolated perfusion for stage I melanoma of the extremities. World J Surg 1992;16:241–245.

    Google Scholar 

  18. Vrouenraets BC, Nieweg OE, Kroon BBR. Thirty-five years of isolated limb perfusion for melanoma: indications and results. Br J Surg 1996;83:1319–1328.

    Google Scholar 

  19. Ghussen F, Krüger I, Smalley RV, Groth W. Hyperthermic perfusion with chemotherapy for melanoma of the extremities. World J Surg 1989;13:598–602.

    Google Scholar 

  20. Schraffordt-Koops H, Vaglini M, Kroon BBR, et al. Value of prophylactic isolated limb perfusion for stage I high risk malignant melanoma: a randomized phase III trial. Abstract. Melanoma Res 1997;7(suppl 1):S34.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Borgstein, P.J., Meijer, S. & van Diest, P.J. Are Locoregional Cutaneous Metastases in Melanoma Predictable?. Ann Surg Oncol 6, 315–321 (1999). https://doi.org/10.1007/s10434-999-0315-x

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-999-0315-x

Key Words

Navigation