Can angiotropism and lymphovascular invasion refine the current cutaneous melanoma staging system?

Namubiru, Patricia; Dalleywater, William; Lashin, Shaimaa; Elsheikh, Somaia

Abstract

Background: Several prognostic factors for primary cutaneous melanoma (PCM) have been identified, and these predict metastasis and survival, to a certain extent. We sought to determine the frequency of angiotropism (AT) and lymphovascular invasion (LVI) in PCM and the relationship between AT, LVI, and other clinicopathological parameters and patient's prognosis. Methods: This study included 538 cases of PCM diagnosed between 2003 and 2016. It comprised 246 females and 292 males whose clinicopathological variables were evaluated with respect to LVI and AT using univariate and multivariate analyses. Overall survival (OS) was assessed by Kaplan–Meier (KM) analysis and Cox regression multivariate analysis. Results: AT occurred more frequently than LVI. Ulceration, mitotic rate, and Breslow thickness were found to be highly associated with both LVI and AT (p < 0.01). All LVI+ cases had AT, with a significant positive correlation (p < 0.01). Both AT and LVI predicted lymph node (LN) metastasis (odds ratio [OR] = 1.47, 1.12, respectively). Multivariate analysis showed LN metastasis, Breslow thickness, LVI, and AT as predictors of OS. LVI and AT independently predicted adverse OS by Cox regression analysis (hazard ratio [HR] = 1.66, 1.49, respectively) and with KM survival analysis. Conclusion: AT is a marker for angiotropic extravascular migratory tumor spread (angiotropic EVMM), and LVI is a marker for intra‐lymphovascular tumor spread. Both predict poor prognosis. Given its ease of detection, AT could be adopted as a histologpathological feature in the routine assessment of primary cutaneous malignant melanoma cases.

Citation

Namubiru, P., Dalleywater, W., Lashin, S., & Elsheikh, S. (2024). Can angiotropism and lymphovascular invasion refine the current cutaneous melanoma staging system?. Journal of Cutaneous Pathology, 51(4), 288-298. https://doi.org/10.1111/cup.14561

• Journal Article Type: Article
• Acceptance Date: Oct 30, 2023
• Online Publication Date: Dec 15, 2023
• Publication Date: 2024-04
• Deposit Date: Jan 16, 2024
• Publicly Available Date: Jan 16, 2024
• Journal: Journal of Cutaneous Pathology
• Print ISSN: 0303-6987
• Electronic ISSN: 1600-0560
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 51
• Issue: 4
• Pages: 288-298
• DOI: https://doi.org/10.1111/cup.14561
• Keywords: Dermatology; Histology; Pathology and Forensic Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/28702001
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/cup.14561