Borgstein P J, Meijer S, van Diest P J
Department of Surgical Oncology, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands.
Ann Surg Oncol. 1999 Apr-May;6(3):315-21. doi: 10.1007/s10434-999-0315-x.
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.
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.
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).
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.
移行转移和卫星病灶是局部皮肤复发的表现，是恶性黑色素瘤的特征。它们是肿瘤细胞栓子被困在原发性肿瘤和区域淋巴结之间的真皮淋巴管中的结果。研究了淋巴管侵犯的组织病理学特征，以确定预测黑色素瘤患者局部皮肤转移的可能性。
在一项前瞻性研究中，258例临床I期黑色素瘤患者接受了广泛局部切除和前哨淋巴结活检。53例（21%）患者发现有淋巴结转移。在29例（11.2%）至今已出现复发的患者中，17例（6.6%）有局部皮肤转移。对所有手术标本进行检查，特别注意淋巴管侵犯或微小卫星灶的组织病理学征象。
258例患者中有14例（5.4%）观察到明确的淋巴管侵犯征象，其中13例（93%）患者随后出现移行转移，中位间隔时间为10个月。7例患者的原发性黑色素瘤位于四肢。中位Breslow厚度为2.5mm，5例有溃疡形成。258例患者中有244例（94.6%）无淋巴管侵犯征象。迄今为止，只有4例（1.6%）患者出现局部皮肤复发，中位间隔时间为29个月。这4例患者均在四肢患有溃疡性黑色素瘤，中位厚度为4.0mm。淋巴管侵犯的存在与早期局部皮肤复发显著相关（P <.0001）。
在存在淋巴管侵犯的组织病理学征象时，局部皮肤复发似乎具有高度可预测性。淋巴管侵犯是一个重要的预后参数，在选择辅助（局部）治疗的患者时应作为分层标准纳入考虑。
