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British Medical Bulletin 51:548-569 (1995)
© 1995 The British Council

research-article

Cutaneous melanoma: pathology, relevant prognostic indicators and progression

A Slominski, J Ross and M C Mihm

Department of Pathology and Laboratory Medicine, Albany Medical Center Albany, New York, USA

Abstract

Malignant melanoma, one of the most rapidly increasing malignancies in man, has recently received substantial attention in the world literature concerning application of traditional morphologic and newer immunologic and molecular biologic methods of predicting progression and ultimate clinical outcome. Although clinical features of patient sex, age and anatomic site vof the lesion are important, classic morphologic variables defining prognosis remain the cornerstone of predicting disease outcome. Extent of radial growth phase and the two microstaging mehods of measuring tumor thickness and determining level of invasion remain the critical disease progression predicators. Assessment of mitotic rate, number of tumor infiltrating lymphocytes, and determining the presence of regression, ulceration, and epitheliod cell component, microscopic satellites and vascular invasion are also important. More recently a variety of molecular and biochemical prognostic markers have been cited for prediction of disease recurrence and metastasis. Both over expression and down regulation of a variety of cell adhesion molecules have been implicated in disease progression as has alterations in the plasminogen activitation system. A series of growth factors, growth factor receptors, oncogenes and tumor suppressor genes have also been considered. Structural and numerical geonomic DNA abnormalities, cell proliferation markers and DNA ploidy status have also been considered. Recently a variety of serum and blood markers indicating disease persistence or progression have been studied including melanin synthesis precursors and intermediate compounds of melanogenesis specific mRNA may become the most sensitive prognostic marker of the future. At present histopathologic and clinical criteria remain the cornerstones of predicting prognosis in malignant melanoma.


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