title: Ki-67 expression in melanoma. A potential method of risk assessment for the patient with a positive sentinel node.
abstract: Melanoma patients with a positive sentinel node biopsy generally proceed to regional lymph node dissection, though ultimately only around 20% have evidence of tumour in their "non-sentinel" nodes. A means to identify patients at high risk of non-sentinel node involvement could potentially spare a large number of patients a procedure with significant morbidity. The proliferation marker Ki-67 has been associated with tumour progression in primary melanoma but has not been extensively studied in metastases. The study aims to investigate Ki-67 in primary melanoma and lymph node metastases and investigate any relationship with disease progression. Tissue Arrays of primary melanoma (n=79) and lymph node metastases (n=92) were constructed from paraffin embedded tissue and Ki-67 expression examined by immunohistochemistry. Staining positivity and intensity were assessed and correlated with standard staging criteria and clinical outcome. High Ki-67 expression was associated with both Breslow thickness (chi(2)=8.54, p=0.035) and presence of ulceration (Fisher's Exact test p=0.003) in primary melanoma. In lymph node metastases high Ki-67 expression correlated with Nodal (N) Stage (chi(2)=8.193, p=0.0 17). High Ki-67 expression is associated with melanoma progression and multiple lymph node involvement. This might potentially form the basis of a risk analysis for patients with positive sentinel nodes.
authors.affiliation: RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK. robert.pearl@talk21.com
authors.forename: R A
authors.initials: RA
authors.lastname: Pearl
authors.forename: M D
authors.initials: MD
authors.lastname: Pacifico
authors.forename: P I
authors.initials: PI
authors.lastname: Richman
authors.forename: D J
authors.initials: DJ
authors.lastname: Stott
authors.forename: G D
authors.initials: GD
authors.lastname: Wilson
authors.forename: A O
authors.initials: AO
authors.lastname: Grobbelaar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000032:analysis*; D008198:Lymph Nodes / Q000276:immunology* / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D046888:Tissue Array Analysis; D014456:Ulcer / Q000473:pathology
chemical_list: D019394:Ki-67 Antigen