title: Prognostic value of the area and density of lymphatic vessels in cutaneous squamous cell carcinoma.
abstract: OBJECTIVE
  Cutaneous squamous cell carcinoma (SCC) is known for its capacity to metastasize via lymphatic vessels. In recent studies, the level of lymphangiogenesis has been reported as a potential prognostic factor for several skin tumors. The aim of this study was to quantify lymphangiogenesis in SCC using either computer-assisted image analysis or the Chalkley count technique. Vascular parameters were evaluated and compared with respect to their predictive power for tumor metastasis.
  
  
  METHODS
  In this case-control study, clinical and histological data of 15 metastatic and 15 nonmetastatic SCC patients were retrospectively analyzed. SCC samples were immunostained for the lymphatic endothelial marker D2-40 and the panvascular marker CD31, and analyzed using computer-assisted morphometric image analyses within hot spots as well as the digitalized Chalkley counting method.
  
  
  RESULTS
  Lymphatic vessel density, relative lymphatic vessel area, and lymphatic Chalkley count were significantly elevated in metastatic SCC. Tumor thickness was significantly higher in metastatic SCC, and had the highest predictive power for metastatic disease. Tumor thickness was a significant predictor of lymphangiogenic parameters.
  
  
  CONCLUSIONS
  Lymphangiogenesis is elevated in metastatic SCC but its extent is influenced by tumor thickness. Tumor thickness remains the most reliable predictive factor for metastatic disease.
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Jorien Tannette
authors.initials: JT
authors.lastname: Krediet
authors.affiliation: Department of Dermatology, Ed. Herriot Hospital, Lyon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Bob
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schmitter
authors.affiliation: Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Annelot Carine
authors.initials: AC
authors.lastname: Krediet
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Röwert
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Eggert
authors.initials: E
authors.lastname: Stockfleth
authors.affiliation: Department of Dermatology and Venereology, State Hospital Klagenfurt, Klagenfurt am Wörthersee, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Painsi
authors.affiliation: Department of Dermatology and Venereology, State Hospital Klagenfurt, Klagenfurt am Wörthersee, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hügel
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Terhorst
authors.affiliation: Skin Cancer Center Charité, Department of Dermatology and Allergy, Charité-Universitaetsmedizin Berlin, Berlin, Germany.|Department of Dermatology and Venereology, State Hospital Klagenfurt, Klagenfurt am Wörthersee, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lange-Asschenfeldt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary*; D003720:Densitometry / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D042583:Lymphangiogenesis; D008207:Lymphatic Metastasis / Q000473:pathology*; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*