Introduction: Despite advances in staging of melanoma through the sentinel node procedure it is difficult to predict whether patients with local invasive high risk melanoma are at risk of recurrence or death or whether they are cured. Our objective was to establish the utility of different markers of tumour invasiveness and immune response in predicting prognosis.
Methods and patients: High risk melanoma patients selected to undergo a sentinel node biopsy (Stage Ib and II) at the Princess Alexandra Hospital in Brisbane were recruited from 1998 to 2007. Primary melanoma tissue was obtained and a random sample was selected and analysed by immunohistochemistry. Follow-up information on recurrence and death was prospectively recorded until end of 2010.
Results: 24 melanoma patients were randomly selected from a cohort of 189 patients with available tissue and data. Average breslow was 2.4 mm. 4 patients had a positive sentinel node at inclusion. 8 patients had a recurrence and 8 were dead during follow-up. Among the antibodies tested, P-STAT5 was predictive of sentinel node status (p=0.02), Twist and p16 predicted death and recurrence (p=0.001, p=0.04). FoxP3, CD163 were associated and indicative of suppressed immunity within the tumour.
Conclusions: Combinations of molecular markers on primary melanomas have prognostic information of higher value than classical clinicopathological co variates such as Breslow index or Ulceration.