Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 10/2019

01-10-2019 | Melanoma | Research Article

Mitotic rate as an important prognostic factor in cutaneous malignant melanoma

Authors: A. Piñero-Madrona, G. Ruiz-Merino, P. Cerezuela Fuentes, E. Martínez-Barba, J. N. Rodríguez-López, J. Cabezas-Herrera

Published in: Clinical and Translational Oncology | Issue 10/2019

Login to get access

Abstract

Background

Recently, the quantification of mitoses in cutaneous melanoma has been discharged from the main prognostic variables of the TNM classification.

Objective

To investigate the prognostic value of the presence of mitoses in primary cutaneous melanoma and to establish the number of mitoses per mm2 that may have prognostic significance.

Methods

A retrospective observational study was performed on 141 patients treated for cutaneous melanoma, who were assessed by the same pathologist, and who had a minimum follow-up of 2 years. Clinical, epidemiological, histopathological and follow-up variables were gathered and compared with the number of mitoses to distinguish the significance of differences by means of univariate, multivariate, and survival analyses.

Results

The cut-off level related to a better sensitivity and specificity was 1.50 mitoses per mm2. The presence of two or more mitoses/mm2 showed a better relationship with prognostic variables and both the overall and disease-free survival than the presence of 1 or more mitoses/mm2. This happens especially in melanomas thicker than 0.8 mm and it could affect the staging in cases with Breslow between 1 and 2 mm.

Conclusions

A mitotic rate of two or more mitoses per mm2 in cutaneous melanoma should be considered as a more accurate prognostic factor than one or more mitoses per mm2, particularly in tumors equal or greater than 0.8 mm in thickness.
Literature
1.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th edition. New York: Springer; 2010.
2.
Caldarella A, Fancelli L, Manneschi G, et al. How staging of thin melanoma is changed after the introduction of TNM 7th edition: a population based study. J Cancer Res Clin Oncol. 2016;142:73–6.CrossRefPubMed
3.
de Waal AC, van Harten-Gerritsen AS, Aben KK, et al. Impact of mitotic activity on the pathological substaging of pT1 cutaneous melanoma. Br J Dermatol. 2014;170:874–7.CrossRefPubMed
4.
Ponti G, Pollio A, Cesinaro AM, et al. Value and prognostic significance of mitotic rate in a retrospective series of pT1 cutaneous malignant melanoma patients. Cancer Epidemiol. 2012;36:303–5.CrossRefPubMed
5.
Lardon AR, Rothschild B, Walls AC, et al. Impact of the 2009 AJCC staging guidelines for melanoma on the number of mitotic figures reported by dermatopathologists al one institution. J Cutan Pathol. 2015;42:536–41.CrossRef
6.
Thompson JF, Soong SJ, Balch CM, et al. Prognostic significance of mitotic rate in localized primary cutaneous melanoma: an analysis of patients in the multi-institutional American Joint Committee on Cancer melanoma staging database. J Clin Oncol. 2011;29:2199–205.CrossRefPubMedPubMedCentral
7.
Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma of the skin, chapter 4. In: Amin MB, Edge SB, Greene FL, et al., editors. AJCC Cancer Staging Manual. 8th edition. Cham: Springer International Publishing AG; 2017. p. 563–585.
8.
Francken AB, Shaw HM, Thompson JF, et al. The prognostic importance of tumor mitotic rate confirmed in 1317 patients with primary cutaneous melanoma and long follow-up. Ann Surg Oncol. 2004;11:426–33.CrossRefPubMed
9.
Maurichi A, Miceli R, Camerini T, et al. Prediction of survival in patients with thin melanoma: results from a multiinstitution study. J Clin Oncol. 2014;32:2479–85.CrossRefPubMed
10.
Murali R, Moncrieff MD, Hong J, Cooper CL, Shingde MV, Samuel DG, Thompson JF, Scolyer RA. The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. Ann Surg Oncol. 2010;17:2922–99.CrossRef
11.
Gimotty PA, Van Belle P, Elder DE, Murry T, Montone KT, Xu X, Hotz S, Raines S, Ming ME, Wahl P, Guery D. Biologic and prognostic significance of dermal ki67 expression, mitoses, and tumorigenicity in thin invasive cutaneous melanoma. J Clin Oncol. 2005;23:8048–56.CrossRefPubMed
12.
Barnhill RL, Katzen J, Spatz A, Fine J, Berwick M. The importance of mitotic rate as a prognostic factor for localized cutaneous melanoma. J Cutan Pathol. 2005;32:268–73.CrossRefPubMed
13.
Elder DE, Gimotty PA, Guerry D. Cutaneous melanoma: estimating survival and recurrence risk based on histopathologic features. Dermatol Ther. 2005;18:369–85.CrossRefPubMed
14.
Scolyer RA, Thompson JF. Mitotic rate in melanoma should be recorded as the number of mitosis per mm2 (not per high power field): surgeons tell your pathologists! Am J Surg. 2013;206:142–3.CrossRefPubMed
15.
Scolyer RA, Shaw HM, Thompson JF, et al. Interobserver reproducibility of histopathologic prognostic variables in primary cutaneous melanomas. Am J Surg Pathol. 2003;27:1571–6.CrossRefPubMed
16.
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Ding S, Byrd DR, Cascinelli N, Cochran AJ, et al. Multivariate analysis of prognostic factors amon 2,313 patients with stage III melanoma: comparison of nodal micrometastases and macrometastases. J Clin Oncol. 2010;28:2452–9.CrossRefPubMedPubMedCentral
17.
National Comprehensive Cancer Network: NCCN Guidelines® Version 2.2016: Melanoma NCCN Evidence Blocks™. p. ME-3.
18.
Namikawa K, Aung PP, Gershenwald JE, Milton DR, Prieto VG. Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study al a comprehensive cancer center. Cancer Med. 2018;7:583–93.CrossRefPubMedPubMedCentral
19.
Evans JL, Vidri RJ, MacGillivray DC, Fitzgerald TL. Tumor mitotic rate is an independent predictor of survival for nonmetastatic melanoma. Surgery. 2018;164:589–93.CrossRefPubMed
20.
Kesmodel SB, Karakousis GC, Botbyl JD, et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol. 2005;12:449–58.CrossRefPubMed
21.
Ottmann K, Tronnier M, Mitteldorf C. Detection of mitotic figures in thin melanomas: immunohistochemistry does not replace the careful search for mitotic figures in hematoxylin–eosin stain. J Am Acad Dermatol. 2015;73:637–44.CrossRefPubMed
22.
Lou S, Lobo AZC, Tanabe KK, Muzikansky A, Durazzo T, Sober A, Tsao H, Osimi B, Lawrence DP, Duncan LM. Clinical significance of microscopic melanoma metastases in the nonhottest sentinel lymph nodes. JAMA Surg. 2015;150:465–72.CrossRef
23.
Han D, Zager JS, Shyr Y, et al. Clinicopathologic predictors of sentinel lymph node metastasis in thin melanoma. J Clin Oncol. 2013;31:4387–93.CrossRefPubMed
24.
Speijers MJ, Bastiaannet E, Sloot S et al. Tumor mitotic rate added to the equation: melanoma prognostic factors changed? A single-institution database study on the prognostic value of tumor mitotic rate for sentinel lymph node status and survival of cutaneous melanoma patients. Ann Surg Oncol. 2015;22:2978–87.CrossRefPubMed
25.
Wat H, Senthiselvan A, Salopek TG. A retrospective multicenter analysis of the predictive value of mitotic rate for sentinel lymph node positivity in thin melanoma. J Am Acad Dermatol. 2016;74:94–101.CrossRefPubMed
26.
27.
Baker JJ, Meyers MO, Deal AM, et al. Prognostic significance of tumor mitotic rate in T2 melanoma staged with sentinel lymphadenectomy. J Surg Oncol. 2015;111:711–5.CrossRefPubMed
28.
Kibrité A, Milot H, Douville P, et al. Predictive factors for sentinel lymph nodes and non-sentinel lymph nodes metastatic involvement: a database study of 1041 melanoma patients. Am J Surg. 2016;211:89–94.CrossRefPubMed
29.
Kirkland EB, Zitelli JA. Mitotic rate for thin melanomas: should a single mitotic figure warrant a sentinel lymph node biopsy? Dermatol Surg. 2014;40:937–45.CrossRefPubMed
30.
Betti R, Santambrogio R, Cerri A, et al. Observational study on the mitotic rate and other prognostic factors in cutaneous primary melanoma arising from naevi and from melanoma de novo. J Eur Acad Dermatol Venereol. 2014;28:1736–41.CrossRef
31.
Lorimer PD, Benham EC, Walsh K, et al. Reporting of mitotic rate in cutaneous melanoma: a study usnig the national cancer data base. J Surg Oncol. 2017;115:281–6.CrossRefPubMed
32.
Roncati L, Piscioli F, Pusiol T. The importance of mitotic rate reporting in primary cutaneous melanoma. J Surg Oncol. 2017;116:958–9.CrossRefPubMed
33.
Tejera-Vaquerizo A, Pérez-Cabello G, Martínez-Leborans L, et al. Is mitotic rate still useful in the management with thin melanoma? JEADV. 2017;31:2025–9.PubMed
Metadata
Title
Mitotic rate as an important prognostic factor in cutaneous malignant melanoma
Authors
A. Piñero-Madrona
G. Ruiz-Merino
P. Cerezuela Fuentes
E. Martínez-Barba
J. N. Rodríguez-López
J. Cabezas-Herrera
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 10/2019
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-019-02064-4

Other articles of this Issue 10/2019

Clinical and Translational Oncology 10/2019 Go to the issue

Research Article

Comparison of overall survival and quality of life between patients undergoing anal reconstruction and patients undergoing traditional lower abdominal stoma after radical resection

Brief Research Article

ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells)

Research Article

Added value of diffusion-weighted MRI for nodal radiotherapy planning in pelvic malignancies

Research Article

Multiple sclerosis outcomes after cancer immunotherapy

Research article

Seven genes for the prognostic prediction in patients with glioma

Research Article

The use of cisplatin plus doxorubicin or paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) for stage IIIC or IV epithelial ovarian cancer: a comparative study
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits