Mitotic Rate Correlates With Sentinel Lymph Node Status and Outcome in Cutaneous Melanoma Interview with:
Dr. Mario Mandalà, MD

Division of Oncology, Department of Oncology and Hematology
Papa Giovanni XXIII Hospital
Bergamo, Italy. What is the background for this study?

Response: The 7th edition of the TNM AJCC classification incorporated mitotic rate (MR) only for primary cutaneous melanoma with Breslow thickness ≤1 mm. We investigated whether and to what extent MR is able to predict sentinel lymph node (SLN) status and clinical outcome of  primary cutaneous melanoma (PCM) patients with BT >1 mm. What are the main findings?

Response: The main finding of our study is that mitotic rate is an independent prognostic factor in  primary cutaneous melanoma patients with BT >1 mm. Incorporating this reliable and reproducible tissue biomarker could provide a better patients’ stratification entering clinical trials in the adjuvant setting. What should readers take away from your report?

Response: Currently, the following pathologic prognostic markers are incorporated for clinical use: Breslow thickness, presence of ulceration, presence of microsatellites, the  regional lymph nodes involvement, while mitotic rate is included only for melanomas ≤1 mm in thickness.

According to the results of our study clinicians should be aware that in clinically stage I-II melanomas, mitotic rate increases the risk of SLN positivity and predicts a poor disease free survival and overall survival, after adjusting for well-known prognostic factors such as BT and ulceration. Furthermore incorporating this reliable and reproducible biomarker provides a more rational treatment strategy, and a more accurate stratification of patients entering clinical trials which investigate new treatments in the adjuvant setting. What recommendations do you have for future research as a result of this study?

Response: To validate our findings in order to incorporate mitotic rate in clinically stage I-II melanomas. Thank you for your contribution to the community.


Mitotic rate correlates with sentinel lymph node status and outcome in cutaneous melanoma greater than 1 millimeter in thickness: A multi-institutional study of 1524 cases 
Mario Mandalà, Francesca Galli, Laura Cattaneo, Barbara Merelli, Eliana Rulli, Simone Ribero, Pietro Quaglino, Vincenzo De Giorgi, Jacopo Pigozzo, Vanna Chiarion Sileni, Alessandra Chirco, Pier Francesco Ferrucci, Marcella Occelli, Gianlorenzo Imberti, Dario Piazzalunga, Daniela Massi, Carlo Tondini, Paola Queirolo, Italian Melanoma Intergroup
Publication stage: In Press Corrected Proof
Journal of the American Academy of Dermatology December 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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