The relationship between Breslow depth and lateral spread of melanoma using histological and immunohistochemical analyses
We plan to prospectively analyze all melanoma in situ and invasive melanomas at Parkland Hospital, UTSW-St. Paul Hospital, UTSW-Ambulatory Services, Zale Lipshy and North Texas VA Health Care System. The clinical margins will be marked using a and amp;quot;scoring and amp;quot; technique. This technique involves using a scalpel to make a superficial incision (to the level of the papillary dermis) around the clinical margin. The margin will be identified utilizing a Wood and amp;apos;s lamp which is standard practice currently. In the event that no clinical tumor is visible, the scar present from the biopsy will be used to identify the clinical margin. All surgeons will be trained in the appropriate use of the Wood and amp;apos;s lamp and scoring technique. We have tested this procedure and found that it reproducibly identifies the clinical margins without effecting the standard evaluation of the tissue. It will also benefit the pathologists by clearly identifying the clinical area of interest within larger excision specimens which should ensure sectioning of the appropriate areas.
After standard processing and evaluation of margin status by pathology, we will require approximately 7 additional sections per excision specimen for additional staining with immunohistochemical and possibly FISH markers. We will identify the clinical margin (these appear as small interruptions in the epidermis which were created by the scoring technique described above) and measure the lateral spread of tumor beyond this clinical margin. In addition, we will stain the additional sections using immunohistochemical markers (specifically the BRAF V600E antibody described above) in attempt to identify the lateral spread of BRAF V600E positive cells. We will also collect standard information regarding the melanomas including the Breslow depth, Clark and amp;apos;s level, mitotic rate, presence of ulceration, and the presence of in-transit metastases/lymphatic invasion. In some cases, this may require evaluation of the diagnostic biopsy specimen. We will attempt to correlate the Breslow depth with the lateral spread of the melanoma beyond the clinical margins identified with the scoring technique. We will also collect the following clinical information on the patients: gender, age, anatomic site of lesion, presence of previous melanomas, nodal status (if known), and BRAF mutational status (if known).
1. Biopsy proven primary cutaneous melanoma or melanoma in situ
2. Age greater than 18 years of age
3. Excision at Parkland Hospital, Zale-Lipshy, UTSW-St. Paul Hospital, UTSW-Ambulatory Services, or VA North Texas Health Care System