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Angiotropism: What's New?

Summary and Comment |
November 27, 2013

Angiotropism: What's New?

  1. Angelica Selim, MD

In malignant melanoma, angiotropism predicts an increased risk for metastasis.

  1. Angelica Selim, MD

The overall median survival of patients with metastatic malignant melanoma is 6 to 10 months; this survival period drops by half when the metastasis affects the brain. Neoplastic cells traveling within vessels is the most widely accepted route of metastatic spread. For malignant melanoma (MM), an alternative pattern of spread has been proposed: extravascular migratory migrations (EVMM), evidenced by angiotropism.

In this retrospective study, researchers analyzed 20 primary MMs and respective metastatic brain lesions in search of angiotropism. The primary MMs were analyzed for presence of angiotropism, Breslow thickness, Clark level, mitotic rate, sentinel lymph node (SLN) status, and time interval between the primary lesion and the metastasis. Of the primary MMs, 70% demonstrated angiotropism; it was found predominantly in men, and the median age in those with angiotropism was 60, versus 47 in those without. Statistically significant differences between MMs with and without angiotropism included Breslow depth (4.4 mm vs. 1.4 mm) and mitotic activity (11 vs. 5 mitoses/mm2). Average time from diagnosis to metastasis was 33 months in patients with angiotropism versus 57 months in those without. More than half of the patients underwent SLN biopsy; all were positive.

Comment

Malignant melanoma is among the tumors (lung, breast, unknown primary) most likely to spread to the brain. On autopsy, brain metastasis is found in 75% of patients with stage four MM. The authors explore an alternative pathway by which malignant cells spread — via the external vessel surface (abluminal), rather than intraluminal. This feature is also seen in gliomas, another tumor with neural crest differentiation. We know that angiotropism in MM correlates with higher frequency of in-transit metastasis. Although this sample is small for drawing clinical conclusions, it appears that angiotropism in primary MM should alert us to increased risk for and a shorter time lapse to brain metastasis. Once metastases appear in the brain, treatment options are limited.

  • Disclosures for Angelica Selim, MD at time of publication Grant / research support NIH/NCI Leadership positions in professional societies International Society of Dermatopathology (Organization Committee)

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