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Evaluation of new histopathologic parameters (modified Breslow index and macroscopic dimension) and immunohistochemistry (KI67 and PRAME) to predict sentinel lymph node outcomes and overall survival of cutaneous melanoma's patients


Cutaneous melanoma carries a high mortality rate and risk of metastasis; its incidence has increased in recent decades. Melanoma arises from a complex interaction between environmental and constitutional factors. It is classified into subtypes with varying epidemiological, histological, and prognostic characteristics. Breslow micrometry measures the tumors from the granular layer to their deepest portions and is critical for determining prognosis and management. Despite widespread use, Breslow micrometry does not consider the variations in the thickness of the normal epidermis throughout the body. Furthermore, the macroscopic diameter of the tumor is usually not considered for prognostic evaluation. Several diagnostic immunohistochemical markers are also routinely used; however, to date, there are no standardized staging protocols that incorporate immunohistochemical markers for the prognostic assessment of cutaneous melanomas. Ki67 is a proliferation marker that may predict outcomes in some neoplasms; its morphological pattern is also related to the proliferative tissue index. The PRAME is used to diagnose melanocytic neoplasms and to perform the prognostic evaluation of other non-melanocytic neoplasms. There are no studies correlating the expression of PRAME with the prognosis and risk of lymph node metastases in cutaneous melanoma. Objective: To correlate the tumor extension, the depth of invasion measured from the basement membrane (modified Breslow), the cell proliferation index measured by Ki67, and the expression of PRAME with the result of the sentinel lymph node and overall survival (five and ten years) in cases of cutaneous melanoma. All cases of invasive melanoma of Hospital das Clínicas de Botucatu and Amaral Carvalho Hospital that underwent sentinel lymph node analysis from January 2000 to December 2020 (21 years) will be reviewed by two dermatopathologists. Sociodemographic and pathological variables such as age, tumor location, and the macroscopic dimension of the lesion will be extracted from the anatomopathological reports. To provide better analysis of modified Breslow, collagen IV and PAS staining with diastase will be performed. Digital and morphological analysis of the Ki67 proliferation index and PRAME immunostaining will also be evaluated concerning sentinel lymph node results and overall survival. (AU)

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