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Title: The role of vascular endothelial growth factor in the nodal metastasis of malignant melanoma
Author: Chawla, Rakhee
ISNI:       0000 0004 6057 863X
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2015
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Introduction: Malignant Melanoma is the most lethal of the skin cancers and the UK incidence is rising faster than that of any other cancer. Breslow thickness remains the best predictor of metastasis and Sentinel Lymph Node Biopsy is the only method of detecting nodal spread in clinically node negative patients. Surgery is the only effective therapy. Angiogenesis – the growth of new vessels from pre-existing vasculature - is an absolute requirement for tumour survival and progression beyond a few hundred microns in diameter. Anti- angiogenic isoforms of VEGF have been demonstrated previously to be protective with regard to metastasis. The aims of this thesis were to determine whether VEGF expression within the tumour may allow prediction of the nodal status. Furthermore another aim was to determine whether via the “Seed and Soil” theory, by examination of angiogenic and lymphangiogenic profiles of the tumour and node can we determine that the tumour may control the microenvironment around the Sentinel Node? Finally, as a cohort of false negative patients emerged with a higher mortality rate than their true negative and true positive patient cohort counterparts, could any further patterns be established by performing the same experiments on these patients? Methods: Archived human tumour and corresponding Sentinel Node samples were used and immunohistochemistry was used to investigate the role of pro and anti angiogenic isoforms of VEGF, VEGF-C, LYVE-1 and CD31 within these patients. Results: VEGF-C expression was significantly increased in the intranodal component of positive Sentinel Lymph Nodes (p < 0.01 Bonferroni). This increased expression appeared to be independent of tumoural influences and no strong evidence for the “Seed and Soil” theory was proved. A significantly higher number of lymphatic vessel counts were identified within node negative patients (p < 0.05 ANOVA). No further significant findings were defined on examination of the false negative cohort of patients. Conclusions: This study has shown that positive Sentinel Lymph Nodes exhibit high levels of intranodal VEGF-C. This expression does not appear to be related to tumoural influences. It would therefore appear that VEGF-C expression within Sentinel Nodes warrants further investigation and may aid diagnosis of spread or represent a target to slow or even prevent the onset of metastasis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General) ; RB Pathology ; RD Surgery ; RL Dermatology