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(American Journal of Pathology. 2000;157:957-965.)
© 2000 American Society for Investigative Pathology

Regular Articles

Reduced Level of CD44 and Hyaluronan Associated with Unfavorable Prognosis in Clinical Stage I Cutaneous Melanoma

Jari M. Karjalainen^*, Raija H. Tammi, Markku I. Tammi, Matti J. Eskelinen^*, Ulla M. Ågren, Jyrki J. Parkkinen, Esko M. Alhava^* and Veli-Matti Kosma^§

From the Departments of Surgery^*
and Clinical Pathology,^§
Kuopio University Hospital, Kuopio; and the Departments of Anatomy
and Pathology and Forensic Medicine,
University of Kuopio, Kuopio, Finland

The cell surface glycoprotein CD44 and its ligand, hyaluronan (HA), enhance growth and metastatic capacity of melanoma cells in vitro, but their clinical significance in primary cutaneous melanoma is still unclear. Therefore, we studied whether the levels of CD44 and HA associate with disease progression and survival of cutaneous melanoma. A series of 292 clinical stage I cutaneous melanomas was analyzed by immunohistochemistry using an anti-CD44H antibody (clone 2C5). HA was demonstrated histochemically using a biotinylated HA-specific affinity probe (bHABC). The reduced staining levels of CD44 and HA were associated with each other and indicators of progressive disease. Reduced CD44 and HA level, high tumor thickness, high pT category, high Clark’s level, bleeding, and male gender predicted short univariate recurrence free survival (RFS) and overall survival (OS). In Cox’s multivariate analysis (N = 251), the decreased level of CD44, high tumor thickness, and bleeding predicted independently short RFS. High tumor thickness and bleeding were associated with short OS. We conclude that the reduced cell surface CD44 and HA levels associate with poor prognosis in clinical stage I cutaneous melanoma. The notion that the decreased level of CD44 independently predicts short RFS suggests that reduced cell surface CD44 enhances the spreading potential in localized cutaneous melanoma and that quantification of CD44 offers a prognostic tool for its clinical evaluation.

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