Bcl-2 expression is not associated with survival in metastatic cutaneous melanoma: a historical cohort study

World J Surg Oncol. 2008 Jun 20:6:65. doi: 10.1186/1477-7819-6-65.


Background: Programmed cell death (apoptosis) has been implicated in tumor development and may affect the metastatic potential of tumor cells. The role of bcl-2, a proto-oncogene that inhibits apoptosis, has been studied in several malignancies, including cutaneous melanoma (CM). The purpose of this study was to evaluate the immunohistochemical expression of bcl-2 in 35 regional lymph node, 28 subcutaneous and 17 visceral CM metastases, correlating the findings with patient survival.

Methods: In a historical cohort study patient survival was correlated with the expression of bcl-2 in regional lymph node, subcutaneous and visceral metastases of CM. Eighty slides containing surgical specimens from 50 patients diagnosed with stage III and IV CM, 28 male (56%) and 22 female (44%), were analyzed. Mean age at diagnosis was 43 years (16-74 years; median = 42 years). Mean Breslow depth was 5.01 mm (0.4-27.5 mm). The slides were submitted to immunohistochemical reaction using anti-bcl-2 monoclonal antibody and classified according to the degree of staining (< 5%; 5 to 50%; or > 50% of tumor cells stained). The relationship between bcl-2 protein expression and survival for each type of metastasis, gender and age at initial diagnosis was analyzed.

Results: Mean overall survival was 33.9 months after the diagnosis of the initial metastatic lesion (range: 0 to 131 months). Twenty-four out of 50 patients (48%) had died from CM by the end of the study period. bcl-2 expression was detected in 74.3, 85.7 and 82.4% of lymph node, subcutaneous and visceral metastases, respectively. After univariate and multivariate analyses, no correlation was found between positive bcl-2 expression and overall survival for the types of metastases evaluated.

Conclusion: The immunohistochemical expression of bcl-2 in metastasis alone is not a prognostic marker for CM.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / metabolism*
  • Cohort Studies
  • Female
  • Humans
  • Immunoenzyme Techniques
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Melanoma / metabolism*
  • Melanoma / mortality
  • Melanoma / pathology
  • Middle Aged
  • Neoplasm Invasiveness
  • Prognosis
  • Proto-Oncogene Mas
  • Proto-Oncogene Proteins c-bcl-2 / metabolism*
  • Skin Neoplasms / metabolism*
  • Skin Neoplasms / mortality
  • Skin Neoplasms / secondary
  • Survival Rate


  • Biomarkers, Tumor
  • MAS1 protein, human
  • Proto-Oncogene Mas
  • Proto-Oncogene Proteins c-bcl-2