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Tumor-associated lymphangiogenesis in conjunctival malignant melanoma
  1. Paul Zimmermann1,
  2. Tina Dietrich2,
  3. Felix Bock1,
  4. Folkert K Horn1,
  5. Carmen Hofmann-Rummelt1,
  6. Friedrich E Kruse1 and
  7. Claus Cursiefen1
  1. 1 Department of Ophthalmology, University of Erlangen-Nürnberg, Germany;
  2. 2 Department of Ophthalmology, University Medical Center Regensburg, Germany
  1. * Corresponding author; email: ccursiefen{at}


Background: To evaluate whether tumor-associated lymphangiogenesis, i.e. the formation of new lymphatic vessels (LVs) induced by a tumor, occurs in and around conjunctival malignant melanoma (MM).

Methods: Clinical files and conjunctival specimens of 20 patients with histologically diagnosed conjunctival MM were analysed. Sections were stained with LYVE-1 and podoplanin antibodies as specific lymphatic endothelial markers and Ki67 as proliferation marker. The tumor area and the area covered by LV (LVA), the LV number (LVN), and the LV density (LVD) were measured within the tumor and in the peritumoral area in digital images of the specimen. The LV results were correlated to histopathological characteristics, tumor location, recurrence rate, mitomycin C therapy and presence of metastases.

Results: LVs were detected in all specimens within the tumor and peritumorally. Significantly more Ki67+ proliferating lymphatic endothelial cells were detected in the tumor and in the peritumoral tissue up to 300 µm compared to the surrounding normal conjunctiva (>300 µm distance). There was a slightly positive correlation between the tumor size and the LVN and LVA in the 50 µm zone adjacent to the tumor. We did not find significant correlations between LVs and histopathological and clinical characteristics (location, shape, relapses, metastases), possibly due to small sample sizes. Non-limbal tumors with involvement of tarsus or fornix showed a tendency of higher LVD compared to limbal tumors.

Conclusion: Conjunctival MMs display tumor-associated LV within and around the tumor. The MM seems to induce lymphangiogenesis not only in the tumor, but also in its proximity.

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