Summary Tumour growth is dependent on angiogenesis. Vascular endothelial growth factor (VEGF) is a secreted endothelial cell-specific cytokine. VEGF is angiogenic in vivo and it also acts as a vascular permeability factor. VEGF is overexpressed in many skin disorders characterized by angiogenesis and increased vascular permeability. We Folkman, 1996). One such stimulus is vascular endothelial growth factor (VEGF), which is a secreted, dimeric 46-kDa protein active as an endothelial cellspecific mitogen and as a vascular permeability factor. VEGF expression has been detected in a large variety of malignant human tumours, and it has been concluded that VEGF has an important role in tumour biology and in the process of tumour angiogenesis (reviewed in Dvorak et al, 1995;Ferrara, 1995). VEGF mRNA has also been detected in metastatic melanoma cells in cerebral melanoma metastases (Hatva et al, 1995).Progression of melanoma is supposed to be associated with an angiogenic response, and several histological studies have shown an increase in vascular structures in malignant melanoma, which is not the case in common naevocellular naevi (reviewed in Denijn and Ruiter, 1993). Expression of VEGF in mouse VEGF cDNAtransected melanoma cells is associated with increased tumour growth, angiogenesis and experimental metastasis in vivo in a nude mouse model (Claffey et al, 1996). This suggests a role for VEGF as a positive regulatory stimulus in angiogenesis, progression and dissemination of malignant melanoma. The aim of the Received 30 October 1996 Revised 13 March 1997 Accepted 20 March 1997 Correspondence to: P Salven present study was to investigate the expression of VEGF in normal dermis, naevocellular naevi and in primary and metastatic melanoma and to study the relationship between VEGF expression and tumour microvessel density, patient survival and other clinicopathological variables.
MATERIALS AND METHODS Patients and tissue samplesThe study includes six patients with a common naevocellular naevus and 55 randomly selected patients with histologically diagnosed malignant melanoma treated with surgery and chemotherapy or chemoimmunotherapy in Helsinki University Central Hospital, during the time period from 1989 to 1995. The prognostic significance of VEGF expression was investigated in a series of 33 patients with a lymph node metastasis from malignant melanoma. Twenty of the patients with metastatic melanoma were male and 13 were female; age at the time of surgery ranged from 30 to 84 years (median 56 years). All patients with metastatic disease were followed up until death or for at least 4 years, as calculated from the surgical removal of the lymph node metastasis. The overall 2-year survival was 35% and 4-year survival 24%.Determination of VEGF expression VEGF expression was determined using a mouse monoclonal antihuman VEGF antibody (MAB293, IgG2b, R&D Research, MN, USA) raised against the 165 amino acid species of the polypeptide. The 5-,um frozen sections were rehydrated, incubated for 30 min in 0.3% hydrogen...