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FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients

American Journal of Otolaryngology



1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence.

Study Design

Retrospective cohort study.


Patients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend.


Fifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p = 0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p = 0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p = 0.02).


FoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.


a Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA

b Department of Pathology, Duke University Medical Center, Durham, NC, USA

c Surgical Service, Section of Otolaryngology–Head and Neck Surgery, Durham VA Medical Center, Durham, NC, USA

lowast Corresponding author at: DUMC 3805, Durham NC 27710, USA. Tel.: + 1 919 681 8449.

Each of the authors has contributed to, read and approved this manuscript. None of the authors have any conflict of interest, financial or otherwise. This manuscript is original and it, or any part of it, has not been previously published; nor is it under consideration for publication elsewhere.

☆☆ Presented at the American Academy of Otolaryngology–Head and Neck Surgery Foundation Annual Meeting, September 29–October 2 2013, Vancouver, Canada.