I read with interest the editorial of Sondak and Messina1 on lymphangiogenesis and melanoma metastasis. Lymphangiogenesis has possibly become the crucial problem of melanoma management. Since vascular endothelial growth factors (VEGFs) A, C, and D induce lymphangiogenesis in experimental wounds in adult animals,2,3 it is possible that wounding stimulates lymphangiogenesis. The slow healing of chronic diabetic ulcers is related to the downregulation of VEGFs, and the administration of VEGF accelerates wound healing.4 Based on these observations, I wish to offer the hypothesis that surgery may promote the same lymphangiogenic activity that promotes the dissemination of malignant cells.
Rebora A. Lymphangiogenesis Induced by Surgery: A Risk for Melanoma Metastasis. Arch Dermatol. 2009;145(1):89. doi:10.1001/archdermatol.2008.543