Reporting Tumor Infiltrating Lymphocytes

Abstract

The presence of many tumor infiltrating lymphocytes (TILs) in primary cutaneous melanoma is associated with a better prognosis. The degree of lymphocytic interaction with the tumor cells is graded as “brisk”, “non-brisk” or “absent” as defined below:

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The presence of many tumor infiltrating lymphocytes (TILs) in primary cutaneous melanoma is associated with a better prognosis. The degree of lymphocytic interaction with the tumor cells is graded as “brisk”, “non-brisk” or “absent” as defined below:

• Brisk

  • TILs present throughout the substance of the vertical growth phase or infiltrating across the entire base of the vertical growth phase (VGP). Lymphocytes must be directly apposed to melanoma cells.

• Non-Brisk

  • TILs present in one or more foci of vertical growth phase

• Absent

  • Lymphocytes may be present but DO NOT infiltrate the melanoma. For example they may be around vessels, in a fibrotic zone, or surrounding but not infiltrating the melanoma

  • There are no lymphocytes in association with any part of the VGP

  • There is a dermal nodule of melanoma without inflammation

Fig. 47.1

Schematic of tumor infiltrating lymphocytes (TILs) in primary cutaneous melanoma. In a brisk pattern the TILs (black small circles) infiltrate throughout the vertical growth phase (VGP) or all along the peripheral margin, touching the melanoma cells (brown circles). In non-brisk infiltrates the interaction between the TILs and melanoma cells is more patchy or focal. In infiltrates termed absent, lymphocytes may be present but do not interact with the melanoma cells