Prognostic Implication of Lymphovascular Invasion Detected by Double Immunostaining for D2-40 and MITF1 in Primary Cutaneous Melanoma

Am J Dermatopathol. 2016 Jul;38(7):484-91. doi: 10.1097/DAD.0000000000000453.

Abstract

Background: Lymphovascular invasion (LVI) is associated with adverse outcomes in primary cutaneous melanoma (PCM). Detection of LVI by hematoxylin and eosin staining alone is 0%-6%, but targeting lymphovascular structures increases the detection rate.

Objective: To examine the prognostic significance of LVI detected by immunostaining for D2-40 and microphthalmia-associated transcription factor 1 (MITF1) in PCM.

Methods: The authors retrospectively analyzed 120 PCM samples. We compared the LVI detection rates of immunostaining for D2-40 only (22%), double staining for D2-40 and MITF1 (38%), and hematoxylin and eosin, and examined the association of LVI with clinicopathologic variables and clinical outcomes.

Results: Immunolabeling with both methods significantly increased the LVI detection rate. Double staining for D2-40 and MITF1 as well as D2-40-detected LVI was significantly associated with increased Breslow thickness, number of mitoses, and sentinel lymph node (SLN) metastasis. D2-40-detected LVI was also associated with ulceration. Although the difference was not significant, double staining for D2-40 and MITF1 allowed for easier detection of LVI than D2-40 alone.

Limitations: This study was conducted in a tertiary referral institution; therefore, a referral bias cannot be excluded.

Conclusions: Immunolabeling increased detection of LVI in PCM. Because LVI is a positive predictive marker for SLN metastasis, the authors propose using anti-D2-40 and anti-MITF1 in the evaluation of LVI in patients with PCM with a certain risk of SLN metastasis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived*
  • Biomarkers, Tumor / analysis*
  • Biopsy
  • Female
  • Humans
  • Immunohistochemistry*
  • Lymphatic Metastasis
  • Lymphatic Vessels / chemistry*
  • Lymphatic Vessels / pathology
  • Male
  • Melanoma / chemistry*
  • Melanoma / pathology
  • Melanoma-Specific Antigens / analysis*
  • Microphthalmia-Associated Transcription Factor / analysis*
  • Middle Aged
  • Mitosis
  • Neoplasm Invasiveness
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Skin Neoplasms / chemistry*
  • Skin Neoplasms / pathology
  • Young Adult

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Biomarkers, Tumor
  • MITF protein, human
  • Melanoma-Specific Antigens
  • Microphthalmia-Associated Transcription Factor
  • monoclonal antibody D2-40