Detection of lymphatic invasion in primary melanoma with monoclonal antibody D2-40: a new selective immunohistochemical marker of lymphatic endothelium.
OBJECTIVE
To identify the presence of lymphatic invasion in primary cutaneous melanoma using monoclonal antibody D2-40, a marker of lymphatic endothelium, and to correlate the presence of lymphatic invasion with other clinicopathologic characteristics of the tumors.


METHODS
Retrospective melanoma case series study comparing conventional hematoxylin-eosin staining with D2-40 immunostaining for detection of lymphatic invasion.


METHODS
Departments of Pathology and Dermatology, Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, Ontario. Patients Forty-four consecutive cases of primary cutaneous melanoma with a tumor thickness greater than 0.75 mm were examined for presence of lymphatic invasion.


RESULTS
Seven (16%) of 44 melanomas showed the presence of lymphatic invasion under immunostaining with D2-40. In 2 cases, subepidermal lymphatic involvement was present; in 5 cases lymphatic invasion was noted within the tumor, including 1 case of additional lymphatic invasion at the invasive edge of the tumor. Lymphatic invasion was not detected on routine hematoxylin-eosin staining. We observed a trend in the association between lymphatic invasion and 2 markers of tumor aggressiveness, namely, a deeper Clark level and increased frequency of ulceration, which suggests that lymphatic invasion detected with D2-40 may indicate a poor prognosis.


CONCLUSIONS
Immunostaining with D2-40 increases the frequency of detection of lymphatic invasion relative to conventional hematoxylin-eosin staining in primary melanoma. Future outcome data will determine the prognostic significance of lymphatic invasion detected by D2-40 immunostaining.
Niakosari
Firouzeh
F
Departments of Pathology and Dermatology, Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada.
Kahn
Harriette J
HJ
Marks
Alexander
A
From
Lynn
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001707:Biopsy, Needle; D015331:Cohort Studies; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology* / Q000503:physiopathology
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C500987:monoclonal antibody D2-40