title: Enhanced immunohistochemical detection of neural infiltration in primary melanoma: is there a clinical value?
abstract: Neural infiltration in primary melanoma is a histopathologic feature that has been associated with desmoplastic histopathologic subtype and local recurrence in the literature. We tested the hypothesis that improved detection and characterization of neural infiltration into peritumoral or intratumoral location and perineural or intraneural involvement could have a prognostic relevance. We studied 128 primary melanoma cases prospectively accrued and followed at New York University using immunohistochemical detection with antihuman neurofilament protein and routine histology with hematoxylin and eosin. Neural infiltration, defined as the presence of tumor cells involving or immediately surrounding nerve foci, was identified and characterized using both detection methods. Neural infiltration rate of detection was enhanced by immunohistochemistry for neurofilament in matched-pair design (47% by immunohistochemistry versus 25% by routine histology). Immunohistochemical detection of neural infiltration was significantly associated with ulceration (P = .021), desmoplastic and acral lentiginous histologic subtype (P = .008), and head/neck/hands/feet tumor location (P = .037). Routinely detected neural infiltration was significantly associated with local recurrence (P = .010). Immunohistochemistry detected more intratumoral neural infiltration cases compared with routine histology (30% versus 3%, respectively). Peritumoral and intratumoral nerve location had no impact on clinical outcomes. Using a multivariate model controlling for stage, neither routinely detected neural infiltration nor enhanced immunohistochemical characterization of neural infiltration was significantly associated with disease-free or overall survival. Our data demonstrate that routinely detected neural infiltration is associated with local recurrence in all histologic subtypes but that improved detection and characterization of neural infiltration with immunohistochemistry in primary melanoma does not add to prognostic relevance.
authors.affiliation: Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Patrick
authors.initials: P
authors.lastname: Scanlon
authors.affiliation: Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Jaiying
authors.initials: J
authors.lastname: Tian
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Judy
authors.initials: J
authors.lastname: Zhong
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Ines
authors.initials: I
authors.lastname: Silva
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Shapiro
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Anna
authors.initials: A
authors.lastname: Pavlick
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Surgery, New York University School of Medicine, 10016, New York, NY.
authors.forename: Russell
authors.initials: R
authors.lastname: Berman
authors.affiliation: Department of Dermatology, New York University School of Medicine, 10016, New York, NY; The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY.
authors.forename: Iman
authors.initials: I
authors.lastname: Osman
authors.affiliation: The New York University Interdisciplinary Melanoma Cooperative Group, 10016, New York, NY; Department of Pathology, New York University School of Medicine, 10016, New York, NY. Electronic address: Farbod.Darvishian@nyumc.org.
authors.forename: Farbod
authors.initials: F
authors.lastname: Darvishian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008545:Melanoma / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D009474:Neurons / Q000378:metabolism / Q000473:pathology*; D010525:Peripheral Nerves / Q000378:metabolism / Q000473:pathology*; D012878:Skin Neoplasms / Q000378:metabolism / Q000473:pathology*
keywords: Immunohistochemistry; Local recurrence; Melanoma; Neural filament antibody; Neural infiltration