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April 2005

Detection of Lymphatic Invasion in Primary Melanoma With Monoclonal Antibody D2-40: A New Selective Immunohistochemical Marker of Lymphatic Endothelium

Author Affiliations

Author Affiliations: Departments of Pathology (Drs Niakosari, Kahn, Marks, and From) and Dermatology (Dr From), Sunnybrook and Women’s College Health Sciences Center, and Banting and Best Department of Medical Research (Dr Marks), University of Toronto, Toronto, Ontario.

Arch Dermatol. 2005;141(4):440-444. doi:10.1001/archderm.141.4.440

Objectives  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.

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

Setting  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.