Detection of mitotic figures in thin melanomas--immunohistochemistry does not replace the careful search for mitotic figures in hematoxylin-eosin stain.

Abstract

The mitotic rate is an important prognostic criterion in patients with thin melanoma ≤ 1 mm. The aim of this study was to investigate the reproducibility of the mitotic rate in thin melanoma in hematoxylin-eosin (H&E) stain and compare it with the detection of mitotic figures by immunohistochemistry. The number of mitoses stated in the routine diagnostic report in 190 pT1 melanomas was compared with the number gained from re-evaluation of H&E sections and the number detected after staining with the mitotic marker, phosphohistone H3 (PHH3). Two different approaches were used for choosing the "hot spot" for evaluation (dermal vs epidermal/dermal). Comparing routine H&E-stained slides with re-evaluation slides, the number of mitotic figures was slightly variable. However, findings did not result in a change of the tumor stage. In 34% of the tumors with dermal mitotic figures on H&E, mitoses could not be found in the corresponding PHH3 slide anymore. In 4% of the cases, stage relevant mitoses could only be found by PHH3 immunohistochemistry. This is a single center study. Immunohistochemical staining for mitotic figures does not replace a careful evaluation of H&E-stained slides. Immunohistochemical detection of mitosis is only an additional tool; the time-saving effect is therefore negligible.