Muzumdar Sonal, Argraves Melissa, Kristjansson Arni, Ferenczi Katalin, Dadras Soheil S
School of Medicine, University of Connecticut, Farmington, Connecticut.
Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
J Cutan Pathol. 2018 Apr;45(4):263-268. doi: 10.1111/cup.13115. Epub 2018 Feb 15.
Histologic differentiation of melanoma in situ (MIS) from solar keratosis on chronically sun-damaged skin is challenging. The first-line immunostain is usually MART-1/Melan-A, which can exaggerate the epidermal melanocytes, causing a diagnostic pitfall for MIS. By comparing MART-1 and SOX10 immunostaining, we scored the percentage of epidermal melanocytes per 2-mm diameter fields in pigmented actinic keratosis (n = 16), lichenoid keratosis (n = 7), junctional melanocytic nevus (n = 6), keratosis with atypical melanocytic proliferation (n = 17) and MIS (n = 10). These cases represented an older population (68 years median age) and the head and neck (50%) was the most common anatomic site. MART-1 score was significantly higher than SOX10 (P value <.05) in solar keratoses, but showed no difference in detecting melanocytic proliferations, demonstrating their equal detection rate of melanocytes. The sensitivity of both MART-1 and SOX10 was 100%, while their specificities were 17% and 96%, respectively. These results show that SOX10 is more specific than MART-1 in distinguishing epidermal melanocytes on sun-damaged skin by avoiding overdiagnosis of melanoma.
在长期受阳光损伤的皮肤上，原位黑色素瘤（MIS）与日光性角化病的组织学鉴别具有挑战性。一线免疫染色通常是MART-1/Melan-A，它会使表皮黑素细胞增多，给MIS的诊断带来陷阱。通过比较MART-1和SOX10免疫染色，我们对色素性光化性角化病（n = 16）、苔藓样角化病（n = 7）、交界性黑素细胞痣（n = 6）、伴有非典型黑素细胞增殖的角化病（n = 17）和MIS（n = 10）中每2毫米直径视野内的表皮黑素细胞百分比进行了评分。这些病例代表了老年人群（中位年龄68岁），头颈部（50%）是最常见的解剖部位。在日光性角化病中，MART-1评分显著高于SOX10（P值<.05），但在检测黑素细胞增殖方面无差异，表明它们对黑素细胞的检测率相同。MART-1和SOX10的敏感性均为100%，而它们的特异性分别为17%和96%。这些结果表明，SOX10在区分阳光损伤皮肤上的表皮黑素细胞时比MART-1更具特异性，可避免过度诊断黑色素瘤。
