mart-1-antigen and Keratosis

Recent studies have proposed that MART-1 may falsely stain clusters of intraepidermal nonmelanocytic cells in lichenoid dermatitides. This may become an issue especially in isolated lesions of lichen planus-like keratosis (LPLK), a condition also known as benign lichenoid keratosis, and one that is often mistaken clinically for a malignant cutaneous neoplasm. LPLKs are known to exhibit basal epidermal pseudonests, mimicking a regressing melanocytic lesion histologically, and often may prompt the pathologist to obtain a MART-1 stain. If MART-1 is falsely positive, it may seal an incorrect diagnosis. To determine whether or not pseudonests in LPLK decorated with MART-1, we reviewed 70 cases from our institution, stained them with MART-1 (Thermo Fisher-Lab Vision, Ab3 clone, 1:400 dilution, heat-induced epitope retrieval with 0.02M citrate buffer at pH 6.0), and evaluated them for the presence or absence of staining within pseudonests. Four cases demonstrated an occasional MART-1-positive junctional nest. In these cases, microphthalmia transcription factor was also positive, confirming a true melanocytic origin. None of the other cases showed a MART-1 pattern that would have been suspicious for a melanocytic lesion. We propose that this discrepancy between our study and prior ones may be explained by differences in staining protocols or by a very low incidence of non-specific staining. Our study suggests that MART-1 is a useful marker in differentiating melanocytic nests from pseudonests in LPLK.

Topics: Biomarkers, Tumor; Diagnosis, Differential; Humans; Immunohistochemistry; Keratosis; Lichenoid Eruptions; MART-1 Antigen; Skin Neoplasms

Pigmented actinic keratosis is one of the simulators of early melanoma in situ from severely sun-damaged skin. Close scrutiny of the hematoxylin and eosin stained section does not always allow an unequivocal diagnosis, because it is sometimes difficult to distinguish pigmented keratinocytes from melanocytes. Immunohistochemical stains, such as S-100 and HMB-45, are used routinely to address this problem. Melan-A, also known as MART-1, is an additional melanocytic marker and has proved to be useful in identifying metastatic tumors of melanocytic origin. The usefulness of this marker to discriminate pigmented actinic keratosis from early melanoma in situ, however, has not yet been a subject of investigation. In this study we evaluated Melan-A expression in ten unequivocal cases of pigmented actinic keratosis and compared the staining pattern with that of S-100, HMB-45, and tyrosinase. In all ten cases the number of cells highlighted with Melan-A was by far larger than those labeled with S-100, HMB-45, and tyrosinase. Four cases showed clusters of Melan-A positive cells being suggestive of melanocytic nests. Even areas of normal skin adjacent to the actinic keratosis featured prominent staining of Melan-A, but only inconsistent labeling of intraepidermal melanocytes with S-100, HMB-45, and tyrosinase. We therefore believe that Melan-A is a more sensitive marker for intraepidermal melanocytes than S-100, HMB-45, and tyrosinase. In addition there may be expression of Melan-A in keratinocytes and nonmelanocytic cells. To avoid an erroneous diagnosis of malignant melanoma one should therefore interpret results obtained from Melan-A stained slides carefully and in the context with other melanocytic markers.

Topics: Aged; Aged, 80 and over; Antigens, Neoplasm; Biomarkers, Tumor; Carcinoma in Situ; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratosis; Male; MART-1 Antigen; Melanoma; Melanoma-Specific Antigens; Middle Aged; Monophenol Monooxygenase; Neoplasm Proteins; S100 Proteins; Skin Neoplasms; Sunlight