p40 in Conjunction With CK20 and E-Cadherin Distinguishes Primary Adnexal Neoplasms of the Skin

Abstract

Although basal cell carcinomas (BCC) show typical histomorphologic features, they sometimes remain difficult in distinction from benign adnexal skin tumors of follicular origin like trichoepithelioma (TE) or trichoblastoma (TB). Consequently, an immunohistochemical marker panel separating described entities would be helpful in clinical routine. Thus, we stained 22 skin lesions (BCC, TE, and TB) against β-catenin, CK20, E-cadherin, p40, and p63. The staining pattern was described and quantified using an immunohistochemical score. Although p40 and p63 revealed a strong staining intensity of all skin lesions without distinction between BCC and benign lesions (P=1.000), established Merkel cell marker CK20 illustrated a loss of staining in BCC compared with TE and TB (P=0.007). In contrast, BCC exhibited an increased expression of E-cadherin in relation to TE and TB (P=0.009). Single application of CK20 or E-cadherin could predict diagnosis of BCC in 81.8% or 72.7%, respectively. Combining consecutive staining of E-cadherin and CK20 could even enhance specificity toward diagnosis of TE or TB. Hence, findings of our study imply that sequential staining of CK20 and E-cadherin prevents false-positive classification of BCC. Furthermore, our study demonstrated that p40 exhibits the same staining pattern in BCC, TE, and TB. Therefore, p40 might replace p63 equivalently establishing diagnosis of primary adnexal neoplasms of the skin in the form of BCC as well as benign adnexal tumors. As a result, the depicted immunohistochemical marker panel may be applied for adnexal skin neoplasms as a diagnostic adjunct especially in surgically challenging body regions.

Cytokeratin expression in epidermal stem cells in skin adnexal tumors

“…Jakobiec et al (14) applied CK15 expression to investigate the property of the adenoma sebaceum, and Andruszkow et al (15) utilized CK19 expression for differential diagnosis of the basal cell carcinoma and adenoma sebaceum. Furthermore, it is reported that CK expression levels can be used to diagnose clear cell hidroadenoma (16) and primary neuroendocrine carcinoma (17) clinically, suggesting that detection of CKs may be beneficial to diagnosing epithelial tumor of the skin.…”

Giant basal cell carcinoma of anterior chest wall reveals metastasis to lungs: A case report

“…While both BCC and SCC tumors may show overlapping features of squamous differentiation by being positive for p63 and CK5/6, 19 , 20 positivity for both Ber‐Ep4 and BCL‐2 14 , 21 are most consistent with BCC. Strong expression of EMA (epithelial membrane antigen) and lack of staining for BCL‐2 is more indicative of squamous cell carcinoma (SCC).…”

p63 Is a Promising Marker in the Diagnosis of Unusual Skin Cancer

“…Ha Lan and colleagues debated the superior quality of p40; while p40 and pan-p63 antibodies gave similar results for AFX and desmoplastic melanoma, pan-p63 showed higher sensitivity in the detection of cSCSCC relative to p40 (81% vs. 56%, respectively) [86]. Notwithstanding this discrepancy, other recent studies have suggested using p40 in the diagnosis of skin cancer [126,127] and as a gold standard for other tumours as non-small cell lung cancer [128]. In line with increased evidence for the usefulness of p40, a monoclonal MMp40 antibody against ΔNp63 (clone BC28) was produced and is currently commercially available for diagnostics (Roche, Cat No.…”