Lentigo maligna: value of PRAME/Melan A IHC double-labelling

Immunohistochemistry is a vital tool in the classification of skin lesions. Here, Rasiyan Salih and colleagues explore and assess the value of double labelling for PRAME and Melan A expression as an improved marker for slow Mohs margin assessment of lentigo maligna.

Lentigo maligna (LM) is a distinct subtype of melanoma in situ (MIS) that is denoted by a lentiginous growth pattern that is presented in chronically photodamaged skin. Given the variable nature of LM, specialised staged excision (SE) approaches such as the (slow) Mohs micrographic surgery (MMS) technique combined with permanent sectioning, has become a therapy of choice in LM patients presenting on complex areas such as the head and neck (H&N).1 Furthermore, permanent sectioning has enabled the use of routine immunohistochemistry (IHC) to aid margin assessment.

Prior studies have shown that Preferentially Expressed Antigen in Melanoma (PRAME) is restrictively expressed in a variety of malignant melanocytic neoplasms.2 This has led to further studies seeking to address the utility of PRAME specifically within the context of LM margin assessment, showing promising sensitivity (93.5%) and specificity (94.7%) profiles.3 Furthermore, PRAME is a nuclear stain, making it an ideal candidate for IHC double-labelling (DL) techniques.

Here, we investigate the potential of maximising the utility of PRAME IHC as an adjunct to haematoxylin and eosin (H&E) staining by combining it with another cytoplasmic melanocytic marker, Melan A. In this study, the PRAME/Melan A DL IHC technique was applied retrospectively on positive LM slow Mohs margin specimens in order to determine if the DL provides improvement over the single-label (SL) IHC counterparts, PRAME and Melan A, respectively.

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