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Karin U. Loeffler, Martina C. Herwig, Frank G. Holz; Melanocytic Markers in Basal Cell Carcinoma of the Eyelid. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4947.
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The differential diagnosis between basal cell carcinoma (BCC) and adnexal tumors of the skin can sometimes be challenging. Having detected a fairly high number of Melan A- and HMB 45-positive cells in a trichoblastoma, and assuming that in BCC there is no significant proliferation of melanocytes, we explored whether or not these melanocytic markers are able to help in distinguishing BCC from other entities.
Twelve tumors diagnosed as typical solid BCC and 7 lesions with hair differentiation were investigated. The mean age in patients with BCC was somewhat higher than in those with "hair tumours" (68 years compared to 59 years). All specimens had been fixed in paraformaldehyde and processed routinely for paraffin histology, and the diagnosis was established on sections stained with Hematoxilin&Eosin and PAS. For immunohistochemistry, sections were reacted with monoclonal antibodies (mAbs) against Melan A (Dako, 1:200), HMB 45 (Dako, 1:50), and CD 68 (Dako, 1:50 ). The immunoreaction was visualized using AEC as chromogen. Immunoreactivity (IR) was graded on a scale form 0 to +++, and tumor tissue was also compared with the overlying epithelium and the surrounding fibrous tissue.
All specimens revealed cells reacting with Melan A and HMB 45 within the tumor itself as well as within the basal epithelium. By contrast, CD 68 was present only in tissue surrounding the tumor; hardly any cell within the tumor tissue reacted. No obvious association was observed between the number of melanocytes within the overlying epithelium and those within the tumor itself. However, HMB 45 was always less reactive than Melan A. IR for melanocytic markers appeared somewhat less intense in hair tumors compared with BCC but no clear distinction could be made.
To our surprise, a fairly high number of melanocytic differentiation was present in BCC as well as in hair tumors. In contrast to primary melanocytic proliferations, however, positively labeled cells usually revealed the classic dendritic melanocyte morphology. In terms of diagnostic differentiation between BCC and hair tumors, no really helpful conclusion could be drawn from our present data.
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