title: Expression of Melan-A and Ki-67 in desmoplastic melanoma and desmoplastic nevi.
abstract: BACKGROUND
  Desmoplastic melanoma (DMM) is an uncommon melanoma variant with a distinct morphology, including a prominent spindle cell component with fibrosis, as well as a distinct immunohistochemical profile. Histologically, the spindle cell component of DMM can be confused with sclerotic/desmoplastic nevi, nonpigmented blue nevi, scar, and neural tumors. The histological distinction between sclerotic/desmoplastic/blue nevi and DMM using standard light microscopic techniques can be exceedingly subtle. Therefore, we investigated whether immunohistochemical staining for Melan-A and Ki-67 expression can be used to discriminate these lesions, distinguishing between epithelioid and spindle cell compartments of the lesions.
  
  
  METHODS
  Fifty cases of DMM and 13 cases of sclerotic/desmoplastic/blue nevi were identified. Standard immunohistochemical techniques were used with antibodies towards HMB-45, Melan-A (A103), and Ki-67; 43 of 50 DMM cases were available for staining with Melan-A, 42 of 50 for HMB-45, and 31 of 50 cases were stained with Ki-67. All 13 nevi were stained for Melan-A and 8 for Ki-67. Immunoreactivity to Ki-67 antibody was scored as 0 to 5%, 6 to 10%, 11 to 30%, or greater than 30% positive tumor cells.
  
  
  RESULTS
  Only 3 of 43 and 3 of 42 of spindle cell compartments of DMMs were positive for Melan-A and HMB-45, respectively. Focal staining of epithelioid cells in the junctional component or superficial dermis was observed in 33% (14/43). In contrast, 100% of the 13 nevi were strongly positive for Melan-A (P < 0.001). Seventeen melanomas (55%) were 0 to 5% positive for Ki-67, five (16%) fell into the 6 to 10% category, three (10%) were between 11 and 30%, and six (19%) were at least focally greater than 30% positive. All 8 nevi (100%) had less than 5% positive cells for Ki-67 (P = 0.02), with only 2 cases having more than 2% positive cells.
  
  
  CONCLUSIONS
  The sclerotic/desmoplastic and hypopigmented blue nevi were uniformly positive for Melan-A, while the vast majority of DMM were negative in their spindle cell compartments. Melan-A is very useful in distinguishing between DMM and sclerotic nevi. Ki-67 appears to be an inconsistent marker for DMM. However, a high labeling index (over 5%) may be used as a clue in diagnosing DMM.
authors.affiliation: Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kucher
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Zhang
authors.forename: Theresa
authors.initials: T
authors.lastname: Pasha
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ming
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Xu
mesh_terms: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor / Q000032:analysis*; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D058965:MART-1 Antigen; D008545:Melanoma / Q000378:metabolism* / Q000473:pathology; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins / Q000096:biosynthesis* / Q000378:metabolism; D009506:Nevus / Q000378:metabolism* / Q000473:pathology; D012878:Skin Neoplasms / Q000378:metabolism* / Q000473:pathology
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D058965:MART-1 Antigen; C548667:MLANA protein, human; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins