Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Discriminating Between Irritated SK and SCC in Situ

J Cutan Pathol; ePub 2018 May 3; Richey, Deng, et al

The combination of IMP3 and BCL‐2 genes may be of diagnostic use in distinguishing between irritated seborrheic keratosis (ISK) and squamous cell carcinoma in situ (SCCIS) in daily clinical practice, according to a recent study that sought to determine if an immunohistochemical profile of select markers can aid in differentiating these 2 entities. Epidermal Growth Factor Receptor (EGFR) immunohistochemistry, however, did not appear to be useful in this setting. Researchers randomly selected and stained 103 ISK and 111 SCCIS for EGFR, IMP3, and BCL‐2. IMP3 staining was scored as negative or 0 (0% positive), 1+ (1‐25% positive), 2+ (26‐50% positive) and 3+ (>50% positive). BCL‐2 and EGFR were graded as either positive or negative. They found:

  • 65 of 103 (63%) ISKs were positive for BCL‐2, none (0%) were positive for IMP3, and 18 (18%) were positive for EGFR.
  • 15 of 111 (14%) SCCISs were positive for BCL‐2, 26 (23%) were positive for IMP3, and 27 (24%) were positive for EGFR.
  • BCL‐2 was moderately sensitive (63%) and specific (87%) in identifying ISK.
  • IMP3 was specific (100%) but not sensitive (23%) for SCCIS.

Richey JD, Deng AC, Dresser K, O’Donnell P, Cornejo KM. Distinguishing between irritated seborrheic keratosis and squamous cell carcinoma in situ using BCL‐2 and IMP3 immunohistochemistry. [Published online ahead of print May 3, 2018]. J Cutan Pathol. doi:10.1111/cup.13269.

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