A quantitative comparison between SOX10 and MART-1 immunostaining to detect melanocytic hyperplasia in chronically sun-damaged skin

Abstract

Histologic differentiation of melanoma in situ (MIS) from solar keratosis on chronically sun-damaged skin is challenging. The first-line immunostain is usually MART-1/Melan-A, which can exaggerate the epidermal melanocytes, causing a diagnostic pitfall for MIS. By comparing MART-1 and SOX10 immunostaining, we scored the percentage of epidermal melanocytes per 2-mm diameter fields in pigmented actinic keratosis (n=16), lichenoid keratosis (n=7), junctional melanocytic nevus (n=6), keratosis with atypical melanocytic proliferation (AMP, n=17) and MIS (n=10). These cases represented an older population (68 years median age) and the head and neck (50%) was the most common anatomic site. MART-1 score was significantly higher than SOX10 (P value < 0.05) in solar keratoses, but showed no difference in detecting melanocytic proliferations, demonstrating their equal detection rate of melanocytes. The sensitivity of both MART-1 and SOX10 was 100% while their specificities were 17% and 96%, respectively. These results show SOX10 is more specific than MART-1 in distinguishing epidermal melanocytes on sun-damaged skin by avoiding over diagnosis of melanoma.