Non-Melanoma Skin Cancers Coverage from Every Angle

Using Immunohistochemical Panel to Differentiate Basal Cell Carcinoma and Trichoepithelioma

By: Melissa E. Fryman, MS
Posted: Tuesday, January 22, 2019

An immunohistochemical protocol, developed by Naglaa A. Mostafa, MD, of Zagazig University, Egypt, and colleagues, may assist pathologists and clinicians in diagnosing basal cell carcinoma and trichoepithelioma. Due to poorly defined expression and staining patterns of small biopsies, accurate differentiation of the two neoplasms has been a long-standing challenge. However, as the outcomes are very different, considerable attention has been paid to improving the accuracy in diagnosis of these diseases. The investigators published their findings in the Journal of Cutaneous Pathology.

In this retrospective study of small biopsy specimens, 19 basal cell carcinoma and 10 trichoepithelioma samples were fixed and stained with antibodies against androgen receptor, CK-19, Ki67, CD10, and PHLDA1. The authors found that immunoreactivity of androgen receptor, Ki67, and CD10 was significantly higher in basal cell carcinoma tumor samples than in trichoepithelioma tumor samples. Conversely, immunoreactivity of PHLDA in tumor cells and stromal CD10 was higher in trichoepithelioma than in basal cell carcinoma samples. Because of the often focal signal of androgen receptor in basal cell carcinoma, the authors advised against using androgen receptor staining in small biopsies, as positive staining can often be missed.

“We suggest a preliminary immunohistochemical panel of CD10, Ki67, and PHLDA1 in differentiating between trichoepithelioma and [basal cell carcinoma],” concluded the authors. “This panel may resolve a difficulty for the pathologists and clinicians, especially in the small and superficial biopsies.”

Disclosure: The study authors’ disclosure information may be found at

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