Background The morpheaform subtype of basal cell carcinoma (BCC) often presents a diagnostic histological challenge, and its true margin may be difficult to determine with accuracy. This tumor may also be difficult to distinguish from other adnexal neoplasms having a benign clinical course. Previous work has shown that cytokeratin 17 (K17) expression is increased in BCC. Objective To confirm the expression of K17 across the subtypes of superficial, nodular and morpheaform BCC variants. Secondly, compare K17 expression in each of these subtypes of BCC to two other adnexal neoplasms. Methods Tissue specimens from each tumor category were randomly collected, immunolabeled, and scored for K17 expression by intensity and extent of immunostaining. Results Our results indicate that K17 is a very useful marker in the identification and outlining of BCC. Moreover, in morpheaform BCC, K17 immunostaining clearly detected individual tumor cells well away from the dermal tumor strands that otherwise seemed non-malignant by hematoxylin and eosin staining alone. In addition, we report that the expression of K17 in morpheaform BCC is capable (100% of specimens; p<0.0001) of distinguishing this tumor from desmoplastic trichoepithelioma. Conclusion We propose that K17 immunostaining could improve the diagnostic and surgical management of these tumors.

A DNA microarray scanner was used as a digital fluorescence microscope to simplify the diagnosis of autoimmune bullous diseases. Frozen sections of skin biopsies were taken from 3 patients with bullous pemphigoid and 1 patient each with lichen planus pemphigoides, linear immunoglobulin (Ig) A disease, and dermatitis herpetiformis. After incubation with cyanine-labeled antibodies, the tissues were scanned at 5-μm resolution using an instrument originally designed to study gene expression. The microarray scanner’s large field of view, unlike that of fluorescence microscopy, allowed a view of the entire specimen, considerably easing the orientation of tissue. All images were diagnostic and included a linear pattern along the basement membrane zone (BMZ) using anti-IgG and anti-C3 in all cases of bullous pemphigoid, a linear pattern of igG along the BMZ in lichen planus pemphigoides, and a linear pattern of IgA along the BMZ in linear IgA dermatosis. IgA deposition along dermal papillary tips was seen in dermatitis herpetiformis, but a granular pattern was indiscernible at the 5-μm resolution. The advantage of the microarray scanner over standard fluorescence microscopy include speed, technical ease, large field of view, potential for visualizing multiple antibodies simultaneously in a tissue section, and convenience of digital image archiving.

No abstract

No abstract