An immunohistochemical study of basal cell carcinoma and trichoepithelioma

The histologic distinction between tricheopithelioma and basal cell carcinoma may be difficult in small biopsies. Immunohistochemical stains have been used to help make this distinction; however, published studies have generally been limited to a few antibodies. To this end we performed a comprehensive immunohistochemical analysis of 20 basal cell carcinomas and 10 tricheopitheliomas from our files, in search of a consistent pattern of reactivity to distinguish the neoplasms in biopsies. The antibodies used were: low molecular weight keratin (Cam 5.2), Cytokeratin 7, (CK7), Cytokeratin 20, (CK20), Carcino-embryonic antigen (CEA), CD30 (Ki-1), bcl-2, Ham 56, HPCA-I (CD34), and Ulex Europaeus type I. In our study, bcl-2 stained all but one basal cell carcinoma in a diffuse pattern, whereas all tricheopitheliomas showed staining of the outermost epithelial layer. No other stain proved to be an independent marker for either neoplasm and no consistent immunohistochemical profile for either neoplasm emerged. Thus, we conclude that bcl-2 may be of some value in distinguishing basal cell carcinoma from tricheopithelioma, limited by the quantitative nature of the difference in staining. Histologic criteria applied to H&E-stained sections remain the cornerstone of histologic diagnosis.