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PRAME Expression in Mucosal Melanoma of the Head and Neck Region
Costantino Ricci1,2, Maria V Altavilla3,1, Barbara Corti1
1Pathology Unit.
Abstract:
PRAME (PReferentially expressed Antigen in MElanoma), a cancer-testis antigen expressed in normal and neoplastic tissues with several functions, proved to be a useful diagnostic tool in the differential diagnosis between benign and malignant melanocytic lesions. The current study aims to perform PRAME stain on a retrospective case series of mucosal melanocytic tumors of the head and neck region to compare 3 different scores and evaluate the most reliable one in this diagnostic set. Immunohistochemical analysis for PRAME was performed in 54 benign and malignant mucosal melanocytic tumors of the head and neck region collected from 41 patients. The best-performing cutoff of PRAME-positive cells (nuclear stain) to differentiate benign and malignant mucosal melanocytic tumors of the head and neck region is that proposed by Raghavan and colleagues (<60%/≥60% of PRAME-positive cells), with 100% and 77.8% of benign lesions and malignant tumors respectively correctly identified. Applying this score, PRAME stain showed the best results (sensitivity, specificity, accuracy, and positive and negative predictive values) for the diagnosis of head and neck melanocytic tumors. However, a subset of PRAME-negative malignant tumors was identified, especially located in the palatal area (hard and soft palate). Finally, high PRAME expression (≥60%) was associated with specific sites (nasal cavity/nasal septum/turbinates nasopharynx, and the maxillary sinus), nodular histotype, and female sex.
Insights
PRAME staining is a valuable tool for diagnosing head and neck mucosal melanocytic tumors. The Raghavan score effectively distinguishes benign from malignant lesions, though some malignant tumors show low PRAME expression.
Area of Science:
- Oncology
- Pathology
- Immunohistochemistry
Background:
- PRAME (PReferentially expressed Antigen in MElanoma) is a cancer-testis antigen with diagnostic utility in melanocytic lesions.
- Its role in mucosal melanocytic tumors of the head and neck requires further evaluation.
Purpose of the Study:
- To assess the efficacy of PRAME immunohistochemistry in differentiating benign and malignant mucosal melanocytic tumors of the head and neck.
- To compare three scoring systems for PRAME expression and identify the most reliable diagnostic method.
- To investigate associations between PRAME expression levels and clinicopathological features.
Main Methods:
- Retrospective analysis of 54 mucosal melanocytic tumors from the head and neck region in 41 patients.
- Immunohistochemical staining for PRAME was performed on tumor tissue.
- Three different scoring methods were evaluated to differentiate benign and malignant lesions.
Main Results:
- The Raghavan score (<60%/≥60% PRAME-positive cells) demonstrated the highest diagnostic performance, correctly identifying 100% of benign lesions and 77.8% of malignant tumors.
- PRAME staining exhibited excellent sensitivity, specificity, accuracy, and predictive values for head and neck melanocytic tumors using this score.
- A subset of malignant tumors, particularly those in the palate, showed PRAME-negative results.
- High PRAME expression (≥60%) correlated with specific anatomical sites (nasal cavity, nasopharynx, maxillary sinus), nodular histotype, and female sex.
Conclusions:
- PRAME immunohistochemistry, particularly using the Raghavan scoring system, is a reliable diagnostic marker for mucosal melanocytic tumors in the head and neck.
- While generally effective, the potential for PRAME-negative malignant tumors, especially in palatal locations, should be considered.
- PRAME expression levels provide insights into tumor characteristics and anatomical distribution within the head and neck region.
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