Abstract：
Dysplastic nevi represent one of the least agreed-upon entities in dermatopathology despite the existence of established criteria. This study explores preferentially expressed antigen in melanoma (PRAME) in dysplastic nevi, an uncharted area. We examined 22 common melanocytic nevi (CMN), 20 cutaneous melanomas (CM), 48 low-grade dysplastic nevi (LG-DN), and 40 high-grade dysplastic nevi (HG-DN). PRAME was immunohistochemically assessed using a five-tiered system (0 to 4 +). Among CMN, 59% scored 0, 32% scored 1 + , and 9% scored 2 + . CM had score 2 + and 4 + in 11% and 89% of cases, respectively. Among LG-DN, 38% presented score 0, 31% score 1 + , 17% score 2 + , 8% score 3 + , and 6% score 4 + . Thirty per cent of HG-DN demonstrated a score 0, 30% with score 1 + , 15% score 2 + , 10% score 3 + , and 15% score 4 + . Compared to CMN and CM, LG-DN and HG-DN showed heterogeneous expression profiles of PRAME. PRAME positivity effectively distinguished HG-DN from CM with 85% specificity and 80% sensitivity (p < 0.0001). Predictive values were 87% (negative) and 76% (positive). Furthermore, a trend of increased PRAME expression from LG-DN to HG-DN was observed. However, the applicability of PRAME in the differential diagnosis of dysplastic lesions remains unclear as can yield conflicting results with morphology, which remains the primary diagnostic tool for melanocytic lesions.
摘要：
尽管存在既定标准，但发育不良痣仍是皮肤病理学中达成共识最少的实体之一。本研究探讨了发育不良痣中黑色素瘤（PRAME）中优先表达的抗原，一个未知的领域。我们检查了22个常见的黑素细胞痣（CMN），20皮肤黑色素瘤（CM），48低级发育不良痣（LG-DN），和40个高级发育不良痣（HG-DN）。PRAME使用五层系统（0至4）进行免疫组织化学评估。在CMN中，59%得分为0，32%得分为1+，9%得分为2+。在11%和89%的病例中，CM的评分为2+和4+，分别。在LG-DN中，38%得分0，31%得分1+，17%得分为2+,8%得3+,6%得4+。30％的HG-DN评分为0，30％，评分为1+，15%得分为2+,10%得分3+,15%得分为4+。与CMN和CM相比，LG-DN和HG-DN显示PRAME的异质表达谱。PRAME阳性有效地将HG-DN与CM区分开,具有85%的特异性和80%的灵敏度(p<0.0001)。预测值分别为87％（阴性）和76％（阳性）。此外，观察到从LG-DN到HG-DN的PRAME表达增加的趋势。然而,PRAME在发育不良病变的鉴别诊断中的适用性尚不清楚，因为可能会产生与形态学冲突的结果。它仍然是黑素细胞病变的主要诊断工具。
