Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma
Carr, Richard Mesiano, Domenico Heffron, Cynthia Radonic, Teodora Wiggins, James Tso, Simon Agrawal, Rishi Cheung, Elaine Slater, David N. Nichols, Linda
Carr, Richard
Mesiano, Domenico
Heffron, Cynthia
Radonic, Teodora
Wiggins, James
Tso, Simon
Agrawal, Rishi
Cheung, Elaine
Slater, David N.
Nichols, Linda
Affiliation
South Warwickshire University NHS Foundation Trust; Cork University Hospital, Ireland; Amsterdam University Medical Center, Netherlands; New Cross Hospital, Wolverhampton; Queen Elizabeth Hospital, Hong Kong; Chesterfield Royal Hospital; University of Warwick; Cheltenham General Hospital
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Publication date
2023-07-20
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Abstract
Keratoacanthoma (KA) is widely considered a benign, usually self-resolving, neoplasm distinct from cutaneous squamous cell carcinoma (cSCC), while some consider KA to be indistinguishable from cSCC. Published studies indicate utility for p16, p53, Ki-67 immunostaining and elastic van Gieson (EVG) in the assessment of KA and cSCC. We compared clinical features and staining patterns for p16, p53, Ki-67 and EVG in fully excised KA, cSCC with KA-like features (cSCC-KAL) and other cSCC (cSCC-OTHER). Significant differences between KA, cSCC-KAL and cSCC-OTHER were found for head and neck location (20%, 86%, 84%), and duration <5 months (95%, 63%, 36%). KA shows both a mosaic pattern for p16 (>25-90% of neoplasm area) and peripheral graded pattern for p53 (up to 50% moderate and strong nuclear staining) in 92% compared with 0% of cSCC-KAL and 0% of cSCC-OTHER. In contrast, a highly aberrant pattern (usually null) for one or both p16 and p53, was present in 0% of KA, 83.8% of cSCC-KAL and 90.9% of cSCC-OTHER. Abnormal distribution of Ki-67 beyond the peripheral 1-3 cells was uncommon in KA (4.2%) and common in cSCC-KAL (67.6%) and cSCC-OTHER (88.4%). Moderate to striking entrapment of elastic and collagen fibres was present in the majority of KA (84%), cSCC-KAL (81%) and cSCC-OTHER (65%). KA are clinically distinct neoplasms typically of short duration occurring preferentially outside the head and neck and generally lacking aberrations of p16, p53 and Ki-67, compared with cSCC that have high rates of aberrant or highly aberrant p16, p53 and Ki-67, but EVG lacked specificity.
Keywords: CDNK2A; Keratoacanthoma; Ki-67; cutaneous squamous cell carcinoma; elastic van Gieson; p16; p53.
Citation
Carr RA, Mesiano D, Heffron C, Radonic T, Wiggins J, Tso S, Agrawal R, Cheung E, Slater DN, Nichols L, Craig P. Aberrant p16, p53 and Ki-67 immunohistochemistry staining patterns can distinguish solitary keratoacanthoma from cutaneous squamous cell carcinoma. Pathology. 2023 Oct;55(6):772-784. doi: 10.1016/j.pathol.2023.07.001. Epub 2023 Jul 20.
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Article