Preferentially expressed antigen in melanoma (PRAME) has shown promising utility in distinguishing benign melanocytic lesions from melanomas, but knowledge of its expression pattern in acral lentiginous melanoma (ALM) and acral nevi (AN) is limited. Immunohistochemical expression of PRAME was examined in 75 ALMs and 34 ANs. The clinical and histopathologic characteristics of ALM patients were collected. PRAME was immunoreactive in 89.3% (67/75) ALMs, but entirely negative in 94.1% (32/34) ANs. When staining at least 50% of lesional melanocytes was determined as positivity, the sensitivity and specificity of PRAME for distinguishing ALM from AN were 69.3% and 100%, respectively. 71 cases of ALM had tumor cells in the epidermis, 71.8% (51/71) of them showed positive for PRAME. By contrast, 61 ALMs had tumor cells in the dermis, 65.6% (40/61) exhibited positive expression. 74.4% (29/39) epithelioid-cell ALMs were observed to be positive for PRAME. By comparison, 63.8% (23/36) of ALMs with spindle tumor cells were positive for PRAME. However, PRAME positive expression was not associated with any clinical and histopathologic characteristics of ALM patients, including Breslow thickness, ulcer, cytomorphology, lymph node metastasis, or tumor infiltrated lymphocytes (TILs). Nevertheless, we observed that 82.6% (19/23) of ALMs with lymph node involvement at diagnosis expressed PRAME, compared with 57.6% (20/35) of those without. In summary, PRAME immunohistochemistry can serve as a helpful adjunct in the differential diagnosis of ALM and AN with good sensitivity and high specificity. Additionally, PRAME tends to have a higher positive rate in epidermal melanocytes than those in the dermis, and is inclined to express in epithelioid cells than in spindle cells of ALM.
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