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. 2016 Mar;33(2):121-7.
doi: 10.5152/balkanmedj.2016.16442. Epub 2016 Mar 1.

The Role of p16, p21, p27, p53 and Ki-67 Expression in the Differential Diagnosis of Cutaneous Squamous Cell Carcinomas and Keratoacanthomas: An Immunohistochemical Study

Recep Bedir  1 , Hasan Güçer  1 , İbrahim Şehitoğlu  1 , Cüneyt Yurdakul  1 , Pelin Bağcı  2 , Pelin Üstüner  3
Affiliations

The Role of p16, p21, p27, p53 and Ki-67 Expression in the Differential Diagnosis of Cutaneous Squamous Cell Carcinomas and Keratoacanthomas: An Immunohistochemical Study

Recep Bedir et al. Balkan Med J. 2016 Mar.

Abstract

Background: Distinguishing squamous cell carcinoma (SCC) from keratoacanthoma (KA) by histopathological features may not be sufficient for a differential diagnosis, as KAs may, in some cases, imitate well-differentiated SCCs.

Aims: In this study, we investigated whether the expression of the p16, p21, p27, p53 genes and a Ki-67 proliferation index are useful in distinguishing between these two tumors.

Study design: Cross-sectional study.

Methods: Immunohistochemistry was used to investigate the expression of the p16, p21, p27, p53 genes and the Ki-67 proliferation index was investigated in well-differentiated SCC with KA-like features (n=40) and KA (n=30).

Results: The results of all of the examined markers, except for p27 (p16, p21, p53, and Ki-67) were found to be significantly different between the SCC and KA samples (p<0.05).

Conclusion: In well-differentiated SCC with KA-like features and KA cases where the differential diagnosis is difficult from a histopathological perspective, the use of p16, p21, p53 expression and a Ki-67 proliferation index can be useful for the differential diagnosis of SCCs and KAs.

Keywords: Differential diagnosis; immunohistochemistry; keratoacanthoma; skin; squamous cell carcinoma.

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Figures

FIG. 1.
FIG. 1.
a–d. In SCC, expression of Ki-67 is seen as a diffuse pattern showing positive nuclear staining through the full thickness of the lesion (X100) (a), in KA, expression of Ki-67 is seen in the peripheral basal and supra-basal layers of the lesion (X100) (b), in SCC, expression of p16 is shown as staining of a complete-layer in SCCs (X100) (c), in KA, expression of p16 is seen as nuclear and cytoplasmic staining observed in the peripheral basal and supra-basal layers of the lesion (X100) (d).
FIG. 2.
FIG. 2.
a–d. In SCC, expression of 21 is shown as nuclear staining with a diffuse pattern of the lesion (X100) (a), in KA, expression of 21 is shown as nuclear staining in peripheral basal and suprabasal cells of the lesion (X100) (b), in SCC, expression of p27 is shown as nuclear staining with a diffuse pattern of the lesion (X100) (c), in KA, expression of 27 is shown as nuclear staining of the peripheral basal and supra-basal cells of the lesion (X200) (d).
FIG. 3.
FIG. 3.
a, b. In well-differentiated SCC, expression of p53 nuclear staining is shown in the peripheral basal and supra-basal cells of the lesion (X100) (a), in KA, expression of 53 nuclear staining is shown in the peripheral basal and supra-basal cells of the lesion (X100) (b).
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