ArticleThe American Journal of dermatopathology2026
Demonstration of 23-Gene Expression Profile Test Utility Within PRAME Immunohistochemistry Results: A Case Series.
Article in The American Journal of dermatopathology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractHistopathological examination using hematoxylin and eosin (H&E)-stained tissue is sufficient for diagnosing most melanocytic neoplasms as benign or malignant; however, diagnostic tools such as PRAME (preferentially expressed antigen in melanoma) immunohistochemistry (IHC) and the 23-gene expression profile (23-GEP) test can aid in the analysis of histopathologically ambiguous lesions, which can be referred to as diagnostically challenging, equivocal, indeterminate, or uncertain. When compared with the gold standard of H&E diagnosis by a dermatopathologist, PRAME IHC showed 83.2% sensitivity and 99.3% specificity in an initial validation cohort and 23-GEP showed 91.5% sensitivity and 92.7% specificity in an independent validation cohort. In addition, 23-GEP has been evaluated in 3 studies with patients with known outcomes (eg, metastasis) and has reported metrics of 90.4%-96.3% sensitivity and 87.3%-96.2% specificity in distinguishing benign versus malignant melanocytic neoplasms. In this study, we present the utility of the 23-GEP test within 8 equivocal cases with various PRAME IHC staining patterns. Cases underwent histopathological review and received at least 4 and up to 5 diagnoses each. In samples where PRAME IHC is inconclusive, conflicting, or ambiguous regarding a final diagnosis, the 23-GEP can provide additional diagnostic information to upgrade or downgrade the overall malignant potential of the lesion in question.
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