PRAME Immunohistochemical Positivity in Superficial Spreading Melanoma: Significance and Association with Melanoma Dermoscopy Features

Cutaneous melanoma, particularly the superficial spreading subtype, remains a diagnostic challenge because of its morphologic heterogeneity and subtle clinical manifestations. The immunohistochemical marker PRAME (Preferentially Expressed Antigen in Melanoma) has recently emerged as a potential adjunct in differentiating malignant from benign melanocytic lesions. To evaluate PRAME expression patterns in superficial spreading melanoma and to explore correlations between PRAME-positive foci and specific dermoscopic features. Twenty-two histologically confirmed superficial spreading melanomas exhibiting symmetrical dermoscopic patterns prior to excision were retrospectively analyzed. PRAME immunohistochemistry was performed on formalin-fixed, paraffin-embedded specimens using standardized protocols. Staining intensity and distribution were semiquantitatively scored (1–4). Five PRAME immunohistochemical hot spots per lesion were selected and retrospectively correlated with dermoscopic colors and structures. Diffuse PRAME expression was detected in 50% of cases and occurred significantly more often in invasive melanomas compared with melanoma in situ (p = 0.04). The predominant PRAME score was 3 (77.3%), followed by 4 (22.7%), with no lesions showing scores 1 or 2. PRAME expression did not correlate with the overall dermoscopic pattern or number of colors per lesion. However, high PRAME positivity within PRAME immunohistochemical hot spots most consistently corresponded to the blue-white veil, while regression structures, blotches, dots, chrysalis-like structures, and pseudonetwork (in one case) also showed strong associations. Specific dermoscopic features may predict underlying PRAME overexpression, potentially improving pre-biopsy diagnostic stratification. These results support the adjunctive role of PRAME in integrated melanoma diagnostics, warranting confirmation in larger, standardized studies.