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Distinction of Melanoma In Situ From Solar Lentigo on Sun-Damaged Skin Using Morphometrics and MITF Immunohistochemistry

Black, Will H MD*; Thareja, Sumeet K BS*; Blake, Brett P MD; Chen, Ren MD, MPH§; Cherpelis, Basil S MD*†; Glass, Lewis Frank MD*†‡

The American Journal of Dermatopathology: August 2011 - Volume 33 - Issue 6 - p 573-578
doi: 10.1097/DAD.0b013e3182093b13
Original Study

Distinction between melanoma in situ (MIS) and solar lentigo (SL) on chronically sun-damaged skin (CSDS) by hematoxylin and eosin (H&E) criteria alone can be difficult and in frozen section (FS) material, may be virtually impossible without immunohistochemistry (IHC). In this study, we used microphthalmia-associated transcription factor (MITF) IHC-directed image analysis to compare melanocyte nuclear morphometrics of MIS, SL, and sections of sun-damaged skin from redundant tissue acquired during Mohs micrographic surgery. The mean nuclear diameter and melanocytic density figures for MIS were greater than those for SL and CSDS by both independent t-test and analysis of variance statistics. No significant differences in these parameters were found between SL and sun-damaged skin. Cutoff values that favored MIS over SL included melanocyte density ≥10 nuclei per 200 μm, nuclear diameter ≥9 μm, and a product of density and diameter of 80 or more, as each of these values was associated with 100% specificity of MIS diagnosis. Our results suggest that image analysis of melanocytes labeled with MITF IHC can be used to produce morphometric data that distinguish MIS from SL and CSDS. The study was conducted using permanent sections, but previous studies with FSs indicate that the findings would apply to FSs as well. Quantitative assessment of melanocytic parameters using image analysis will likely become increasingly important as an adjunct to conventional histopathology for the diagnosis and surgical management of MIS on sun-damaged skin.

From the *Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL; †Department of Dermatology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; ‡Department of Dermatology, James A. Haley Veterans' Hospital, Tampa, FL; §Office of Research, Biostatistics Core, University of South Florida, Tampa, FL; and ‖Dermatology of Dermatology, Eastern Virginia Medical School, Norfolk, VA.

Reprints: Lewis Frank Glass, MD, Department of Dermatology and Cutaneous Surgery, University of South Florida, 12901 Bruce B. Downs, MDC 79 (MDA 1174) Tampa, FL 33612-4272 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.