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Arch Dermatol. 2006 Jul;142(7):871-6.

Melanocytes in long-standing sun-exposed skin: quantitative analysis using the MART-1 immunostain.

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1
UPMC Shadyside Hospital, University of Pittsburgh Medical Center, and Departments of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

OBJECTIVE:

To help distinguish early melanoma from normal sun-damaged skin by quantifying the density, confluence, and depth of follicular penetration of melanocytes in long-standing sun-exposed skin of the face and neck.

DESIGN:

Case series.

SETTING:

Referral center.

PATIENTS:

Random selection of 149 patients undergoing Mohs surgery for basal cell and squamous cell carcinomas of the face and neck.

INTERVENTION:

Frozen-section slides were made from long-standing sun-exposed normal skin and stained with MART-1 (melanoma antigen recognized by T cells 1 staining) immunostain.

MAIN OUTCOME MEASURES:

The number, confluence, and depth of penetration of melanocytes along the follicular epithelium were quantified per high-power field (original magnification x 400, equivalent to 0.5 mm of skin). Confluence was categorized by the number of adjacent melanocytes (none, 0-1; mild, 2; moderate, 3-6; and severe, >6).

RESULTS:

The mean number of melanocytes per high-power field was 15.6 (range, 6-29). Confluence was severe in 1.0% of the specimens, moderate in 34.0%, mild in 54.0%, and absent in 11.0%. Focal areas of increased melanocyte density occurred in 24.2% of the specimens; in these areas, the mean number of melanocytes per high-power field was 20.3 (range, 7-36) and the confluence of melanocytes was severe in 13.0%, moderate in 50.0%, and mild in 37.0%. The mean depth of follicular epithelium penetration by melanocytes was 0.38 mm. Pagetoid spread and nesting of melanocytes were not seen. Nonspecific scattered MART-1-staining dermal cells were in half of the slides.

CONCLUSIONS:

Melanocytes in long-standing sun-exposed skin have an increased density and a confluence that is often moderate (3-6 adjacent melanocytes), but they do not exhibit pagetoid spread or nesting. Nonspecific MART-1-staining dermal cells should not be interpreted as invasive melanoma.

PMID:
16847203
DOI:
10.1001/archderm.142.7.871
[Indexed for MEDLINE]
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