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Hendi A, Brodland DG, Zitelli JA. Melanocytes in Long-standing Sun-Exposed Skin: Quantitative Analysis Using the MART-1 Immunostain. Arch Dermatol. 2006;142(7):871–876. doi:10.1001/archderm.142.7.871
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.
Random selection of 149 patients undergoing Mohs surgery for basal cell and squamous cell carcinomas of the face and neck.
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 ×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).
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.
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.
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