Morphometric and ultrastructural analyses of melanocytes, nevus cells, and melanoma cells.

Cytological atypia, revealed in the course of routine light microscopy, is considered a valuable indicator of malignancy in melanocytic lesions. A clear definition of the term cytological atypia, however, is lacking. Therefore, by morphometric analysis of ultrathin sections of 11 malignant melanomas (7 invasive, 3 in situ, and 1 lentigo maligna melanoma) and 10 compound nevi, we evaluated the discriminating power of the various facets of cytological atypia, i.e., nuclear area, area of the nucleolus, area of the total cell, and nuclear irregularity. In each case, at least 50 intraepidermal melanocytic cells were examined. The two-sided U-test showed significant differences between intraepidermal nevus and melanoma cells, with regard to the mean values (mean) and standard deviations (s) of the nuclear area (mean and s, p = 0.00011), area of the nucleolus (mean, p = 0.00043; s, p = 0.00011), and area of the total cell (mean, p = 0.00011; s, p = 0.00093). However, only the mean values and standard deviations of the nuclear area allowed a clear distinction in each individual case. The area of the nucleus can be estimated in the course of routine histology. We therefore think that the size and variation of the nuclear area should be considered in the histological differential diagnosis between malignant melanomas and benign nevi.