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Title:
Can Numeric Maturation Value Be Used as a Prognostic Indicator and Diagnostic Tool in Cutaneous Melanomas? A Morphometric Study
Authors:  Mehmet Gamsizkan, M.D., Seyma Buyucek, M.D., Sinem Kantarcioglu Coskun, M.D., Mehmet Ali Sungur, Ph.D., Emin Ozlu, M.D., Atike Bahcivan, M.D., and Binnur Onal, M.D.
  Objective: Some melanocytic lesions can be diffi­cult to diagnose because of ambiguous histological and immunohistochemical features. Morphometric features of melanocytes in the upper and lower parts of a chal­lenging lesion may help to facilitate an accurate diag­nosis.
Study Design:
We studied 32 cases of invasive cutaneous melanoma, 35 cases of mild or moderate dysplastic nevus, and 31 cases of benign melanocytic nevus. All cases were immunostained with Sox10. The nuclear areas of 30 melanocytes were measured on each papillary (upper [U]) dermis and reticular dermis/sub­ cutaneous tissue (lower [L]) in all cases by using the Image J analysis program. Then, a maturation index (U/L) was calculated for each case. Also, cutaneous mel­anomas were categorized into 2 groups that displayed pseudo­maturation or the lack of it. There were statistically significant differences between melanoma and dysplastic nevus (p = 0.012) and be­ tween melanoma and benign melanocytic nevus (p<0.001) for the maturation index. Although pseudo­ maturation was associated with low mitotic activity and thin Breslow thickness, there was no significant difference between survival distributions of 2 melanoma groups.
Conclusion:
Calculation of the maturation index can be used as a supporting tool for the differential diagnosis of challenging cases. However, it may possess limitation for evaluation of nevoid melanoma, melanoma in situ, or clonal nevus.
Keywords:  biomarkers, tumor; diagnosis; immunohistochemistry; maturation; melanocytes; melanoma; morphometry; nevus, melanocytic; Schwann cells; skin; skin neoplasms; Sox10 protein, human; Sox10 transcription factor
   
   
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