Assessing Nuclear and Nucleolar Areas Between Malignant Melanoma and Benign Nevi

Distinguishing malignant melanoma (MM) from benign melanocytic nevi presents a diagnostic challenge that can result in suboptimal management. We sought to assess whether quantifying nuclear and nucleolar areas in histological samples provided utility in differentiation. Our study used deidentified hematoxylin and eosin (H&E)-stained teaching slides, 77 MM cases and 73 benign nevi cases (N = 150). Using ImageJ software, 20 nuclei and their corresponding nucleoli were measured per slide in square pixels and converted to square microns. Nuclei selection was contingent on visualization of the nuclear envelope and a singular nucleolus. Mann-Whitney U tests were applied to compare average nuclear and nucleolar areas between groups. Significant differences were observed in both nuclear and nucleolar areas. The mean nuclear area was significantly larger in MM compared with benign nevi (702.04 ± 236.55 μm2 vs. 481.18 ± 153.89 μm2; P < 0.001). Similarly, the mean nucleolar area was markedly larger in MM compared with benign nevi (90.88 ± 52.25 μm2 vs. 58.03 ± 25.35 μm2; P < 0.001).