Lanin and pheomelanin (a/b 1516647 ratio). Comparison of the a/b ratio in melanomas “Low Breslow” and “High Breslow” and in nevi vs “High Breslow” melanomas inTubastatin-A web melanoma Diagnosis via Electron Spin ResonanceFigure 5. ESR double integral values. Calculations reported in Fig. 3 and Fig. 4 carried out on double integral values. A) ESR value recorded in nevi (white bars) and melanomas (grey bars) in the “Measuring Set” and “Validation Set”; ns stands for “not significant”. B) Comparison of nevi (white bars) vs melanoma (grey bars) in each subgroup of the “All Set”; * indicates p,0.01. C) Each subgroup was classified according to tumour thickness (High or Low Breslow’s depth). Bars report the ESR mean value of each subgroup with SEM; * indicates p#0.05. D) ANOVA analysis with Bonferroni Multiple Comparison Test of nevi, melanomas “Low Breslow’s depth” (,1 mm) and melanomas “High Breslow’s depth” ( 1 mm) groups; * indicates p,0.01. 
doi:10.1371/journal.pone.0048849.gthe present study JI-101 web indicated a significant difference between the copolymers composition in these patients groups. It is therefore reasonable to hypothesize that melanin in melanoma cells undergoes a qualitative change associated with deregulation of eumelanin/pheomelanin ratio, leading to paramagnetic melanin-based radicals accumulation [59]. The significant increase of a/b ratio in melanomas “High Breslow” (Fig. 4C) also suggests a contribution of pheomelanin in melanoma [20]; this contribution increases with the progression of melanoma indicating an interesting field of future investigations. A strong statistical difference of the ESR-signal was measured in human melanoma specimens versus nevus samples; this was observed in any subgroup analyzed (such as body location and sex) except in “Limbs” subgroup, indicating that in most cases ESR is consistently and significantly higher in melanomas than in nevi (Fig. 4A). When all nevi were compared to “Low Breslow” melanomas and “High Breslow” melanomas, ANOVA analysis showed a significant difference as function of Breslow’s depth (Fig. 4B) indicating that ESR analysis may discriminate nevi from melanomas as well as “Low Breslow” from “High Breslow” melanomas, while it is unable to discriminate nevi from melanomas “Low Breslow”. Most interestingly Spearman’s correlation test confirmed such observation, demonstrating avery significant 
positive correlation between ESR signal and Breslow’s depth, computed with either amplitude and integral values. These observations prompted us to suggest a potential application of ESR-spectroscopy to melanoma diagnosis; such hypothesis was then verified by ROC analysis (Fig. 6), showing a strong and highly significant discriminating ability of ESR signal to identify melanomas from nevi. ESR technique has been previously suggested for diagnosis and employed in melanoma research [41,42], however the present study is the first reporting a clear association of a specific ESR signal to a large number (n = 52) of human melanomas using a large number of healthy controls (n = 60 nevi). Furthermore, a different eu/pheomelanin ratio in nevi vs melanomas “High Breslow” has been shown here for the first time, strongly supporting that qualitative melanin changes may occur in nevi as compared to melanomas with worst prognosis. The quantitative information of ESR spectra is usually expressed in arbitrary units by the integral intensity of the absorption signal. In the present study we report calc.Lanin and pheomelanin (a/b 1516647 ratio). Comparison of the a/b ratio in melanomas “Low Breslow” and “High Breslow” and in nevi vs “High Breslow” melanomas inMelanoma Diagnosis via Electron Spin ResonanceFigure 5. ESR double integral values. Calculations reported in Fig. 3 and Fig. 4 carried out on double integral values. A) ESR value recorded in nevi (white bars) and melanomas (grey bars) in the “Measuring Set” and “Validation Set”; ns stands for “not significant”. B) Comparison of nevi (white bars) vs melanoma (grey bars) in each subgroup of the “All Set”; * indicates p,0.01. C) Each subgroup was classified according to tumour thickness (High or Low Breslow’s depth). Bars report the ESR mean value of each subgroup with SEM; * indicates p#0.05. D) ANOVA analysis with Bonferroni Multiple Comparison Test of nevi, melanomas “Low Breslow’s depth” (,1 mm) and melanomas “High Breslow’s depth” ( 1 mm) groups; * indicates p,0.01. doi:10.1371/journal.pone.0048849.gthe present study indicated a significant difference between the copolymers composition in these patients groups. It is therefore reasonable to hypothesize that melanin in melanoma cells undergoes a qualitative change associated with deregulation of eumelanin/pheomelanin ratio, leading to paramagnetic melanin-based radicals accumulation [59]. The significant increase of a/b ratio in melanomas “High Breslow” (Fig. 4C) also suggests a contribution of pheomelanin in melanoma [20]; this contribution increases with the progression of melanoma indicating an interesting field of future investigations. A strong statistical difference of the ESR-signal was measured in human melanoma specimens versus nevus samples; this was observed in any subgroup analyzed (such as body location and sex) except in “Limbs” subgroup, indicating that in most cases ESR is consistently and significantly higher in melanomas than in nevi (Fig. 4A). When all nevi were compared to “Low Breslow” melanomas and “High Breslow” melanomas, ANOVA analysis showed a significant difference as function of Breslow’s depth (Fig. 4B) indicating that ESR analysis may discriminate nevi from melanomas as well as “Low Breslow” from “High Breslow” melanomas, while it is unable to discriminate nevi from melanomas “Low Breslow”. Most interestingly Spearman’s correlation test confirmed such observation, demonstrating avery significant positive correlation between ESR signal and Breslow’s depth, computed with either amplitude and integral values. These observations prompted us to suggest a potential application of ESR-spectroscopy to melanoma diagnosis; such hypothesis was then verified by ROC analysis (Fig. 6), showing a strong and highly significant discriminating ability of ESR signal to identify melanomas from nevi. ESR technique has been previously suggested for diagnosis and employed in melanoma research [41,42], however the present study is the first reporting a clear association of a specific ESR signal to a large number (n = 52) of human melanomas using a large number of healthy controls (n = 60 nevi). Furthermore, a different eu/pheomelanin ratio in nevi vs melanomas “High Breslow” has been shown here for the first time, strongly supporting that qualitative melanin changes may occur in nevi as compared to melanomas with worst prognosis. The quantitative information of ESR spectra is usually expressed in arbitrary units by the integral intensity of the absorption signal. In the present study we report calc.
