Scanning electron microscopy (SEM) was used to compare the topographic fine structure of urothelium from normal, neoplastic and inflamed human bladders. The three groups of patients show different patterns. The normal bladder lining is characterized by regularly arranged large superficial cells with ridged surfaces. By contrast, the surface cells of a transitional cell carcinoma are rounded up and covered with microvilli. In some patients with cystitis or post inflammatory hyperplasia SEM appearances intermediate between normal and neoplastic patterns are encountered. However, except in extremely severe cystitis it is possible on SEM to differentiate between inflamed and neoplastic urothelium. Surface microvilli provide a useful malignant marker for transitional cell carcinoma. However, severe inflammation of the bladder, when diagnosed on cystoscopic examination, can and must be excluded by light microscopy before this marker is considered diagnostic for neoplasia.