Cleft formation and consumption of the epidermis in cutaneous melanocytic lesions—reply

Braun‐Falco, Markus

doi:10.1016/j.humpath.2005.09.027

“…The changes in cadherin expression and degradation of the basal membrane with proteolytic enzymes facilitates CoE development in malignant melanoma (1,4). We found an increased CoE incidence in the presence of ulceration in this study.…”

Section: Discussionsupporting

confidence: 59%

“…The term consumption of epidermis (CoE) has recently been used to indicate the epidermal structural changes associated with malignant melanoma (MM) (1)(2)(3). CoE defines the thinning of the epidermis and loss of the retes neighboring the melanocyte group due to the decreased basal and suprabasal layers in the epidermis.…”

Section: Introductionmentioning

confidence: 99%

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Kaygusuz

¹

,

Çetiner²,

Şahin³

2011

TJPATH

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Objective: The aim of the study was to investigate the importance of consumption of the epidermis as an additional diagnostic criteria for malignant melanoma and to evaluate its relationship to clinicopathological findings. Material and Method:The age, gender, localization of the lesion and the histopathological parameters such as tumor type, Breslow thickness, ulceration, Clark's level, mitosis/mm 2 , lymphocytic infiltration were noted in 40 malignant melanoma cases. Consumption of the epidermis was evaluated in tumor sections. Consumption of the epidermis (CoE) due to thinning of the epidermis and loss of rete ridges was noted as (+) or (-). Furthermore, CoE was compared with clinical and histopathological parameters. The Shapiro Wilk and Logistic regression tests were used for statistical analysis. The results were accepted as significant if the p value was <0.05. Results:CoE was detected in 60% (24/40) of malignant melanoma cases. a positive correlation was present between CoE and head and neck localization (p=0,698), superficial spreading melanoma (p=0,341), ulceration (p=0,097) and brisk lymphocytic infiltration (p=0,200) but the results were not statistically significant. CoE was frequently detected in males but the difference was not statistically significant (p=0.796). There was no correlation or significant statistical association between CoE and age, Breslow thickness, Clark's level or the mitotic index. Conclusion:The detection of CoE in most of the patients suggests that CoE could be a histopathological criterion in the diagnosis of malignant melanoma. The frequent association between CoE and the presence of ulceration could also direct attention to CoE as regards prognostic importance. Bulgular: Epidermal yapısal değişiklikler malign melanom olgularının %60'ında (24/40) mevcuttu. Epidermal yapısal değişiklikler ile baş-boyun yerleşimi (p=0,698), yüzeyel yayılan tümör tipi (p=0,341), ülserasyon varlığı (p=0,097) ve şiddetli lenfositik infiltrasyon (p=0,200) arasında pozitif korelasyon vardı. ancak istatistiksel olarak anlamlı değildi. Epidermal yapısal değişiklikler erkeklerde kadınlara göre daha sık olarak izlendi, ancak aradaki fark istatistiksel olarak anlamlı bulunmadı (p=0,796). Epidermal yapısal değişiklikler ile yaş, Breslow kalınlığı, Clark düzeyi ve mitoz sayısı arasında herhangi bir korelasyon veya anlamlı istatistiksel birliktelik saptanmadı.Sonuç: Epidermal yapısal değişikliklerin olguların çoğunda saptanmış olması, malign melanom tanısında epidermal yapısal değişikliklerin bir histopatolojik kriter olabileceğini düşündürmektedir. ayrıca epidermal yapısal değişikliklerin, ülserasyon varlığı ile olan sık birlikteliği, kötü prognostik gösterge olabilirliği açısından dikkat çekicidir.

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“…28 The physical force of a pushing border from rapid tumor growth in lesions such as Spitz nevi may contribute to epidermal thinning. 28,29 Immunologic factors likely contribute to the COE seen in halo nevi, 6,30-32 but they are less likely to play a major causal role in melanomas because infiltrating lymphocytes were not significantly associated with COE in the invasive melanomas in our study (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…28 The physical force of a pushing border from rapid tumor growth in lesions such as Spitz nevi may contribute to epidermal thinning. 28,29 Immunologic factors likely contribute to the COE seen in halo nevi, 6,30-32 but they are less likely to play a major causal role in melanomas because infiltrating lymphocytes were not significantly associated with COE in the invasive melanomas in our study (Table 2). Notably, COE can be found in malignant melanomas of all levels, including MIS, indicating that molecular alterations may play a pivotal role in malignant 33 and degradation of the basement membrane by proteolytic enzymes 28,33-35 may make the epidermis more susceptible to COE.…”

Section: Discussionmentioning

confidence: 99%

Consumption of the Epidermis: A Criterion in the Differential Diagnosis of Melanoma and Dysplastic Nevi That is Associated With Increasing Breslow Depth and Ulceration

Walters¹,

Groben²,

Busam³

et al. 2007

The American Journal of Dermatopathology

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Consumption of the epidermis (COE), defined as thinning of the epidermis with attenuation of basal and suprabasal layers and loss of rete ridges adjacent to collections of melanocytes, is a recently coined term encompassing changes of the epidermal architecture associated with melanoma. To evaluate this feature as an additional diagnostic criterion for melanoma, we examined COE in 453 melanocytic lesions, including 213 invasive melanomas from a population-based series and 240 suspicious pigmented lesions from a clinic-based series, excluding halo and Spitz nevi. In the population-based series, COE was identified in 92/213 (43%) invasive melanomas and became progressively more frequent with increasing Breslow depth (P < 0.0001) and Clark level (P = 0.0002). COE was more frequent when mitotic figures (P < 0.0001), ulceration (P = 0.005), or vertical growth phase (P = 0.009) were present, but it was not significantly associated with age, gender, site, regression, or tumor-infiltrating lymphocytes. In the clinic-based series of pigmented lesions, COE was present in 2/25 (8%) in situ melanomas, 1/29 (3%) lesions classified as melanoma in situ/high-grade dysplastic nevi, and 1/40 (2.5%) high-grade dysplastic nevi. COE was not identified in 146 low-grade dysplastic, congenital, or common nevi. In the combined datasets, 94/96 (98%) lesions exhibiting COE were classified as melanoma. This study demonstrates that COE is frequently present in invasive melanomas, is associated with more aggressive histopathologic features (including increased Breslow depth and ulceration) and may be a useful supplementary diagnostic criterion for melanoma. Furthermore, the process leading to COE may be the first step in a progression to ulceration.

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“…The possible mechanisms responsible for the histological changes seen in CoE are mechanophysical factors, immunological causes and molecular changes. The physical force of rapid tumor growth is said to contribute to the epidermal thinning (1,4). However, there is no net tumor thickness range specified for CoE (5).…”

Section: Resultsmentioning

confidence: 99%

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Kaygusuz¹,

Çetiner²,

Şahin³

2011

TJPATH

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Objective: The aim of the study was to investigate the importance of consumption of the epidermis as an additional diagnostic criteria for malignant melanoma and to evaluate its relationship to clinicopathological findings. Material and Method: The age, gender, localization of the lesion and the histopathological parameters such as tumor type, Breslow thickness, ulceration, Clark's level, mitosis/mm 2 , lymphocytic infiltration were noted in 40 malignant melanoma cases. Consumption of the epidermis was evaluated in tumor sections. Consumption of the epidermis (CoE) due to thinning of the epidermis and loss of rete ridges was noted as (+) or (-). Furthermore, CoE was compared with clinical and histopathological parameters. The Shapiro Wilk and Logistic regression tests were used for statistical analysis. The results were accepted as significant if the p value was <0.05. Results: CoE was detected in 60% (24/40) of malignant melanoma cases. a positive correlation was present between CoE and head and neck localization (p=0,698), superficial spreading melanoma (p=0,341), ulceration (p=0,097) and brisk lymphocytic infiltration (p=0,200) but the results were not statistically significant. CoE was frequently detected in males but the difference was not statistically significant (p=0.796). There was no correlation or significant statistical association between CoE and age, Breslow thickness, Clark's level or the mitotic index. Conclusion: The detection of CoE in most of the patients suggests that CoE could be a histopathological criterion in the diagnosis of malignant melanoma. The frequent association between CoE and the presence of ulceration could also direct attention to CoE as regards prognostic importance.

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Cleft formation and consumption of the epidermis in cutaneous melanocytic lesions—reply

Cited by 5 publications

References 4 publications

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

Consumption of the Epidermis: A Criterion in the Differential Diagnosis of Melanoma and Dysplastic Nevi That is Associated With Increasing Breslow Depth and Ulceration

Lsil/asc-h (lsil-h) in cervicovaginal smear: histopathological outcomes and clinical significance

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