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

Walters, Ruth F; Groben, Pamela A.; Busam, Klaus J.; Millikan, Robert C.; Rabinovitz, Harold; Cognetta, Armand B.; Mihm, Martín C.; Prieto, Víctor G.; King, Roy; Moore, Dominic T.; Woosley, John T.; Thomas, Nancy E.

doi:10.1097/dad.0b013e318156e0a7

Cited by 28 publications

(21 citation statements)

References 29 publications

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“…a controversial issue regarding prognosis is whether brisk lymphocytic infiltration which tends to limit the increase in primary melanoma thickness has prognostic significance as generally accepted (7 (4). We found a correlation between the presence of CoE and lymphocytic infiltration density in this study but it was not statistically significant .…”

Section: Discussioncontrasting

confidence: 51%

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

Kaygusuz

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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Section: Discussioncontrasting

confidence: 51%

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

Kaygusuz

Çetiner²,

Şahin³

2011

TJPATH

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“…These figures are in line with those reported in other studies (11,13). Consumption was first defined and introduced as an important factor for differentiating melanomas from Spitz nevi (10), whereas Walters et al showed a correlation between COE and ulceration (11). In this latter study, COE was frequently found at the edges of ulcerated areas and it was thought of as an early step in the progression toward ulceration (8).…”

Section: Consumption Of the Epidermis:a Possible Precursor Of Ulceratsupporting

confidence: 81%

Section: Consumption Of the Epidermis:a Possible Precursor Of Ulceratsupporting

confidence: 80%

“…COE has been defined as thinning of the epidermis-attenuation of basal and suprabasal layers and loss of the normal rete-ridge configuration in areas overlying melanoma tissue (10)-and its presence is reported in between 37 and 86% of all melanomas (8,(10)(11)(12) (Figure 1). COE can be detected in thin melanomas, but its likelihood rises with increasing Breslow thickness, and only 18% of thin melanomas (<1 mm) and 46% of the thicker melanomas (2-4 mm) had COE (8).…”

Section: Consumption Of the Epidermis:a Possible Precursor Of Ulceratmentioning

confidence: 99%

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Ulcerated Melanoma: Aspects and Prognostic Impact

Bønnelykke-Behrndtz

Steiniche

2017

Cutaneous Melanoma: Etiology and Therapy

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Ulceration is an important prognostic factor for patients with melanoma and also a predictive marker for the response of adjuvant immunestimulating therapy. A consensual definition and accurate assessment of ulceration is therefore crucial for proper staging and clinical management, but can be difficult even between experienced pathologists. The definition of ulceration is stated differently in the available literature but is generally understood as loss of epidermal matrix. Thinning of the epidermis, also termed consumption of the epidermis (COE), is associated with ulcerated lesions and correlates with enhanced tumor cell proliferation in nonulcerated melanoma. These results suggest that COE may be a proliferative precursor of ulceration, characterized by erosive growth into the epidermal layer (infiltrative type) or expansive growth that may stretch and eventually disrupt the epidermis (attenuative type), which is reflected in the histopathology. We have no means to determine the dynamic changes of human ulcerated melanoma or to determine whether these wounds have re-epithelialization (RE) potential. However, the presence of reactive hyperplasia (REH) and changes indicating RE associates with increased density of neutrophils and may herald resolved or late-stage ulcerations. Combining the extent of ulceration (> or <70% of the total tumor length) and the presence of 68epidermal involvement (COE, REH, and/or RE) stratifies prognosis more accurately and supports the relevance of including these factors in the definition of ulceration and to define ulceration of a primary melanoma as loss of epidermis with evidence of a host response (infiltration of neutrophils or fibrin deposition) and thinning, effacement, or REH of the surrounding epidermis.

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“…Their data suggested that consumption is a useful criterion for the diagnosis of melanocytic neoplasms. Subsequently, Walters et al carried out a population‐based study in which consumption 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) 6 . These results were interesting, but this series included only two cases of acral lentiginous melanoma (ALM), which is the most common type of melanoma in Japan 7 .…”

mentioning

confidence: 97%

Consumption of the epidermis in acral lentiginous melanoma

et al. 2012

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Journal of Cutaneous Pathology Consumption of the epidermis in acral lentiginous melanomaBackground: Consumption of the epidermis (hereafter, consumption), namely thinning of the epidermis with attenuation of basal and suprabasal layers and loss of rete ridges adjacent to collections of melanocytes, has been used to differentiate invasive melanoma from Spitz nevi. Evaluation of 213 invasive melanomas, including only two cases of acral lentiginous melanoma (ALM), showed that the frequency of consumption increases with increasing tumor thickness. Methods: We evaluated consumption in 52 acral melanomas relative to age, gender, Breslow depth, tumor thickness (based on the 2010 American Joint Commission on Cancer guidelines), Clark level, mitoses, ulceration, vertical-growth phase, regression, tumor-infiltrating lymphocytes and anatomical site. Results: Consumption was more frequent in ALM with increasing Breslow depth (p = 0.01), and in the presence of ulceration (p = 0.0078); in all cases with ulcer, consumption was found adjacent to the ulceration. There was no statistically significant difference in consumption in nail melanomas in comparison to melanomas of acral skin other than the nail. Conclusions: These results support the hypothesis that epidermal thinning in consumption represents an early phase of ulceration. No statistically significant difference in consumption was found between nail melanomas and melanomas of acral skin other than the nail, probably because of similar tumor thickness in both groups.

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

Cited by 28 publications

References 29 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

Ulcerated Melanoma: Aspects and Prognostic Impact

Consumption of the epidermis in acral lentiginous melanoma

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