title: Consumption of the epidermis: a criterion in the differential diagnosis of melanoma and dysplastic nevi that is associated with increasing breslow depth and ulceration.
abstract: 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.
authors.affiliation: Department of Pathology, University of North Carolina Hospitals, Chapel Hill, NC 27599-7287, USA.
authors.forename: Ruth Fulghum
authors.initials: RF
authors.lastname: Walters
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Groben
authors.forename: Klaus
authors.initials: K
authors.lastname: Busam
authors.forename: Robert C
authors.initials: RC
authors.lastname: Millikan
authors.forename: Harold
authors.initials: H
authors.lastname: Rabinovitz
authors.forename: Armand
authors.initials: A
authors.lastname: Cognetta
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mihm
authors.forename: Victor G
authors.initials: VG
authors.lastname: Prieto
authors.forename: Paul B
authors.initials: PB
authors.lastname: Googe
authors.forename: Roy
authors.initials: R
authors.lastname: King
authors.forename: Dominic T
authors.initials: DT
authors.lastname: Moore
authors.forename: John
authors.initials: J
authors.lastname: Woosley
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Thomas
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D018450:Disease Progression; D004416:Dysplastic Nevus Syndrome / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D004817:Epidermis / Q000473:pathology*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011230:Precancerous Conditions / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012878:Skin Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D012883:Skin Ulcer / Q000473:pathology*