title: Epidermal consumption in benign and malignant melanocytic neoplasms.
abstract: Consumption of the epidermis associated with effacement of the rete ridge pattern has been cited as a useful criterion in the diagnosis of melanoma, but the significance of consumption in the absence of rete ridge effacement is unknown. We evaluated 701 melanocytic neoplasms for presence and 'grade' of consumption by melanocytic nests relative to diagnosis, body location, gender and age. We defined 1+ consumption as collections of melanocytes occupying greater than two thirds of the viable epidermis, with or without loss of the rete ridge pattern. Nests extending to the bottom of, within, and through the granular layer were graded 2+, 3+ and 4+, respectively. Consumption was more frequent and higher grades were found in melanomas followed by Spitz nevi compared with conventional melanocytic nevi (p < 0.001). Melanomas with higher Breslow thickness showed higher grades (p < 0.05). In conventional nevi, consumption occurred most frequently in back (13.7%), acral (11.9%) and scalp (9.8%) locations. Consumption without the requirement for rete ridge effacement occurs more frequently and at higher grades in melanoma. Higher grades correlate with higher Breslow thickness. Consumption is also common in Spitz nevi and occurs at lower grades in conventional (non-Spitz) nevi, especially on the back, the scalp and at acral sites.
authors.affiliation: Dermatology Resident, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Bandino
authors.affiliation: International Research Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Viktoryia
authors.initials: V
authors.lastname: Kazlouskaya
authors.affiliation: International Research Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Şeniz
authors.initials: Ş
authors.lastname: Ergin
authors.affiliation: Dermatology Resident, Hospital Arnau de Vilanova, Valencia, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Molés-Poveda
authors.affiliation: Dermatopathology Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Cleaver
authors.affiliation: Dermatopathology Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Filamer D
authors.initials: FD
authors.lastname: Kabigting
authors.affiliation: Dermatopathology Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Shackelton
authors.affiliation: Dermatopathology Fellow, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Khanh
authors.initials: K
authors.lastname: Thieu
authors.affiliation: Managing Director, Ackerman Academy of Dermatopathology, New York, NY, USA.
authors.forename: Dirk M
authors.initials: DM
authors.lastname: Elston
keywords: consumption; displacement; effacement; melanocytic nevi; melanoma