Consumption of the epidermis: a criterion in the differential diagnosis of melanoma and dysplastic nevi that is associated with increasing breslow depth and ulceration.
Consumption of the epidermis: a criterion in the differential diagnosis of melanoma and dysplastic nevi that is associated with increasing breslow depth and ulceration.
复制标题
表皮消耗：黑色素瘤和发育不良痣的鉴别诊断标准，与布雷斯洛深度增加和溃疡有关。
DOI：
10.1097/dad.0b013e318156e0a7
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Thomas,NancyE
中科院分区：
文献类型：
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作者：
Walters,RuthFulghum;Groben,PamelaA;Busam,Klaus;Millikan,RobertC;Rabinovitz,Harold;Cognetta,Armand;MihmJr,MartinC;Prieto,VictorG;Googe,PaulB;King,Roy;Moore,DominicT;Woosley,John;Thomas,NancyE
表皮消耗（COE），定义为表皮变薄，基底层和基底上层变薄，以及邻近黑色素细胞集合的网状脊丧失，是一个最近创造的术语，涵盖与黑色素瘤相关的表皮结构的变化。为了评估这一特征作为黑色素瘤的附加诊断标准，我们检查了 453 个黑色素细胞病变的 COE，其中包括基于人群的系列中的 213 个侵袭性黑色素瘤和基于临床的系列中的 240 个可疑色素性病变，不包括晕轮和斯皮茨痣。在基于人群的系列中，COE 在 92/213 (43%) 侵袭性黑色素瘤中被发现，并且随着 Breslow 深度 (P< 0.0001) 和 Clark 水平 (P= 0.0002) 的增加而变得越来越频繁。当存在有丝分裂象（P<0.0001）、溃疡（P=0.005）或垂直生长期（P=0.009）时，COE更常见，但与年龄、性别、部位、消退或肿瘤浸润淋巴细胞没有显着相关性。在基于临床的色素病变系列中，COE 存在于 2/25 (8%) 原位黑色素瘤、1/29 (3%) 分类为原位黑色素瘤/高度不典型增生痣的病变和 1/40 (2.5%) 高度不典型增生痣中。 146 例低度发育不良、先天性或常见痣中未发现 COE。在合并数据集中，94/96 (98%) 表现出 COE 的病变被归类为黑色素瘤。这项研究表明，COE 经常存在于侵袭性黑色素瘤中，与更具侵袭性的组织病理学特征（包括 Breslow 深度增加和溃疡）相关，并且可能是黑色素瘤的有用补充诊断标准。此外，导致 COE 的过程可能是进展为溃疡的第一步。
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.