Case and Research Letters
Epidermal Effacement in Malignant Melanoma
Adelgazamiento epidérmico en melanomas malignos
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Corbalán-Vélez, I. Oviedo-Ramírez, E. Martínez-Barba, A. Clemente-Ruiz de Almirón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Corbalán-Vélez" "email" => array:1 [ 0 => "raulcorb@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Oviedo-Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Martínez-Barba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Clemente-Ruiz de Almirón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adelgazamiento epidérmico en melanomas malignos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 700 "Ancho" => 952 "Tamanyo" => 225369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Superficial spreading melanoma: the overlying epidermis consists of just a single layer of cells in some areas (hematoxylin-eosin, original magnification ×100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermal effacement, also known as consumption of the epidermis, is a histologic feature that can be seen in a number of malignant melanomas.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> It consists of the thinning or disappearance of epidermal cell layers overlying the melanoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Hantschke et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> found epidermal effacement in 88 (86%) of 102 melanomas but in only 12 (9.6%) of 125 Spitz nevi. They also studied 61 spitzoid lesions without a clear diagnosis using genomic hybridization techniques and found epidermal effacement in 6 (14%) of 42 lesions that were reclassified as benign lesions and in 14 (74%) of 19 lesions that were reclassified as malignant lesions. Walters et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> found epidermal effacement in 92 (43%) of 213 melanomas but in just 4 (4.2%) of 94 melanomas in situ or high-grade dysplastic nevi. There was no effacement in 146 benign nevi (114 low-grade dysplastic nevi, 8 congenital nevi, and 24 common nevi). In other words, epidermal effacement could be used, with caution, as a diagnostic criterion for differentiating melanoma from Spitz nevus or dysplastic nevus.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Even though epidermal effacement is a relatively common finding in melanomas (found by Hantschke et al<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and Walters et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 86% and 43% of cases, respectively), very few studies have analyzed it. Furthermore, we believe that this histologic feature is unfamiliar to the majority of dermatologists.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We recently saw 2 cases of malignant melanoma with epidermal effacement. The first was a superficial spreading melanoma (SSM), located on the right arm, that had entered the vertical growth phase (Breslow depth of 0.95<span class="elsevierStyleHsp" style=""></span>mm and Clark level III) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The second was also a SSM in the vertical growth phase (Breslow depth of 1.87<span class="elsevierStyleHsp" style=""></span>mm and Clark level IV) but located on the abdomen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The tumors had been removed from a 51-year-old and a 50-year-old man, respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">It has been postulated that epidermal effacement is the result of an autoimmune or immunologic process as this histologic feature has also been seen in certain halo nevi (pseudo-epidermal effacement).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Walters et al<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> do not believe this to be the case as they found no association between epidermal effacement and either tumor regression or inflammatory infiltrates. It might also be a physical phenomenon related to the compression caused by tumor growth<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a>; this, however, would not explain why epidermal effacement is found in some thin melanomas (with a low Breslow depth) or indeed why it is not found in the vast majority of thick melanomas. Epidermal effacement has also been seen in areas adjacent to melanoma ulceration as well as in association with fissures, clefting, and areas of dermal-epidermal separation, explaining why numerous studies have suggested that this histologic feature might be a marker of subsequent progression to ulceration.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> In support of this theory, we have seen epidermal effacement in several epidermotropic metastatic melanomas.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Further studies are necessary to determine whether epidermal effacement, like ulceration, is associated with poorer prognosis in melanoma.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Moreover, epidermal effacement is observed more frequently in association with other indicators of poorer prognosis in malignant melanomas<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a>: increasing Breslow depth, number of mitoses per field, ulceration, and vertical growth.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Until it is determined whether or not epidermal effacement, like ulceration, is associated with poorer prognosis, we believe that it should be included in protocols for melanoma histopathology reports.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It is also interesting to note that paratumoral epidermal hyperplasia, which is precisely the opposite of epidermal effacement, located in zones adjacent to melanoma is associated with better prognosis in thick melanomas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The question remains as to why epidermal effacement and ulceration occur in certain malignant melanomas independently of tumor duration, Breslow depth, or faster growth. Epidermal effacement (and therefore subsequent ulceration) might be caused by the action of metalloproteases or the alteration of certain calcium-dependent adhesion molecules such as E-cadherin.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,9,10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Corbalán-Vélez R, et al. Adelgazamiento epidérmico en melanomas malignos. Actas Dermosifiliogr.2011;102:634-5.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 952 "Tamanyo" => 243297 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidermal effacement overlying malignant melanoma (hematoxylin-eosin, original magnification ×100).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 700 "Ancho" => 952 "Tamanyo" => 225369 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Superficial spreading melanoma: the overlying epidermis consists of just a single layer of cells in some areas (hematoxylin-eosin, original magnification ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consumption of the epidermis. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 6 | 21 |
| 2024 Octubre | 113 | 62 | 175 |
| 2024 Septiembre | 129 | 51 | 180 |
| 2024 Agosto | 112 | 74 | 186 |
| 2024 Julio | 110 | 49 | 159 |
| 2024 Junio | 135 | 32 | 167 |
| 2024 Mayo | 93 | 36 | 129 |
| 2024 Abril | 86 | 41 | 127 |
| 2024 Marzo | 88 | 43 | 131 |
| 2024 Febrero | 79 | 28 | 107 |
| 2024 Enero | 83 | 39 | 122 |
| 2023 Diciembre | 54 | 24 | 78 |
| 2023 Noviembre | 89 | 32 | 121 |
| 2023 Octubre | 83 | 41 | 124 |
| 2023 Septiembre | 76 | 51 | 127 |
| 2023 Agosto | 47 | 32 | 79 |
| 2023 Julio | 61 | 58 | 119 |
| 2023 Junio | 57 | 30 | 87 |
| 2023 Mayo | 81 | 43 | 124 |
| 2023 Abril | 56 | 37 | 93 |
| 2023 Marzo | 79 | 34 | 113 |
| 2023 Febrero | 67 | 32 | 99 |
| 2023 Enero | 33 | 43 | 76 |
| 2022 Diciembre | 38 | 42 | 80 |
| 2022 Noviembre | 37 | 29 | 66 |
| 2022 Octubre | 24 | 44 | 68 |
| 2022 Septiembre | 30 | 49 | 79 |
| 2022 Agosto | 21 | 40 | 61 |
| 2022 Julio | 29 | 42 | 71 |
| 2022 Junio | 28 | 29 | 57 |
| 2022 Mayo | 28 | 43 | 71 |
| 2022 Abril | 52 | 47 | 99 |
| 2022 Marzo | 37 | 50 | 87 |
| 2022 Febrero | 41 | 25 | 66 |
| 2022 Enero | 49 | 49 | 98 |
| 2021 Diciembre | 35 | 39 | 74 |
| 2021 Noviembre | 52 | 66 | 118 |
| 2021 Octubre | 60 | 60 | 120 |
| 2021 Septiembre | 35 | 47 | 82 |
| 2021 Agosto | 49 | 38 | 87 |
| 2021 Julio | 29 | 39 | 68 |
| 2021 Junio | 39 | 29 | 68 |
| 2021 Mayo | 37 | 31 | 68 |
| 2021 Abril | 76 | 58 | 134 |
| 2021 Marzo | 85 | 46 | 131 |
| 2021 Febrero | 56 | 38 | 94 |
| 2021 Enero | 48 | 37 | 85 |
| 2020 Diciembre | 31 | 29 | 60 |
| 2020 Noviembre | 31 | 20 | 51 |
| 2020 Octubre | 17 | 9 | 26 |
| 2020 Septiembre | 31 | 14 | 45 |
| 2020 Agosto | 24 | 26 | 50 |
| 2020 Julio | 22 | 16 | 38 |
| 2020 Junio | 33 | 20 | 53 |
| 2020 Mayo | 21 | 22 | 43 |
| 2020 Abril | 25 | 36 | 61 |
| 2020 Marzo | 37 | 26 | 63 |
| 2020 Febrero | 2 | 11 | 13 |
| 2020 Enero | 0 | 12 | 12 |
| 2019 Diciembre | 4 | 16 | 20 |
| 2019 Noviembre | 0 | 5 | 5 |
| 2019 Octubre | 0 | 10 | 10 |
| 2019 Septiembre | 4 | 9 | 13 |
| 2019 Agosto | 0 | 10 | 10 |
| 2019 Julio | 0 | 22 | 22 |
| 2019 Junio | 0 | 52 | 52 |
| 2019 Mayo | 2 | 35 | 37 |
| 2019 Abril | 0 | 18 | 18 |
| 2019 Marzo | 0 | 12 | 12 |
| 2019 Febrero | 2 | 4 | 6 |
| 2019 Enero | 0 | 1 | 1 |
| 2018 Diciembre | 1 | 5 | 6 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 2 | 3 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Abril | 0 | 7 | 7 |
| 2018 Marzo | 0 | 7 | 7 |
| 2018 Febrero | 45 | 9 | 54 |
| 2018 Enero | 46 | 7 | 53 |
| 2017 Diciembre | 41 | 11 | 52 |
| 2017 Noviembre | 32 | 11 | 43 |
| 2017 Octubre | 37 | 4 | 41 |
| 2017 Septiembre | 39 | 7 | 46 |
| 2017 Agosto | 62 | 20 | 82 |
| 2017 Julio | 50 | 4 | 54 |
| 2017 Junio | 70 | 10 | 80 |
| 2017 Mayo | 58 | 10 | 68 |
| 2017 Abril | 45 | 5 | 50 |
| 2017 Marzo | 38 | 9 | 47 |
| 2017 Febrero | 33 | 11 | 44 |
| 2017 Enero | 37 | 12 | 49 |
| 2016 Diciembre | 50 | 9 | 59 |
| 2016 Noviembre | 59 | 4 | 63 |
| 2016 Octubre | 54 | 11 | 65 |
| 2016 Septiembre | 54 | 7 | 61 |
| 2016 Agosto | 55 | 5 | 60 |
| 2016 Julio | 48 | 13 | 61 |
| 2016 Junio | 10 | 8 | 18 |
| 2016 Mayo | 10 | 14 | 24 |
| 2016 Abril | 3 | 5 | 8 |
| 2016 Marzo | 9 | 6 | 15 |
| 2016 Febrero | 6 | 1 | 7 |
| 2016 Enero | 7 | 3 | 10 |
| 2015 Diciembre | 8 | 1 | 9 |
| 2015 Noviembre | 17 | 0 | 17 |
| 2015 Octubre | 14 | 2 | 16 |
| 2015 Septiembre | 11 | 5 | 16 |
| 2015 Agosto | 14 | 4 | 18 |
| 2015 Julio | 62 | 7 | 69 |
| 2015 Junio | 52 | 9 | 61 |
| 2015 Mayo | 93 | 14 | 107 |
| 2015 Abril | 87 | 17 | 104 |
| 2015 Marzo | 68 | 3 | 71 |
| 2015 Febrero | 39 | 5 | 44 |
| 2015 Enero | 57 | 8 | 65 |
| 2014 Diciembre | 65 | 10 | 75 |
| 2014 Noviembre | 34 | 10 | 44 |
| 2014 Octubre | 60 | 19 | 79 |
| 2014 Septiembre | 28 | 11 | 39 |
| 2014 Agosto | 41 | 11 | 52 |
| 2014 Julio | 69 | 22 | 91 |
| 2014 Junio | 87 | 17 | 104 |
| 2014 Mayo | 78 | 12 | 90 |
| 2014 Abril | 76 | 11 | 87 |
| 2014 Marzo | 74 | 16 | 90 |
| 2014 Febrero | 43 | 18 | 61 |
| 2014 Enero | 51 | 13 | 64 |
| 2013 Diciembre | 70 | 13 | 83 |
| 2013 Noviembre | 53 | 12 | 65 |
| 2013 Octubre | 46 | 12 | 58 |
| 2013 Septiembre | 15 | 4 | 19 |
| 2013 Agosto | 12 | 6 | 18 |
| 2013 Julio | 7 | 11 | 18 |
| 2013 Junio | 17 | 14 | 31 |
| 2013 Mayo | 16 | 3 | 19 |
| 2013 Abril | 12 | 18 | 30 |
| 2013 Marzo | 13 | 8 | 21 |
| 2013 Febrero | 36 | 7 | 43 |
| 2013 Enero | 18 | 2 | 20 |
| 2012 Diciembre | 12 | 3 | 15 |
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