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Cleft formation and consumption of the epidermis in cutaneous melanocytic lesions

To the Editor, The article Subepidermal cleft formation by Braun-Falco et al, recently published in Human Pathology , proposed an additional feature to distinguish melanoma from nevi: cleft formation (CF), defined as separation between the epidermis and underlying melanocytes at the epidermal-dermal junction [1] . Fig. 2A to C, as examples of CF in melanoma, showed a thinned epidermis with attenuation of the basal and suprabasal layers and loss of the rete ridges, that is, a recently described feature for the differentiation of melanoma and Spitz nevi, termed as consumption of the epidermis (COE) [2] . A relationship between CF and COE seems to exist. Braun-Falco underlined that CF and COE may be associated [1] ; Hantschke stated that clefts were variably present in lesions with COE [2] . Cleft formation was detected in 24% of melanomas and in 1% of nevi [1] . Consumption of the epidermis was found in 86% of melanomas and in 9.6% of Spitz nevi. These studies, recognizing new features for melanoma diagnosis, pose, however, the question of what CF-COE is. Braun-Falco did not discuss the possible pathogenesis of CF [1] . Hantschke stated that COE may be caused directly by melanoma cells, rather than by lymphocytes [2] . Thus, COE, especially if associated to CF, seems to be an expression of the aggressiveness of melanoma and should be regarded as a sign of malignancy. Against this interpretation, however, there is the fact that CF-COE has been said to occur in some nevi [1,2] . Hantschke remarked that in halo nevi, the thinning of the epidermis seems to be caused by underlying lymphocytes, rather than by melanocytes. Therefore, the thinning of the epidermis occurring in halo nevus seems to have a pathogenesis different from that of COE (inflammatory rather than neoplastic), appearing similar but intrinsically different from COE. The possible differential histological characteristics between COE and thinning of the epidermis in nevi (pseudo-COE) is a point that deserves to be clarified. The presence of a band-like lymphocytic infiltrate next to the undersurface of the epidermis [2] and the integrity of the suprabasal layers may speak in favor of pseudo-COE. The interpretation of CF-COE as a sign of malignancy conflicts, however, with the observation that it was present in 9% of Spitz nevi [1,2] . Reading the articles carefully, it seems that CF-COE occurring in melanomas had no morphological characteristics different from CF-COE observed in Spitz nevi, nor does it seem that COE observed in Spitz nevi is interpretable as pseudo-COE observed in halo nevi. Therefore, 2 alternatives are possible: (1) CF-COE is not a sign of malignancy but a feature occurring in benign and malignant lesions, although with different prevalence; (2) lesions diagnosed as Spitz nevi, but showing CF-COE, were malignant. If we accept the first, it is to be explained why a benign melanocytic proliferation destroys the epidermis. The second implies that a subset of lesions labeled as Spitz nevi were malignant. This latter hypothesis is not impossible because it is accepted that, applying the current histological criteria, a subset of Spitzoid melanomas can be misinterpreted as Spitz nevi even by expert pathologists [3-5] .</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Human Pathology Elsevier

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