Melanocytic lesions with eczematous reaction (Meyerson's phenomenon) - a histopathologic analysis of 64 cases

Eczematous (spongiotic) reaction in melanocytic lesions (Meyerson's phenomenon) has not been systematically analyzed and has not been convincingly documented in melanoma.

We analyzed 64 consecutive melanocytic lesions with spongiotic reaction, occurring in 57 patients (age range 14-81 years; mean, 39 years; 30 females, 27 males) including 16 common acquired nevi, 3 nevi with congenital features, 2 Spitz nevi, 29 dysplastic nevi, 6 in situ and 8 invasive melanomas.

The intensity of the spongiotic reaction was graded as mild in 24 (38%), moderate in 22 (34%) and marked in 18 (28%) lesions. It was moderate/marked in 6 of 14 (43%) in situ or invasive melanomas. Upward migration of melanocytes in the epidermis was noted in 7 (33%) non-dysplastic and 10 (34%) dysplastic nevi but was generally limited to the lower half of the epidermis. Moderate/severe cytologic atypia was found in 14 (48%) dysplastic nevi and all melanomas but not in non-dysplastic nevi.

Prominent spongiotic reaction with eosinophils in the inflammatory infiltrate can affect all types of melanocytic lesions. Upward migration involving the uppermost layers of the epidermis, especially when extensive and present in areas with a less pronounced spongiotic reaction, and moderate/severe cytologic atypia indicate a melanoma.