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The Journal of Investigative Dermatology Mar 1993The term ocular melanoma refers to a heterogeneous group of cancers of melanocytic origin. The precursor of most cases of conjunctival melanoma is known to...
The term ocular melanoma refers to a heterogeneous group of cancers of melanocytic origin. The precursor of most cases of conjunctival melanoma is known to ophthalmologists as primary acquired melanosis. This condition passes through well-defined stages of tumor progression. Although tumor progression is not obligatory, as a conjunctival melanocytic lesion acquires new biologic properties it is more likely to progress further. Although junctional nevi are seldom encountered beyond childhood and primary acquired melanosis usually develops in middle-aged individuals, these two conditions may be histologically indistinguishable. Most junctional nevi eventually show evidence of differentiation, whereas nearly half of the cases of primary acquired melanosis with atypia progress to melanoma. Therefore, it is possible that aging may modulate the capability of certain clonal proliferations to differentiate. Uveal melanocytes normally reside in mesenchyme, so that the traditional histologic criterion for establishing the diagnosis of most melanomas--breach of an epithelial basement membrane--does not apply. Because uveal melanomas are not easily accessible to incisional biopsy (without disruption of vision), only two points in the spectrum of tumor progression are defined clinically: nevus and melanoma. Experimental evidence suggests that a spectrum of atypical melanocytic proliferations separates benign nevi from melanomas capable of generating metastases. Unlike conjunctival melanomas that spread first to regional lymph nodes, choroidal and ciliary body melanomas preferentially spread first to the liver and are examples of organ-specific metastases.
Topics: Eye Neoplasms; Humans; Melanoma; Neoplasm Staging
PubMed: 8440916
DOI: 10.1111/1523-1747.ep12470222 -
Transactions of the American... 1999To report the clinical and histologic features of combined nevi of the conjunctiva, a type of nevus that is not uncommon in the skin but has rarely been reported in the... (Comparative Study)
Comparative Study
PURPOSE
To report the clinical and histologic features of combined nevi of the conjunctiva, a type of nevus that is not uncommon in the skin but has rarely been reported in the conjunctiva.
METHODS
Conjunctival nevi and melanomas from the files of the University of California, San Francisco, eye pathology laboratory were reviewed from 1984 to 1999 for the presence of features of both standard nevocytic nevi and blue nevi. Clinical histories and, when available, clinical photographs were obtained.
RESULTS
Thirty-one combined nevi were discovered during the 15-year period between 1984 and 1999. One case before 1984 had been incorrectly diagnosed as a junctional nevus. The dendritic and spindle-shaped blue nevus cells had been overlooked because they were not recognized as distinct from the standard nevocytic nevus cells. The recognition of a blue as well as a brown color, a deep as well as a superficial component in the lesion, or a history of pigmentation since birth may help to establish the correct clinical diagnosis and prevent an unnecessarily deep surgical resection. Although growth of the lesion or "satellites" in some patients may favor a clinical diagnosis of melanoma, none of the lesions in this series were malignant.
CONCLUSION
Despite a paucity of reports of combined nevi of the conjunctiva in the medical literature, this type of nevus--a combination of a nevocytic and a blue nevus--is common and has been overlooked in the past.
Topics: Adolescent; Adult; Aged; Child; Conjunctival Neoplasms; Cryotherapy; Diagnosis, Differential; Female; Humans; Male; Melanoma; Middle Aged; Nevus, Blue; Nevus, Pigmented; Ophthalmologic Surgical Procedures; Retrospective Studies
PubMed: 10703123
DOI: No ID Found -
Journal of Clinical Pathology Nov 1989The presence of both laminin and type IV collagen was sought at the dermo-epidermal junction and in the dermis adjacent to benign melanocytic naevi of the junctional,...
The presence of both laminin and type IV collagen was sought at the dermo-epidermal junction and in the dermis adjacent to benign melanocytic naevi of the junctional, compound, and intradermal types; dysplastic naevi; and both primary and secondary melanoma. In all, 154 lesions were studied, using antibodies to laminin and type IV collagen and an indirect immunoperoxidase technique. The staining patterns seen with the two antibodies were virtually identical, although that of laminin was generally fainter. Breaks in and thinning of the normally continuous line of type IV collagen and laminin at the dermo-epidermal junction were seen in association with the junctional activity of benign naevi, and in malignant melanomas in association with invasive tumour cells. Both benign and malignant cells of the melanocyte series showed relatively light pericellular staining around individual cells and clusters of cells in the papillary dermis. This staining pattern was much stronger in the deeper reticular dermis. It is concluded that the pattern of staining of these two antibodies and in particular the presence of breaks in type IV collagen and laminin at the dermo-epidermal junction are not specific for either benign or malignant melanocytic lesions and cannot be used as a diagnostic marker of invasive malignancy.
Topics: Collagen; Humans; Immunoenzyme Techniques; Laminin; Melanocytes; Melanoma; Nevus; Nevus, Pigmented; Skin Neoplasms; Staining and Labeling
PubMed: 2479664
DOI: 10.1136/jcp.42.11.1173 -
Acta Dermato-venereologica May 2020Sutton naevi can sometimes present a challenging appearance with atypical presentation, also by dermoscopy. Reflectance confocal microscopy could help in making a...
Sutton naevi can sometimes present a challenging appearance with atypical presentation, also by dermoscopy. Reflectance confocal microscopy could help in making a diagnosis. This study prospectively collected two groups of Sutton nevi: the first one was composed by typical white halo naevi monitored for one year (13, 23%) and the second one was made up of atypical lesions excised in order to rule out melanoma, which were histologically diagnosed as Sutton naevi (21, 37%). These two groups of Sutton naevi were compared to a retrospectively collected cohort of thin melanomas with histologic regression features (23, 40%). On dermoscopy, atypical Sutton naevi and melanomas were indistinguishable. Reflectance confocal microscopy demonstrated significant differences at the dermo-epidermal junction: marked dermo-epidermal junction thickening and non-edged papilla were associated with melanoma, while the presence of nests was associated with Sutton naevi. However, reflectance confocal microscopy also detected marked intraepidermal pagetoid cells in Sutton naevi that were a combination of MelanA+ and CD1a+ cells. Sutton naevi can simulate melanoma, under both dermoscopy and reflectance confocal microscopy. Nevertheless, relevant confocal dermo-epidermal junction features and the clinical scenario can be helpful to make a final diagnosis, especially in those situations where melanoma must be ruled out.
Topics: Adult; Dermoscopy; Diagnosis, Differential; Female; Humans; Male; Melanoma; Microscopy, Confocal; Middle Aged; Nevus; Skin Neoplasms; Young Adult
PubMed: 32318743
DOI: 10.2340/00015555-3488 -
The American Journal of Pathology May 1986The authors have generated monoclonal antibodies to an extract of melanoma. When tested on a variety of fixed, embedded sections of malignant tumors, one antibody... (Comparative Study)
Comparative Study
The authors have generated monoclonal antibodies to an extract of melanoma. When tested on a variety of fixed, embedded sections of malignant tumors, one antibody (HMB-45) reacted with 60 of 62 melanomas and none of 168 nonmelanomas (carcinomas, lymphomas, and sarcomas). The antibody reacts with junctional nevus cells but not intradermal nevi, and recognizes fetal and neonatal melanocytes but not normal adult melanocytes. This antibody thus demonstrates absolute specificity for melanocytic tumors and thus has great utility for the surgical pathologist in distinguishing among poorly differentiated tumors of uncertain origin. It also identifies differences among populations of melanocytes which may be useful in understanding the biology of and interrelationships between these cells.
Topics: Animals; Antibodies, Monoclonal; Antibody Specificity; Carcinoma; Cell Line; Fluorescent Antibody Technique; Humans; Immunoenzyme Techniques; Lymphoma; Melanocytes; Melanoma; Mice; Mice, Inbred BALB C; Nevus, Pigmented; S100 Proteins; Sarcoma; Skin Neoplasms
PubMed: 3518473
DOI: No ID Found -
The Malaysian Journal of Pathology Apr 2024Spitz tumour with ALK rearrangement is a recently described entity and a rare tumour. The incidence of Spitz tumour was estimated at 3.63 per 100,000 persons in American... (Review)
Review
Spitz tumour with ALK rearrangement is a recently described entity and a rare tumour. The incidence of Spitz tumour was estimated at 3.63 per 100,000 persons in American paediatric population; while there is no data in Asian population. Here we reported a case of an eleven-year-old Asian boy who presented with a left shin nodule of two months' duration. The skin biopsy revealed a Spitz tumour with predominantly spindle cell morphology arranged in fascicles, vertically orientated nests and radial growth pattern. Junctional component, melanin pigment or Kamino bodies were not identified. Immunohistochemical study displayed homogenous cytoplasmic staining for ALK. Fluorescence in-situ hybridisation (FISH) analysis confirmed ALK rearrangement. Review of the literatures demonstrated that positive ALK immunohistochemistry may not correlate with ALK rearrangement. ALK-rearranged Spitz tumour confirmed with FISH analysis favour clinically benign behaviour despite atypical histomorphology or positive sentinel lymph node. Therefore, correlation of histomorphology, immunohistochemical stain and molecular study are important for the definitive diagnosis of this entity.
Topics: Humans; Male; Nevus, Epithelioid and Spindle Cell; Anaplastic Lymphoma Kinase; Child; Gene Rearrangement; Skin Neoplasms; In Situ Hybridization, Fluorescence; Immunohistochemistry; Receptor Protein-Tyrosine Kinases; Biomarkers, Tumor
PubMed: 38682850
DOI: No ID Found -
Archives of Dermatological Research Jan 2014High-definition optical coherence tomography (HD-OCT) is a non-invasive in vivo imaging technique with cellular resolution based on the principle of conventional optical...
High-definition optical coherence tomography (HD-OCT) is a non-invasive in vivo imaging technique with cellular resolution based on the principle of conventional optical coherence tomography. The objective of this study was to evaluate HD-OCT for its ability to identify architectural patterns and cytologic features of melanocytic lesions. All lesions were examined by one observer clinically and using dermoscopy. Cross-sectional HD-OCT images were compared with histopathology. En face HD-OCT images were compared with reflectance confocal microscopy (RCM). Twenty-six melanocytic lesions of 26 patients were imaged. Identification of architectural patterns in cross-sectional mode and cytologic features of pigmented cells in the epidermis, dermo-epidermal junction, papillary dermis, and superficial reticular dermis in the en face mode was possible by HD-OCT. HD-OCT provides morphological imaging with sufficient resolution and penetration depth to discriminate architectural patterns and cytologic features of pigmented cells in epidermis and dermis. The method appears to offer the possibility of additional three-dimensional structural information complementary to that of RCM, albeit at a slightly lower lateral resolution. The diagnostic potential of HD-OCT regarding malignant melanoma is not high enough for ruling out a diagnosis of malignant melanoma.
Topics: Dermis; Dermoscopy; Epidermal Cells; Humans; Melanocytes; Melanoma; Nevus, Pigmented; Pilot Projects; Skin Neoplasms; Skin Pigmentation; Tomography, Optical Coherence
PubMed: 23832144
DOI: 10.1007/s00403-013-1387-9 -
PloS One 2018Conjunctival naevi are the most frequently diagnosed primary melanocytic lesions of the conjunctiva. The clinical manifestations are greatly variable which may result in... (Comparative Study)
Comparative Study
PURPOSE
Conjunctival naevi are the most frequently diagnosed primary melanocytic lesions of the conjunctiva. The clinical manifestations are greatly variable which may result in diagnostic difficulties and differential diagnostic confusions. Therefore aims of the present study were: 1) to assess the morphologic features of conjunctival naevi; 2) to delineate the anterior segment optical coherence tomography (AS-OCT) characteristics of these lesions; 3) to compare AS-OCT and ultrasound biomicroscopy (UBM) as diagnostic tools in these alterations and 4) to correlate histological results with the AS-OCT pictures in case of surgically excised naevi.
METHODS
All lesions were photo-documented. AS-OCT and UBM (over the age of 18 years) were performed. Surgically excised lesions were admitted to histological examinations.
RESULTS
In our series of 57 conjunctival naevi, 54.4% were highly pigmented, 15.8% proved to be amelanotic. AS-OCT could detect intralesional cysts in 61.4% of the naevi, while slit-lamp and UBM proved to be less sensitive (40.3% vs. 28.5%). UBM could visualize the posterior margins of all naevi, while AS-OCT proved to be less sensitive with the detection of 89.4% of posterior naevus margins. Thickness of the conjunctival epithelial layer could be measured with AS-OCT in case of subepithelial naevi, while no distinct epithelial layer could be detected in compound and junctional naevi.
CONCLUSIONS
Superiority of AS-OCT over UBM was demonstrated in visualizing internal structures of conjunctival naevi. UBM proved to be a better tool in highly pigmented and remarkably elevated naevi. Correlation was found between the histological type of the naevus and the thickness of the epithelial layer covering the lesion.
Topics: Adolescent; Adult; Aged; Anterior Eye Segment; Child; Child, Preschool; Conjunctiva; Eye Neoplasms; Female; Humans; Hungary; Male; Microscopy, Acoustic; Middle Aged; Nevus, Pigmented; Tomography, Optical Coherence; Young Adult
PubMed: 29444155
DOI: 10.1371/journal.pone.0192908 -
Romanian Journal of Morphology and... 2009We present the case of 10-year-old girl who have had from birth a plane tumor, of tan color, 3-4 mm of diameter, localized on the face on the cutaneous part of the...
We present the case of 10-year-old girl who have had from birth a plane tumor, of tan color, 3-4 mm of diameter, localized on the face on the cutaneous part of the superior lip. This tumor has been stabile until 8-year-old. Then, after repeated sunlight exposures, the lesion has become more stark, hemispheric in shape, has increased in size becoming about 5-6 mm, with irregular borders, and after an accidental traumatism it began to bleed. We have performed the electroexcision of the lesion for diagnostic and therapeutic purpose. The histopathologic exam distinguished typical images of Spitz nevus on some of the histological sections but also of melanocytary tumor with uncertain malignant potential on the others where atypical mitoses localized in the deeper component of the tumor are being noticed. The immunohistochemical assessment of the tumoral cells showed positivity for the melanocytic markers HMB45 and Melan A, within junctional intraepidermic nevic cells and in the nevic cells from superficial dermis, and also for CD44 protein (belonging to the adhesion molecules family). However, cyclin D1 was positive in rare nevic cells, and the proliferation rate of the tumor was small, with a proliferation index for Ki67 lesser than 5%. The correlation between histopathological and immunohistochemical data conducive to final diagnosis of Spitz nevus with uncertain malignant potential. The clinical evolution confirmed the histopathological diagnosis by the fact that the patient did not presented clinical signs of local recurrences or metastasis at three years after the excision of the tumor.
Topics: Antigens, Neoplasm; Biomarkers, Tumor; Child; Cyclin D1; Diagnosis, Differential; Female; Humans; Hyaluronan Receptors; Ki-67 Antigen; MART-1 Antigen; Melanoma; Melanoma-Specific Antigens; Neoplasm Proteins; Nevus, Epithelioid and Spindle Cell; Skin Neoplasms
PubMed: 19434323
DOI: No ID Found -
Archives of Dermatological Research Mar 2019The histopathological differentiation of melanocytic nevi from malignant melanoma (MM) is based on well-known criteria, and is straightforward in the vast majority of...
The histopathological differentiation of melanocytic nevi from malignant melanoma (MM) is based on well-known criteria, and is straightforward in the vast majority of cases. However, there are few cases of melanocytic lesions (ML), the diagnosis of which is very challenging or even impossible. Here we have studied several morphological characteristics with particular focus on elastic fibers (EF) to identify features, helpful for the distinction between nevi and MM. In a monocentric retrospective study we have analyzed 14 morphological histological characteristics in 30 MMs and 90 nevi, encompassing 30 compound/dermal nevi, 30 junctional nevi, 30 dysplastic nevi. All consecutive cases were retrieved from the archives of our tertiary referral centre during the 6-month study period. Nine characteristics including loss of EF in the ML, loss of EF in lesional fibrosis, pushing of the EF, UV-elastosis, loss of rete ridges of the epidermis, regression of the ML, atrophy of the epidermis, pigment incontinence, and concentric eosinophilic fibroplasia (CEF) showed a statistical significant difference (p < 0.05 and at least an OR > 2) distinguishing nevi from MM. Loss of EF was found in 73.1% of MM cases, but in less than 2.5% of nevi. We identified nine morphological characteristics that are helpful to differentiate melanocytic nevi from MM. A loss of the EF in a ML appeared to be highly associated with MM.
Topics: Adult; Aged; Aged, 80 and over; Atrophy; Diagnosis, Differential; Elastic Tissue; Eosinophils; Epidermis; Female; Fibrosis; Humans; Male; Melanocytes; Melanoma; Middle Aged; Nevus, Pigmented; Retrospective Studies
PubMed: 30547366
DOI: 10.1007/s00403-018-1885-x