-
Journal of the European Academy of... Apr 2019Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or... (Observational Study)
Observational Study
BACKGROUND
Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin neoplasms, and in-vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement.
METHODS
A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis.
RESULTS
Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus-like globular and non-globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non-edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P < 0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy.
CONCLUSIONS
Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis.
Topics: Dermis; Dermoscopy; Epidermis; Female; Humans; Intravital Microscopy; Melanoma; Microscopy, Confocal; Retrospective Studies; Skin Neoplasms
PubMed: 30394598
DOI: 10.1111/jdv.15329 -
Current Health Sciences Journal 2019Melanonychia is the brown or black color of the finger or toe nail due to melanin deposition or melanocytes in the nail plate. The evidence of melanocytic disease is...
UNLABELLED
Melanonychia is the brown or black color of the finger or toe nail due to melanin deposition or melanocytes in the nail plate. The evidence of melanocytic disease is made by the dermatoscope, which allows to highlight the anomalies of the plate. The purpose of our study was to evaluate dermatoscopically the melanonychia, both in the form of stain and longitudinal on finger and/or toe nails in order to establish the type of nail hyperpigmentation.
MATERIALS AND METHOD
33 patients with longitudinal and stain melanonychia were examined with 30x Molemax HD computerized dermatoscope between May 2017-septembre 2018 in this prospective study conducted in the Department of Dermatology of Medical Center Dr. Ianosi (Craiova, Romania). Clinical data included: type of melanonychia, number and name of involved fingers, the presence or absence of fungal infections, nail apparatus tumors or hemorrhage.
RESULTS
The most frequent nail diagnosis was fungal infection (onychomycosis) observed in 18 patients (54.54%), malignant melanoma was diagnosed in 1 patient (3.03%) and the junctional nevus in 4 patients (12.12%). In 18 patients which has longitudinal melanonychia, the most frequent involved finger was the big toe, and in 15 patients which has stain melanonychia, all of them (100%) had affected the big toe, 7 (46.66%) patients had affected the thumb and the same percent the forth finger.
CONCLUSION
Nail dermatoscopy is an important method in establishing the diagnosis of melanonychia and allowed to avoid unnecessary biopsy for melanonychia.
PubMed: 31297260
DOI: 10.12865/CHSJ.45.01.04 -
California Medicine Mar 1958Benign melanocytic lesions include lentigo, ephelid (freckle), pigmented nevus, sacral spot, blue nevus, and combined nevus and blue nevus. Malignant melanocytic lesions...
Benign melanocytic lesions include lentigo, ephelid (freckle), pigmented nevus, sacral spot, blue nevus, and combined nevus and blue nevus. Malignant melanocytic lesions are melanomas, which arise from melanocytes at the epidermodermal junction, or, rarely, from blue nevi. They usually originate in brown plaques known as lentigo maligna, in pigmented nevi, or in normal skin. Melanoma is diagnosed clinically in less than 50 per cent of instances. Biopsy is therefore of great importance, since practically all melanoma can be cured by adequate early resection.
Topics: Biopsy; Humans; Hutchinson's Melanotic Freckle; Lentigo; Melanocytes; Melanoma; Melanosis; Nevus; Nevus, Blue; Nevus, Pigmented; Pigmentation; Skin; Skin Neoplasms
PubMed: 13511215
DOI: No ID Found -
Journal of Oral & Maxillofacial Research 2022Oral melanocytic nevi are relatively rare in comparison to their cutaneous counterparts. The aim of this manuscript is to present a case of acquired compound oral...
BACKGROUND
Oral melanocytic nevi are relatively rare in comparison to their cutaneous counterparts. The aim of this manuscript is to present a case of acquired compound oral melanocytic nevi on the hard palatal mucosa of a child.
METHODS
A 5-year-old female girl was referred for evaluation of a pigmented lesion on the hard palate. The lesion was asymptomatic and present for approximately 2 months. Oral clinical examination revealed a well-circumscribed brownish macule on the hard palatal mucosa, adjacent to the left first primary upper molar. Considering the recent onset of the lesion, biopsy was recommended, but the patient returned 3 years later, when increase in size with slight asymmetry and colour variation were noticed. An excisional biopsy was performed.
RESULTS
Microscopic examination revealed nevus cells randomly distributed along the basal cell layer and organized into nests along the junctional area and within the papillary layer of lamina propria, while immunohistochemical evaluation showed positivity of nevus cells for SOX-10 and Melan-A. A final diagnosis of compound melanocytic nevi was rendered, and the patient was advised to attend regular follow-up appointments.
CONCLUSIONS
Although oral melanocytic nevi are rare in childhood, their potential development should not be overlooked. Acquired oral melanocytic nevi need to be differentiated from several other common (e.g. amalgam tattoo) and uncommon (e.g. melanoma) oral pigmented lesions, as well as from the more rare congenital oral melanocytic nevi. Oral melanocytic nevi with junctional activity (i.e. junctional, compound subtypes) appear to be more common in children, possibly reflecting an earlier developmental stage.
PubMed: 35574207
DOI: 10.5037/jomr.2022.13105 -
Journal of Cutaneous and Aesthetic... 2022The treatment of common acquired melanocytic nevus (CAMN) is mostly desired for cosmetic purposes due to which a number of "faster and less traumatizing" techniques have...
BACKGROUND
The treatment of common acquired melanocytic nevus (CAMN) is mostly desired for cosmetic purposes due to which a number of "faster and less traumatizing" techniques have been developed. The major cause of recurrence is incomplete removal; there is a need for early detection of any residual pigment.
AIMS AND OBJECTIVES
This study aimed to assess the recurrence of common acquired melanocytic nevi and whether dermoscopy can be used as a noninvasive tool for the assessment of residual pigment following shave excision.
MATERIALS AND METHODS
A total of 100 patients of age more than 18 years with clinical features suggestive of common acquired melanocytic nevi were enrolled in the study. The nevi were assessed clinically and dermoscopically and, if found benign, were excised using shave excision. The specimen obtained was sent for histopathological examination. Dermoscopy was used immediately after shave excision for observing any residual pigment and, if present, was removed using radiofrequency current. The patients were followed up at 6 and 12 weeks for recurrence.
RESULTS
On histopathology, 87% nevi were intradermal, 8% were compound, and 5% had insufficient tissue for diagnosis, which were clinically diagnosed as junctional nevi. Dermoscopy immediately after shave excision helped in detecting residual pigment in 91% nevi, which was immediately ablated with radiofrequency, thus decreasing the risk of recurrences. Recurrences were seen in 33% nevi and all were intradermal with the presence of hair in the majority (66.67%) of them.
CONCLUSION
Shave excision is a minimally invasive and easily performed procedure. Dermsocopy can be used for assessing residual pigment after shave excision and thus reducing the risk of recurrences. On combining shave excision with radiofrequency ablation and assessing by dermoscopy, majority of patients were satisfied with the cosmetic results. Using dermoscope for follow-up helps in early recognition of recurrence and thus appropriate treatment can be provided at the earliest.
PubMed: 36561402
DOI: 10.4103/JCAS.JCAS_174_21 -
Indian Journal of Ophthalmology Nov 2017A 20-year-old girl presented with a large pigmented lesion over the temporal aspect of left lateral canthus involving the lateral one-third of both eyelids, since birth....
A 20-year-old girl presented with a large pigmented lesion over the temporal aspect of left lateral canthus involving the lateral one-third of both eyelids, since birth. A slow increase in its size had been noticed for the past 2 years. On examination, a hairy nevus measuring 34 mm × 22 mm was noticed involving left eyelid skin, the mucocutaneous junction (MCJ), palpebral conjunctiva, and lateral canthus. The surface was irregularly thick and covered with long, thick, and pigmented hairs. A clinical diagnosis of kissing nevus of eyelids was kept and a surgical resection with reconstruction planned. A customized full-thickness skin graft (FTSG) and amniotic membrane grafts (AMGs) were used for the reconstruction of cutaneous and MCJ, respectively. Histopathology showed the features of junctional nevus. At 4 months of follow-up, a well taken FTSG and healthy/sharp MCJ were noticed with no recurrence. We advocate a possible role of AMG, particularly in the reconstruction of the conjunctival mucosa and MCJ.
Topics: Amnion; Eyelid Neoplasms; Female; Humans; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Young Adult
PubMed: 29133658
DOI: 10.4103/ijo.IJO_407_17 -
Dermatology Practical & Conceptual Jan 2017"Nevi of special sites" is a term that denotes melanocytic nevi presenting in specific anatomic locations including the scalp, genital area, flexural sites, and acral...
"Nevi of special sites" is a term that denotes melanocytic nevi presenting in specific anatomic locations including the scalp, genital area, flexural sites, and acral sites [1]. Nevi from these anatomic sites display at times histopathologic features that may lead the reading pathologist to recommend re-excision of these benign nevi. Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that allows for visualization of epidermal, dermal-epidermal junctional (DEJ), and superficial dermal tissue structures at cellular level resolution. RCM features of special site nevi have not been previously described in the literature. Defining the RCM characteristics of special site nevi may increase diagnostic accuracy and assist in ruling out melanoma. Here, we report a case of a pigmented lesion appearing in the axilla of a patient with a recently diagnosed melanoma. Dermoscopic and histopathologic results were consistent with the diagnosis of nevus in flexural anatomic sites. In this case, RCM showed a regular honeycomb pattern of epidermal keratinocytes and enlarged, non-homogenous, discohesive nests at the DEJ, a pattern that corresponded well with the histopathologic findings. Larger studies are needed to establish RCM features of special site nevi in order to reliably rule out melanoma and lower the rate of unnecessary excisions of these benign nevi.
PubMed: 28243497
DOI: 10.5826/dpc.0701a11 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Nov 2021To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects.
OBJECTIVE
To explore the effectiveness and safety of Pacman flap for repair of eyelid and periocular soft tissue defects.
METHODS
The clinical data of 12 patients who underwent repair of eyelid and periocular soft tissue defects with Pacman flap between April 2015 and September 2020 was retrospectively reviewed. There were 5 males and 7 females, aged from 18 to 87 years, with a median age of 63 years. The disease duration ranged from 6 months to 50 years, with a median time of 3 years. The defect was located on the lateral eyelid in 5 cases, inferior eyelid in 3 cases, inferior and medial eyelid in 2 cases, inferior and lateral eyelid in 2 cases, and lateral eyebrow in 1 case. Pathological diagnosis included 4 cases of basal cell carcinoma, 4 cases of squamous cell carcinoma, 1 case of junction nevus, 1 case of intradermal nevus, 1 case of seborrheic keratosis, and 1 case of keratoacanthoma. The size of defects ranged from 1.4 cm×1.2 cm to 5.5 cm×5.0 cm. According to the skin mobility and toughness around the defects, Pacman flaps with the size of 1.6 cm×1.4 cm to 10.0 cm×6.0 cm were designed and advanced to repair the defects.
RESULTS
All flaps survived completely with no necrosis. One patient had infection, and another patient had partial wound dehiscence, but the wounds healed after dressing change without further debridement. Other patients all recovered successfully. The follow-up time ranged from4 to 51 months, with a median time of 12 months. No recurrence and metastasis occurred, and the scars were invisible without deformity of eyelid and brow. All patients were satisfied with the aesthetic and functional outcomes of the eyes.
CONCLUSION
Pacman flap is a simple and feasible technique for repair of eyelid and periocular soft tissue defects, with satisfactory effectiveness.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Eyelids; Female; Humans; Male; Middle Aged; Perforator Flap; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome; Young Adult
PubMed: 34779174
DOI: 10.7507/1002-1892.202106066 -
Inflammatory juvenile compound conjunctival nevi. A clinicopathological study and literature review.Romanian Journal of Morphology and... 2017The conjunctival nevus affecting children and adolescents is a rare condition and the literature showed only few reports on this issue. The aim of this article is to... (Review)
Review
AIM
The conjunctival nevus affecting children and adolescents is a rare condition and the literature showed only few reports on this issue. The aim of this article is to determine the histopathological features for the correct diagnosis of an inflammatory juvenile compound nevus of the conjunctiva (IJCNC) in order to make the difference between this tumor and other lesions, like conjunctival melanoma or lymphoma, very similar from a gross point of view. This article is a clinical pathological study of two cases of IJCNC with particular histopathological characteristics, who were admitted at the 2nd Ophthalmology Clinic, "Prof. Dr. Nicolae Oblu" Emergency Clinical Hospital, Iasi, Romania, over a period of five years (from July 1, 2012 to June 30, 2017). Both patients were adolescents, a boy (13-year-old) and a girl (12-year-old). Both lesions were bulbar juxtalimbal located and grew in size over one year. Seen at slit-lamp biomicroscopy, the first one presented as a non-pigmented lesion, while the second was a pigmented nevus, but their dimensions did not exceed 10 mm in diameter. From a histopathological point of view, both of them showed a nested junctional growth pattern, along with intra- and subepithelial location, of the nevomelanocytes. Tumoral cells demonstrated different degrees of atypical cytology, but in the second case, it was more obvious. Microscopic examination also revealed epithelial cystic inclusions, and prominent inflammation in the stroma of these two nevi. One of the cases presented heavy inflammation that took the form of lymphoid follicles and sheets of eosinophils, but the other showed only diffuse inflammation with lymphocytes plasma cells, and eosinophils within its stroma. The immunohistochemical characterization (anti-melan A, anti-S100 protein and anti-cytokeratin AE1÷AE3 antibodies) of the tumoral cells helped to the diagnosis.
CONCLUSIONS
IJCNC represent a small group of nevi that develop in adolescents and have some particular histopathological features. The pathological diagnosis is difficult as the microscopic features are very similar to a conjunctival melanoma, but a detailed microscopic examination, immunohistochemical stainings and the young age of the patient could help in establishing the benign nature of these lesions.
Topics: Adolescent; Child; Conjunctival Neoplasms; Female; Humans; Male; Nevus, Pigmented
PubMed: 29250649
DOI: No ID Found -
Histopathology Feb 2015Melanocytic naevi on the umbilicus have been described as a form of flexural naevi, with the most common feature being a 'nested and dyshesive pattern'. We have...
AIMS
Melanocytic naevi on the umbilicus have been described as a form of flexural naevi, with the most common feature being a 'nested and dyshesive pattern'. We have encountered a distinct group of umbilical naevi with more significant atypia and prominent fibrosis, not reported previously. This study aimed to characterize these naevi more clearly.
METHODS AND RESULTS
Eighty-one umbilical naevi from 2000 to 2013 were reviewed retrospectively, 20 cases of which showed lamellar fibrosis and atypia and were designated as atypical umbilical naevi (AUN). Lamellar fibrosis in AUN was extensive and frequently entrapped dermal melanocytes, resulting in low-grade cytological atypia (74% of cases) and impaired maturation (47%) of the dermal component. Other common features included bridging (95%), shoulder architecture (94%), lentiginous growth (85%) and high-grade junctional cytological atypia (85%). 'Nested and dyshesive pattern' was observed in only 20% of AUN. Ki-67 immunostaining performed on 12 AUN revealed a consistently low proliferation index of <1%. All AUN in this series lacked junctional confluence, florid pagetoid spread and dermal mitoses.
CONCLUSION
A subset of special site naevi in the umbilical region demonstrate characteristic lamellar fibrosis, architectural disorder and cytological atypia. Familiarity with these site-related atypical features would avoid overdiagnosis of melanoma.
Topics: Adolescent; Adult; Child; Female; Humans; Male; Middle Aged; Nevus, Pigmented; Skin Neoplasms; Umbilicus; Young Adult
PubMed: 25109391
DOI: 10.1111/his.12503