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Postepy Dermatologii I Alergologii Oct 2013Melanomas in situ (MIS) are difficult to diagnose as they lack well-established, dermoscopic descriptors. In numerous clinical cases, there are no definitive...
Melanomas in situ (MIS) are difficult to diagnose as they lack well-established, dermoscopic descriptors. In numerous clinical cases, there are no definitive differentiating criteria between atypical nevus and melanoma in situ. So far, no digital dermoscopic criteria have been developed which can clearly distinguish atypical naevi from MIS. It is necessary to search for predictors of MIS and clinically suspected skin lesions in dermoscopy. We present 2 patients diagnosed with and treated for melanoma in situ and junctional nevus in its inflammatory stage. This includes a new morphological structure in dermoscopy known as the "mistletoe sign". Below, we have described dermoscopic pictures, with appropriate histopathology, for patients with the "mistletoe sign". Dermoscopy in two cases revealed multiple, well-circumscribed areas, consisting of non-uniform, sometimes pseudo-dichotomously branched structures, mimicking pseudopods, which were not reticular, arising from overall reticular or homogenous patterns resembling the mistletoe. Due to the fact that this is one of the several reports of its kind, further research and observation are still necessary. The "mistletoe sign" may be a descriptor of the melanocytic nevus in the inflammatory stage and the melanoma in situ; however, further studies are necessary.
PubMed: 24353493
DOI: 10.5114/pdia.2013.38362 -
British Journal of Cancer Nov 1991The dysplastic melanocytic nevus (DMN) is the key clinical marker for the familial dysplastic nevus syndrome and has also been associated with high risk for non-familial...
The dysplastic melanocytic nevus (DMN) is the key clinical marker for the familial dysplastic nevus syndrome and has also been associated with high risk for non-familial melanoma. Characterisations of DMN itself have been qualitative and on a case-by-case basis. In this study, we provided clinical and histological characterisations for each of 150 pigmented lesions from 150 patients with prior malignant melanoma. The steps involved in the study were as follows: (1) The two to four clinicians characterised pigmented lesions on each of 150 patients, and the lesion closest in characteristics to an atypical nevus was quantitatively described based on size, border characteristics and colour characteristics; (2) The lesion was then removed and independently quantified by a single dermatopathologist without knowledge of the clinical features; (3) We computed the correlation between each of the clinical variables and each of the histologic features for each of the 150 patients. Histologic diagnosis of dysplastic nevus was strongly associated with total number of palpable arm nevi, total number of any arm nevi, total number of nevi on the body of any type, and total number of clinically atypical nevi on the body (correlation coefficients 23.2% to 30.4% with P less than 0.01 in each instance). There were also strong correlations between the counts of numbers of nevi and certain types of architectural histologic features, including fusion (bridging of junctional nests), lymphocyte response and fibroplasia of the papillary dermis. Histologic evaluation of solar elastosis was negatively correlated with total numbers of nevi and total number of clinically atypical nevi (P less than 0.01). Freckling on forearm and on shoulders showed no significant positive or negative correlations with any of the histologic features nor with overall diagnosis of dysplastic nevus. We conclude that observations regarding total numbers of nevi (either normal or clinically atypical nevi) are correlated with nuclear and architectural histologic dysplasia on biopsy of the most atypical pigmented lesions.
Topics: Adult; Aged; Dysplastic Nevus Syndrome; Humans; Melanocytes; Melanoma; Melanosis; Middle Aged; Pigmentation; Skin Neoplasms
PubMed: 1931621
DOI: 10.1038/bjc.1991.431 -
Postgraduate Medical Journal Oct 1977Three patients presented with an asymptomatic longitudinal pigmented band in a nail. A junctional melanocytic naevus in the nail matrix was suspected; this was confirmed...
Three patients presented with an asymptomatic longitudinal pigmented band in a nail. A junctional melanocytic naevus in the nail matrix was suspected; this was confirmed by histological examination in each case. Differential diagnosis and management are discussed, together with a review of the literature. Local excision is considered to be the treatment of choice.
Topics: Adult; Female; Humans; Nails; Nevus, Pigmented; Skin Diseases
PubMed: 593983
DOI: 10.1136/pgmj.53.624.624 -
Ocular Oncology and Pathology Aug 2020A 52-year-old male presented with a perilimbal-epibulbar, flat, pigmented lesion of 7 months' duration. Microscopic evaluation disclosed a proliferation of...
A 52-year-old male presented with a perilimbal-epibulbar, flat, pigmented lesion of 7 months' duration. Microscopic evaluation disclosed a proliferation of intraepithelial dendritic melanocytes without frank atypia, a lesion formerly termed "primary acquired melanosis." Within the lesion there were also intraepithelial basal junctional nevocytic nests and occasional small subepithelial nevocytic clusters which were positive for MART-1, HMB-45, and SOX-10 and negative for Ki-67. This remarkable lesion was suggestive of dendritic melanocytes transforming into rounded nevocytes lacking dendrites. The embryologic and biologic implications of these findings are explored, notably in regard to the unusual acquisition in mature adults of common nevomelanocytic nevi.
PubMed: 33005614
DOI: 10.1159/000505492 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Dec 2012To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free...
OBJECTIVE
To explore a reconstruction method for complete nail bed defect caused by various kinds of reasons and to retrospectively analyze the effect of application of free full-thickness skin graft for the whole nail unit repair.
METHODS
Between Apr. 2010 and Mar. 2012, the method of free full-thickness skin graft was done for reconstruction of the completely nail unit defect in seven cases. There were 2 male and 5 female patients; the mean age of these patients at the time of surgery was 51.9 years (range: 7 to 70 years). The preoperative diagnoses included two cases of malignant melanoma, one of chronic infection, one of squamous cell carcinoma, two of subungual pigmentation and one of junctional nevus. There were 2 thumb lesions, 3 middle and 2 index finger lesions. Nail unit defect was in the range of 1.5 cm×2 cm to 2.5 cm × 3.5 cm and full thickness skin graft was harvested from the same medial side of upper arm (3 cases), forearm cubital fossa (1 case) and contralateral side of groin region (3 cases).
RESULTS
All the patients were followed with an average follow-up time being 10 months. All the free skin graft taken was achieved with 100% in all the 7 cases, even in those patients whose partial cortical bone had been curetted. The skin graft was often bluish initially, and superficial blisters were always noticed within 1.5 months postoperatively and the survival skin graft was smooth eventually, and skin graft was adhered to the underlying bone tightly. There was no epidermal inclusion cyst and no residual nail formation. The skin donor sites were without complications. Aesthetic appearance was assessed by the surgeons and found no unacceptable for their patients. And all the patients were satisfied with the cosmetic appearance and active range of motion of their involved fingers, who did not express a desire to undergo any further of nail reconstruction.
CONCLUSION
Free full-thickness skin grafting for reconstruction of the complete nail unit defect is a simple, safe and effective procedure which provides a satisfactory aesthetic appearance and does not make any significant skin donor site morbidity especially for middle-aged and elder patients.
Topics: Adolescent; Adult; Aged; Carcinoma, Squamous Cell; Child; Female; Humans; Male; Middle Aged; Nail Diseases; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation; Young Adult
PubMed: 23247446
DOI: No ID Found -
Modern Pathology : An Official Journal... Oct 2005Atypical lentiginous melanocytic proliferations in elderly patients continue to pose a diagnostic dilemma with lesions variably categorized as dysplastic nevus, atypical...
Atypical lentiginous melanocytic proliferations in elderly patients continue to pose a diagnostic dilemma with lesions variably categorized as dysplastic nevus, atypical junctional nevus, melanoma in situ (early or evolving) and premalignant melanosis. We present pigmented lesions from 16 patients (seven male and nine female) and with the exception of one case, all were older than 50 years of age. The anatomical sites included trunk (7), head and neck (6) and upper extremity (3). The clinical diagnosis was variable and included lentigo maligna, atypical nevus, pigmented basal cell carcinoma, seborrheic keratosis and lentigo. The initial biopsies mimicked lentiginous nevus or dysplastic nevus and were characterized by a lentiginous proliferation of melanocytes at the dermoepidermal junction both as single cells and as small nests with areas of confluent growth, extending to the edges of the biopsy. The retiform epidermis was maintained and pagetoid spread of melanocytes was not prominent in hematoxylin- and eosin- stained sections. Dermal fibrosis was variably present and the melanocytic proliferation demonstrated cytological atypia. The subsequent re-excisions demonstrated similar atypical melanocytic proliferation occurring over a broad area flanking the prior biopsy sites. The diagnosis of melanoma was more easily recognized in the complete excision specimens. Immunohistochemical stains for Mitf and Mart-1 highlighted the extent of the basalar melanocytic proliferation as well as foci of pagetoid spread by melanocytes. Familiarity with this pattern of early melanoma should facilitate proper classification of lentiginous melanocytic proliferations in biopsies from older adults.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Basal Cell; Diagnosis, Differential; Dysplastic Nevus Syndrome; Female; Humans; Hutchinson's Melanotic Freckle; Immunohistochemistry; Lentigo; Male; Melanoma; Middle Aged; Nevus, Pigmented; Skin Neoplasms
PubMed: 15976811
DOI: 10.1038/modpathol.3800454 -
Experimental Dermatology Jul 2022Differential diagnosis of extrafacial flat pigmented lesions with dermoscopic reticular and/or homogeneous pattern is challenging. Dendritic cells upon reflectance...
Differential diagnosis of extrafacial flat pigmented lesions with dermoscopic reticular and/or homogeneous pattern is challenging. Dendritic cells upon reflectance confocal microscopy (RCM) still represent a pitfall. This study aims to determine the role of dendritic cells upon RCM in the epidermis and dermo-epidermal junction (DEJ), together with common RCM features for melanoma and nevi, in dermoscopically equivocal extrafacial flat pigmented lesions. A retrospective evaluation of RCM images of melanocytic extrafacial flat pigmented lesions with reticular and/or homogeneous dermoscopic pattern and with histopathological diagnosis, was performed. A multivariate model of RCM features was used to obtain a score of independent risk factors. A total of 698 lesions were included. Increasing patient age, epidermal dendritic cells, many dendritic cells in the DEJ (>30%) and many (>5/mm ) round atypical cells were independent risk factors for melanoma. Edged papillae and melanophages were indicative of nevus. A score based on these features was developed to assist in melanoma differential diagnosis. The RCM observation of abundant (>30%) dendritic cells in the DEJ is highly suggestive of malignity. This independent risk factor should also be considered for improved differential diagnosis of extrafacial melanoma.
Topics: Dendritic Cells; Dermoscopy; Diagnosis, Differential; Humans; Melanoma; Microscopy, Confocal; Nevus; Retrospective Studies; Skin Neoplasms
PubMed: 35220636
DOI: 10.1111/exd.14553 -
Anais Brasileiros de Dermatologia 2016Blue nevi are benign melanocytic lesions located in the deeper reticular dermis, consequence of failure of melanocytic migration into the dermal-epidermal junction from...
Blue nevi are benign melanocytic lesions located in the deeper reticular dermis, consequence of failure of melanocytic migration into the dermal-epidermal junction from the neural crest. Lesions are usually asymptomatic and solitary, but may present in a multiple or agminated (grouped) pattern. The agminated subtype is formed when bluish-pigmented lesions cluster together in a well-defined area. Lesions can be flat or raised. We report the case of a patient who presented multiple bluish macules (1-3 mm in diameter) grouped on the left upper back. Dermoscopy and anatomic pathological examination were consistent with blue nevus.
Topics: Back; Dermoscopy; Humans; Male; Melanocytes; Middle Aged; Nevus, Blue; Skin Neoplasms
PubMed: 27828645
DOI: 10.1590/abd1806-4841.20164448 -
Diagnostics (Basel, Switzerland) May 2022Multinucleate cell angiohistiocytoma (MCAH) is a rare, benign, vascular or fibrohistiocytic tumor usually presenting as single or multiple, reddish-brown papules mostly...
Multinucleate cell angiohistiocytoma (MCAH) is a rare, benign, vascular or fibrohistiocytic tumor usually presenting as single or multiple, reddish-brown papules mostly affecting the limbs and dorsum of the hands of middle-aged females. Since 1985, relatively few MCAH cases have been reported. In vivo reflectance confocal microscopy (RCM) findings of MCAH have never been described. We report a case of MCAH with new non-invasive imaging findings through RCM in correlation with dermoscopy and histopathology. A 66-year-old woman with an unremarkable family and personal history of an atypical nevus presented with a lesion on her right breast. It had appeared 12 months earlier and progressively enlarged. Physical examination revealed a 20 × 11.6 mm, non-tender, reddish-brown maculo-papular lesion with blurred margins. Dermoscopy showed diffusely arranged reddish areas, coalescing whitish patches, truncated and dotted vessels, and a peripheral brown reticulated pattern. RCM revealed a poorly outlined lesion with a normal honeycomb pattern, numerous vessels at the dermal-epidermal junction, and isolated, large, mildly reflective, bizarre structures with angulated edges. These findings correlated well with histological features, which established the diagnosis of MCAH. Even though histopathology remains the gold standard in the diagnosis of MCAH, non-invasive tools such as RCM can help rule out other entities, therefore reducing surgery-associated morbidity.
PubMed: 35626431
DOI: 10.3390/diagnostics12051276 -
Acta Dermato-venereologica Nov 2021BRAF/V600E mutation and other cell growth/growth-control mechanisms are involved in naevogenesis and melanomagenesis. Immunoexpression of BRAF/V600E and other molecules...
Differential Immunoexpression of BRAF/V600E, Senescence Markers, PTEN, and T-type Calcium Channels in Acquired Naevi According to their Histopathological and Dermoscopic Classification.
BRAF/V600E mutation and other cell growth/growth-control mechanisms are involved in naevogenesis and melanomagenesis. Immunoexpression of BRAF/V600E and other molecules (p16, phosphatase and tensin homologue (PTEN), Ki67, hTERT and Cav3.1 and 3.2 calcium channels) were investigated in 80 histopatho-logically and dermoscopically classified acquired naevi. Regarding BRAF/V600E, dysplastic naevi showed lower immunostaining than common naevi, which was significant in comparison with intradermal naevi, which showed the highest BRAF/V600E histoscore. Junctional naevi showed the lowest BRAF/V600E levels. Globular/cobblestone and reticular dermoscopic patterns were consistently associated with high and low BRAF/V600E immunoexpression, respectively, but Zalaudek's peripheral globule pattern (CR/PG) showed the highest BRAF/V600E immunoexpression. Among global patterns, the previously not investigated multicomponent pattern showed the lowest BRAF/V600E immunoexpression. Regarding the remaining biomarkers, new immunohistochemical features were found, in particular p16 and PTEN low expression in multicomponent pattern; and Ki67, hTERT and Cav.3.1 high expression in CR/PG. In conclusion, histopathology and dermoscopy provide complementary information regarding the biology of melanocytic naevi.
Topics: Biomarkers; Calcium Channels, T-Type; Dermoscopy; Humans; Nevus, Pigmented; PTEN Phosphohydrolase; Proto-Oncogene Proteins B-raf; Skin Neoplasms
PubMed: 34643739
DOI: 10.2340/actadv.v101.361