DOCSLIB.ORG

Laser Therapy of Pigmented Lesions: Pro and Contra

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Laser Therapy of Pigmented Lesions: Pro and Contra Acta Dermatovenerol Croat 2010;18(3):185-189 REVIEW Laser Therapy of Pigmented Lesions: Pro and Contra Zrinka Bukvić Mokos, Jasna Lipozenčić, Romana Čeović, Daška Štulhofer Buzina, Krešimir Kostović University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, Zagreb, Croatia Corresponding author: SUMMARY Although frequently performed, laser removal of Assist. Prof. Zrinka Bukvić Mokos, MD, PhD pigmented lesions still contains certain controversial issues. Epidermal pigmented lesions include solar lentigines, ephelides, University Hospital Center Zagreb café au lait macules and seborrheic keratoses. Dermal lesions Department of Dermatology and Venereology include melanocytic nevi, blue nevi, drug induced hyperpigmentation School of Medicine University of Zagreb and nevus of Ota and Ito. Some lesions exhibit both an epidermal and dermal component like Becker’s nevus, postinflammatory Šalata 4 hyperpigmentations, melasma and nevus spilus. Due to the wide HR-10000 Zagreb absorption spectrum of melanin (500-1100 nm), several laser systems Croatia are effective in removal of pigmented lesions. These lasers include [email protected] the pigmented lesion pulsed dye laser (510 nm), the Q-switched ruby laser (694 nm), the Q-switched alexandrite laser (755 nm) and the Q-switched Nd:YAG laser (1064 nm), which can be frequency- Received: July 7, 2010 doubled to produce visible green light with a wavelength of 532 Accepted: July 30, 2010 nm. The results of laser therapy are usually successful. However, there are still many controversies regarding the use of lasers in treating certain pigmented lesions. Actually, the essential question in removing pigmented lesions with lasers is whether the lesion has atypical features or has a malignant potential. Dermoscopy, used as a routine first-level diagnostic technique, is helpful in most cases. If there is any doubt whether the lesion is benign, then a biopsy for histologic evaluation is obligatory. KEY WORDS: laser, pigmented lesions, nevi INTRODUCTION In recent years, lasers have been frequently dermal and mixed (epidermal/dermal) pigmented successfully used in treating various pigmented lesions. Epidermal pigmented lesions include so- lesions. The results are usually successful. How- lar lentigines, ephelides, café au lait macules and ever, there are still many controversies regarding seborrheic keratoses. Dermal lesions include me- laser therapy of certain pigmented lesions. lanocytic nevi, blue nevi, drug induced hyperpig- In general, pigmented lesions are categorized mentation and nevus of Ota and Ito. Some lesions by location of pigment in three groups: epidermal, exhibit both an epidermal and dermal component: 185 Bukvić Mokos et al. Acta Dermatovenerol Croat Laser Therapy of Pigmented Lesions: Pro and Contra 2010;18(3):185-189 Becker’s nevus, postinflammatory hyperpigmen- due to absorption of laser energy by oxyhemo- tations, melasma and nevus spilus (1). globin. A fine crust typically forms over the laser Melanin is the main natural cutaneous pigment treated area and peels off after one week (6,7). to be considered when dealing with pigmented le- sions. It is contained in melanosomes within the QS ruby laser (QSRL) epidermis and dermoepidermal junction (melanin The Q-switched ruby laser emits visible red light horizontal distribution). Also, it is highly concen- at a wavelength of 694 nm and pulse duration of trated in hair follicles and vertical growth compo- 25-40 nanoseconds. This wavelength is strongly nents of nevomelanocytic nevi (2). absorbed by superficial melanin, which can lead to To obtain selective photothermolysis of mela- permanent hypopigmentation and depigmentation nin, pigmented lesions must be treated with laser in darker-skinned individuals. The absorption of light having a wavelength appropriate to absorp- ruby laser energy by hemoglobin is minimal. After tion characteristics of melanin. Due to the wide ab- treatment, the crust is formed at the site of laser sorption spectrum of melanin (500-1100 nm), sev- irradiation and peels off after several days (8,9). eral laser systems are effective in the removal of pigmented lesions: pigmented lesion pulsed dye QS alexandrite laser laser (510 nm), Q-switched ruby laser (694 nm), This laser operates at a wavelength of 755 nm Q-switched alexandrite laser (755 nm) and Q- and a pulse duration of 50-100 nanoseconds. Its switched Nd:YAG laser (1064 nm), which can be longer wavelength permits deeper tissue penetra- frequency-doubled to produce visible green light tion and less unwanted hypopigmentation com- with a wavelength of 532 nm. Lasers which emit pared with QSRL. Postoperative healing is similar green light with shorter wavelengths penetrate op- to other QS pigment-specific lasers, but is consid- tically very little into skin layers and require rela- ered less severe (10). tively less energy to produce irreversible thermal damage to melanosomes; therefore, they should QS Nd:YAG laser be selected to treat epidermal lesions. Lasers that emit red light with longer wavelengths are more It emits 1064 nm light, but it can also be fre- successful in treating deeper dermal melano- quency-doubled using a potassium diphosphate somes, i.e. dermal lesions (3). crystal to produce visible green light with a wave- length of 532 nm (a pulse duration of 5-10 nano- Selective pigment destruction depends not only seconds). Melanin has a strong affinity for 532 on wavelength but also on pulse duration. Submi- nm green light, whereas the longer 1064 nm red crosecond laser pulses are required for selective wavelength penetrates deeper in the dermis but disruption of melanosomes because their thermal with a lower melanin absorption coefficient. After relaxation time ranges from 250 to 1000 nanosec- the use of smaller spot sizes, tissue splatter usu- onds, depending on their size. Therefore, short- ally occurs, leading to crusting that may take sev- pulsed lasers with pulse durations from 40 to 750 eral weeks to fully resolve (11,12). nanoseconds are used, whereas longer pulse du- rations, in millisecond domain, do not cause spe- EPIDERMAL PIGMENTED LESIONS cific melanosome damage. At these pulsewidths, laser-tissue interaction produces a combination of Epidermal pigmented lesions can be effectively photothermal and photomechanical effects (4). In treated with both shorter wavelengths (green light addition, shorter wavelengths (<600 nm) require lasers) and longer wavelengths (red light lasers). relatively less energy fluences, while at longer Ephelides are very difficult to treat because wavelengths higher fluences are required to pro- they recur frequently after laser therapy. Before duce an efficient photothermal reaction (5). treatment, bleaching agents like hydroquinone may be used (1,13). Pigmented lesion dye laser Among all pigmented lesions, lentigines show The pigmented lesion dye laser emits light of probably the best response to laser therapy. They a 510 nm wavelength and a pulse duration of 300 typically fade by 50% or more after one treatment nanoseconds, which enables targeting superficial session. Complete eradication is usually observed melanosomes. This laser is effective in the treat- after three treatments in 6- to 8-week intervals ment of lentigines and other epidermal pigmented (14,15). lesions. Up to 50% of patients develop purpura Café au lait macules respond variably to laser 186 ACTA DERMATOVENEROLOGICA CROATICA Bukvić Mokos et al. Acta Dermatovenerol Croat Laser Therapy of Pigmented Lesions: Pro and Contra 2010;18(3):185-189 therapy and recur in as many as 50% of patients. types of melanocytic nevi require longer wave- Repeated treatments over a long period (several lengths, higher fluences and longer pulsewidths, months or even years) are needed to achieve max- and still tend to recur (1,13,20,21). In some treat- imal clearing of the lesion. Repigmentation occurs ed nevi, irregular repigmentation is observed af- from adjacent untreated melanocytes; therefore, ter laser treatment, termed pseudomelanoma. In the entire lesion should be treated at each session these cases, excisional biopsy must always be (1,13). performed, followed by dermopathology. For the above-mentioned reasons, surgical excision must MIXED EPIDERMAL/DERMAL be considered as the treatment of choice in these PIGMENTED LESIONS indications, while one must keep in mind the pos- sible risks when treating melanocytic nevi with la- Laser removal of Becker’s nevus is difficult. sers (22,23). Again, there is a variable response and a high rate of recurrences. Long pulsed lasers may prove Congenital nevi may pose a risk of melanoma most effective in treating both epidermal and fol- that increases with the size of lesion. Therefore, licular melanocytes (13,16). surgical excision is primary treatment of choice, while laser treatment should always be remem- Postinflammatory hyperpigmentations are bered as a secondary option performed in an at- often resistant to laser treatment. Multiple sessions tempt to either reduce the pigment or to remove are required to assess a slight improvement. associated hair growth. Laser treatment is asso- Melasma is often a therapeutic problem. Pig- ciated with several problems: variable response, ment can be located in epidermis, or in dermis, or permanent hypopigmentation, local scarring and in both of them. Similar to other traditional meth- rarely achieved complete clinical response. Ad- ods (sunscreen, retinoic acid, hydroquinone and ditionally, incomplete nevus
Load more

Recommended publications
  • Nevus Spilus: Is the Presence of Hair Associated with an Increased Risk for Melanoma?
    Nevus Spilus: Is the Presence of Hair Associated With an Increased Risk for Melanoma? Robert Milton Gathings, MD; Raveena Reddy, MD; Ashish C. Bhatia, MD; Robert T. Brodell, MD PRACTICE POINTS • Nevus spilus (NS) appears as a café au lait macule studded with darker brown “moles.” • Although melanoma has been described in NS, it is rare. • There is no evidence that hairy NS are predisposed to melanoma. copy not Nevus spilus (NS), also known as speckled len- he term nevus spilus (NS), also known as tiginous nevus, is characterized by background speckled lentiginous nevus, was first used café au lait–like lentiginous melanocytic hyperpla- Tin the 19th century to describe lesions with sia speckled with small, 1- to 3-mm, darker foci.Do background café au lait–like lentiginous melanocytic Nevus spilus occurs in 1.3% to 2.3% of the adult hyperplasia speckled with small, 1- to 3-mm, darker population worldwide. Reports of melanoma aris- foci. The dark spots reflect lentigines; junctional, ing within hypertrichotic NS suggest that hyper- compound, and intradermal nevus cell nests; and trichosis may be a marker for the development of more rarely Spitz and blue nevi. Both macular and melanoma. We present a case of a hypertrichotic papular subtypes have been described.1 This birth- NS without melanoma and also provide a review of mark is quite common, occurring in 1.3% to 2.3% previously reported cases of hypertrichosis in NS. of the adult population worldwide.2 Hypertrichosis We believe that NS has aCUTIS lower risk for malignant has been described in NS.3-9 Two subsequent cases degeneration than congenital melanocytic nevi of malignant melanoma in hairy NS suggested that (CMN) of the same size, and it is unlikely that lesions may be particularly prone to malignant hypertrichosis is a marker for melanoma in NS.
    [Show full text]
  • Acquired Bilateral Nevus of Ota–Like Macules (Hori's Nevus): a Case
    Acquired Bilateral Nevus of Ota–like Macules (Hori’s Nevus): A Case Report and Treatment Update Jamie Hale, DO,* David Dorton, DO,** Kaisa van der Kooi, MD*** *Dermatology Resident, 2nd year, Largo Medical Center/NSUCOM, Largo, FL **Dermatologist, Teaching Faculty, Largo Medical Center/NSUCOM, Largo, FL ***Dermatopathologist, Teaching Faculty, Largo Medical Center/NSUCOM, Largo, FL Abstract This is a case of a 71-year-old African American female who presented with bilateral periorbital hyperpigmentation. After failing treatment with a topical retinoid and hydroquinone, a biopsy was performed and was consistent with acquired bilateral nevus of Ota-like macules, or Hori’s nevus. A review of histopathology, etiology, and treatment is discussed below. cream and tretinoin 0.05% gel. At this visit, a Introduction Figure 2 Acquired nevus of Ota-like macules (ABNOM), punch biopsy of her left zygoma was performed. or Hori’s nevus, clinically presents as bilateral, Histopathology reported sparse proliferation blue-gray to gray-brown macules of the zygomatic of irregularly shaped, haphazardly arranged melanocytes extending from the superficial area. It less often presents on the forehead, upper reticular dermis to mid-deep reticular dermis outer eyelids, and nose.1 It is most common in women of Asian descent and has been reported Figure 4 in ages 20 to 70. Classically, the eye and oral mucosa are uninvolved. This condition is commonly misdiagnosed as melasma.1 The etiology of this condition is not fully understood, and therefore no standardized treatment has been Figure 3 established. Case Report A 71-year-old African American female initially presented with a two week history of a pruritic, flaky rash with discoloration of her face.
    [Show full text]
  • Optimal Management of Common Acquired Melanocytic Nevi (Moles): Current Perspectives
    Clinical, Cosmetic and Investigational Dermatology Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW Optimal management of common acquired melanocytic nevi (moles): current perspectives Kabir Sardana Abstract: Although common acquired melanocytic nevi are largely benign, they are probably Payal Chakravarty one of the most common indications for cosmetic surgery encountered by dermatologists. With Khushbu Goel recent advances, noninvasive tools can largely determine the potential for malignancy, although they cannot supplant histology. Although surgical shave excision with its myriad modifications Department of Dermatology and STD, Maulana Azad Medical College and has been in vogue for decades, the lack of an adequate histological sample, the largely blind Lok Nayak Hospital, New Delhi, Delhi, nature of the procedure, and the possibility of recurrence are persisting issues. Pigment-specific India lasers were initially used in the Q-switched mode, which was based on the thermal relaxation time of the melanocyte (size 7 µm; 1 µsec), which is not the primary target in melanocytic nevus. The cluster of nevus cells (100 µm) probably lends itself to treatment with a millisecond laser rather than a nanosecond laser. Thus, normal mode pigment-specific lasers and pulsed ablative lasers (CO2/erbium [Er]:yttrium aluminum garnet [YAG]) are more suited to treat acquired melanocytic nevi. The complexities of treating this disorder can be overcome by following a structured approach by using lasers that achieve the appropriate depth to treat the three subtypes of nevi: junctional, compound, and dermal. Thus, junctional nevi respond to Q-switched/normal mode pigment lasers, where for the compound and dermal nevi, pulsed ablative laser (CO2/ Er:YAG) may be needed.
    [Show full text]
  • A Nevus of OTA with Intraoral Involvement: a Rare Case Report
    Shivare P. et al.: Nevus of OTA- a rare entity CASE REPORT A Nevus of OTA with Intraoral Involvement: A Rare Case Report Peeyush Shivhare1, Lata S.2, Monu Yadav3, Naqoosh Haidry4, Shruthi T. Patil5 1,5- Senior lecturer department of oral medicine and radiology, Narsinhbhai patel dental college and hospital, Visnagar, Gujarat. 2- Professor and head of the department, Rungta Correspondence to: College Of Dental Sciences And Research, Bhilai, Chhattisgarh. 3- PG student. Dr. Peeyush Shivhare Senior lecturer department of Department Of Oral Medicine And Radiology, Carrier Dental College And Hospital. oral medicine and radiology, Narsinhbhai patel dental Lucknow. 4- Senior lecturer department of maxillofacial surgery, Narsinhbhai patel college and hospital, Visnagar, Gujarat. dental college and hospital, Visnagar, Gujarat. Contact Us: www.ijohmr.com ABSTRACT Nevus of Ota, which originally was described by Ota and Tanino in 1939. It is characterized as congenital or acquired hamartoma of dermal melanocytes, presents clinically as a blue or gray patch on the face within the distribution of the ophthalmic and maxillary branches of the fifth cranial (trigeminal) nerve. Involvement of the palatal mucosa occurs rarely in nevus of Ota, when it occurs, it usually blends with the oral mucosa and is typically irregular, ill defined and often present as a mottled patch. Nevus of Ota is rare in the Indian subcontinent. So far very less cases of nevus of ota with intraoral involvement have been documented in the English literature. We report a rare case of intraoral nevus of Ota in a 20 year-old female patient. KEYWORDS: Nevus of Ota, Melanoma, Hamartoma, Glaucoma AA aaaasasasss INTRODUCTION The nevus of Ota (nevus fuscoceruleus ophthal- momaxillaris” or oculodermal melanocytosis) is a macular discoloration of the face, found most commonly in the Japanese people.1 Nevus of ota develops when the melanocyte get entrapped in the upper third of the dermis.
    [Show full text]
  • Nevus of Ota in Children
    PEDIATRIC DERMATOLOGY Series Editor: Camila K. Janniger, MD Nevus of Ota in Children Smeeta Sinha, MD; Philip J. Cohen, MD; Robert A. Schwartz, MD, MPH Nevus of Ota, synonymously termed oculodermal seen most commonly in individuals of Japanese melanosis, is an uncommon dermal melanosis descent, and is less likely to present in individuals most commonly seen at birth in children of of Chinese or Korean descent, though individuals Japanese descent, though it can affect individu- descending from the Indian subcontinent, Africa, als of any age or ethnicity. The disease tends to and Europe also may be affected.7 In early sur- persist and extend locally, becoming increasingly veys of Japanese patients at dermatology clinics, prominent with age, puberty, and postmenopausal the incidence of nevus of Ota was determined to state. Treatment should begin early after diagno- be 0.4% (110/27,500).4 Cowan and Balistocky8 sis using multiple sessions of laser photother- calculated the incidence of oculodermal melano- molysis to avoid darkening and extension of the cytosis in black patients to be 0.016%. A study of lesion. Important associated disorders include 2914 Chinese children in Calgary, Alberta, Canada, ipsilateral glaucoma; intracranial melanocyto- reported an incidence of oculodermal melanocytosis sis; and rarely cutaneous, ocular, or intracranial of 0.034% (1/2914).9 melanoma. Recommendations are discussed for managing nevus of Ota in children. Clinical Manifestation Cutis. 2008;82:25-29. The typical nevus of Ota is a unilateral facial dis- coloration that is macular, speckled, and bluish gray or brown, with edges that blend with bordering skin evus of Ota is a rare disorder characterized (Figure).10 The dermatomal distribution of pigment by melanocytic pigmentation of the sclera characterizes this diagnosis in most cases.
    [Show full text]
  • Nevus of Ota – an Intraoral Presentation: a Case Report Jennifer Maguire1* and Deborah Holt2
    Maguire and Holt Journal of Medical Case Reports (2019) 13:174 https://doi.org/10.1186/s13256-019-2101-0 CASEREPORT Open Access Nevus of Ota – an intraoral presentation: a case report Jennifer Maguire1* and Deborah Holt2 Abstract Background: Nevus of Ota or “oculodermal melanocytosis” is a rare congenital hamartoma of dermal melanocytes causing a blue-gray hyperpigmentation of the eye and surrounding structures. The condition, originally described by Ota and Tanino in 1939, mainly affects the ophthalmic and maxillary divisions of the trigeminal nerve. We describe the first reported case of unilateral oculodermal melanocytosis in a Caucasian woman with oral buccal mucosal involvement. Oral involvement of nevus of Ota is very rare. Case presentation: A 48-year-old Caucasian woman was referred by the dermatology division to the oral medicine department at the University of Liverpool School of Dentistry with new-onset oral pigmentation to the left buccal mucosa. The patient had a previous diagnosis of oculodermal nevus. Conclusion: An incisional biopsy of the left buccal mucosa was completed. The report stated that histological and immunohistochemical features were in keeping with a blue nevus, but within the context of the preexisting occulodermal pigmentation, a diagnosis of oculodermal melanocytosis, also known as “nevus of Ota,” was made. The patient will be kept under review in the oral medicine department because the progression of the lesion on the left buccal mucosa requires active monitoring owing to the potential for malignant change. The patient also requires regular review in the dermatology and ophthalmology divisions. Keywords: Oral, Pigmentation, Nevus, Ota, Oculodermal, Buccal, Mucosa Background the left buccal mucosa.
    [Show full text]
  • Nevus of Ota: Clinical-Ophthalmological Findings Nevo De Ota: Achados Clínicos E Oftalmológicos
    278 ARTIGO ORIGINAL Nevus of Ota: clinical-ophthalmological findings Nevo de Ota: achados clínicos e oftalmológicos Sebastião Cronemberger1, Nassim Calixto1, Henrique Leite Freitas2 ABSTRACT Objective: To analyze the clinical and ophthalmological findings of patients with nevus of Ota. Methods: Retrospective analysis of patients’ charts with nevus of Ota. We registered the demographic data, location of the nevus and date of appearance, family history of similar spots, biomicroscopic, gonioscopic, tonometric, ophthalmoscopic and perimetric findings. Results: We included 14 patients, six (43.0%) men and eight (57.0%) women, with a mean age of 21.7±17.5 years. Ten (71%) were mulatto, three (21.4%) white and one (7.1%) black. Twelve (85.7%) patients presented the spots at birth and two in puberty. Nine patients presented conjunctival and episcleral pigmentation in the right eye and five in the left eye. According to Tanino’s classification, five (35.7%) nevi were class 1, eight (57.1%) class 2 and one (7.1%) class 3. Heterochromia iridis was found in eight (57.1%) patients. Anisocoria was present in three (21.4%) patients. Five (35.7%) patients presented a suspected glaucomatous cup disc ratio (≥0.7); six (42.9%) presented a cup disc ratio ≤ 0.5 and three (21.4%), no cup disc. We found two curious and remarkable findings: a nevus of Ota on the palate of one patient and other on the optic disc associated with a pigmentary mottling of the fundus in another patient. The pigmentary mottling of the fundus was also seen in four more eyes. Conclusions: The nevus of Ota was frequently present at birth, in mulattos, and classified as Tanino’s class 1 and 2.
    [Show full text]
  • A Deep Learning System for Differential Diagnosis of Skin Diseases
    A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu ,​ Ayush Jain ,​ Clara Eng ,​ David H. Way ,​ Kang Lee ,​ Peggy Bui ,​ Kimberly Kanada ,​ ​ ​ ‡ ​ 1​ ​ 1 ​ 1 ​ Guilherme de Oliveira Marinho ,​ Jessica Gallegos ,​ Sara Gabriele ,​ Vishakha Gupta ,​ Nalini 1,3,§ 1 ​ ​ 4 ​ 1 ​ ​ 1 Singh ,​ Vivek Natarajan ,​ Rainer Hofmann-Wellenhof ,​ Greg S. Corrado ,​ Lily H. Peng ,​ Dale ​ ​ 1 1 ​ † 1, ​ 1, ​ 1, ​ R. Webster ,​ Dennis Ai ,​ Susan Huang ,​ Yun Liu *​ , R. Carter Dunn *​ *, David Coz *​ * ​ ​ ​ ​ ​ ​ Affiliations: 1 G​ oogle Health, Palo Alto, CA, USA 2 U​ niversity of California, San Francisco, CA, USA 3 M​ assachusetts Institute of Technology, Cambridge, MA, USA 4 M​ edical University of Graz, Graz, Austria † W​ ork done at Google Health via Advanced Clinical. ‡ W​ ork done at Google Health via Adecco Staffing. § W​ ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and ​ ​ ​ ​ ​ ​ ​ under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories).
    [Show full text]
  • Acquired Blue Nevus of the Nail Bed
    Volume 23 Number 2 | February 2017 Dermatology Online Journal || Case Report DOJ 23 (2): 3 Acquired blue nevus of the nail bed Daniel M. Klufas BS, Syril Keena T. Que MD, Adrienne Berke MD, Brett Sloan MD Affiliations: Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA Corresponding Author: Steven Brett Sloan, MD, Associate Professor of Dermatology, VA Site Director, University of Connecticut Health Center, Department of Dermatology, 21 South Road, Suite 200, Farmington, CT 06030-6231, Tel: 860-679-4600, Email: Steven.Sloan@ va.gov Abstract been reports of malignant degeneration particularly of the cellular variant [1,2,6]. Nonetheless, careful Blue nevi are benign proliferations of melanin- examination and evaluation should be performed producing dendritic melanocytes located in the in order to differentiate between a blue nevus and dermis. These nevi tend to occur mostly on the skin, a subungual malignant melanoma, which carries predominantly on the head and neck, dorsal aspects a poor prognosis. We report here on a 47-year-old of the distal extremities, and the sacral area, but Japanese man with an acquired blue nevus in the can also occasionally appear on mucosal surfaces. nail bed of his right first toe and discuss clinical and Blue nevi of the nail apparatus are uncommon. The pathologic characteristics of this rare finding. majority originate in the nail matrix where there is a higher density of melanocytes. Herein we report on Case Synopsis a 47-year-old man with a rare common blue nevus of A 47-year-old Japanese man with a family history of the nail bed, an area with low melanocyte density.
    [Show full text]
  • Nevus Spilus
    PEDIATRIC DERMATOLOGY Series Editor: Camila K. Janniger, MD Nevus Spilus Darshan C. Vaidya, MD; Robert A. Schwartz, MD, MPH; Camila K. Janniger, MD Nevus spilus (NS), also known as speckled frequently arises in childhood as an evenly pig- lentiginous nevus (SLN), is a relatively com- mented, brown to black patch that is indistinguish- mon cutaneous lesion that is characterized by able from a junctional melanocytic nevus. Special multiple pigmented macules or papules within types of lentigo simplex are lentiginosis profusa (or a pigmented patch. It may be congenital or LEOPARD syndrome)3,4 and NS. NS is both a len- acquired; however, its etiology remains unknown. tigo and a melanocytic nevus. NS deserves its own place in the spectrum of classification of important melanocytic nevi; as a Clinical Description lentigo and melanocytic nevus, it has the slight NS is a pigmented patch on which multiple darker potential to develop into melanoma. Accordingly, macules or papules appear at a later stage (Figure). we recommend consideration of punch excisions The term spilus is derived from the Greek word spilos of the speckles alone if excision of the entire NS (spot). Three types of NS exist: small or medium is declined. sized (,20 cm), giant, and zosteriform. The lesions Cutis. 2007;80:465-468. may be congenital or acquired, appearing as subtle tan macules at birth or in early childhood and pro- gressing to the more noticeable pigmented black, evus spilus (NS), also known as speckled brown, or red-brown macules and papules over lentiginous nevus (SLN), is a relatively com- months or years.5 NS may occur anywhere on the N mon cutaneous lesion that is characterized by body but is most commonly identified on the torso multiple pigmented macules or papules within a pig- and extremities.
    [Show full text]
  • Rare Case Report on Nevus of Ota
    Rare Case Report on Nevus of Ota Rakhi Chandak1, Shirish Degwekar1, Manoj Chandak2, Rahul Bhowte1, Shivlal Rawlani1, 1Department of Oral Medicine & Radiology 2Department of Conservative Dentistry, Sharad Pawar Dental College, DMIMS, Sawangi (M), Wardha, Maharashtra, India Corresponding Author Dr. Shivlal Rawlani, M.D.S (Oral Medicine and Radiology) Senior Lecturer, Dept. Of Oral Medicine & Radiology, Sharad Pawar Dental College, DMIMS, Sawangi (M), Wardha, Maharashtra, India. Email : [email protected] Received for publication Jan 22, 2010; Accepted for publication Mar 16, 2010 Abstract Nevus of Ota is a hamartoma of dermal melanocytes. Clinically, Nevus of Ota is manifested as blue or gray patch on the face; such condition is congenital or acquired and is within the distribution of branches of the trigeminal nerve. The nevus can be unilateral or bilateral. In addition to skin, it may involve ocular and oral mucosal surfaces. The case of an 18-year old female with unilateral bluish black macule on the right side of the face since birth is presented. She also had a bluish patch on the right shoulder at birth, which disappeared when she turned 10 years. The pathogenesis of Nevus is unknown, and effective treatment has been realized with pigment-specific lasers. Keywords Nevus of Ota, hamartoma, dermal melanocytes, bluish patch J Kor Dent Sci. 2010; 3(1) : - Introduction patch on the face; such condition is congenital or acquired and is within the distribution of the Originally described by Ota and Tanino in 1939, ophthalmic and maxillary branches of the trigeminal Nevus of Ota is a hamartoma of dermal melanocytes1). nerve2). Clinically, Nevus of Ota is manifested as blue or gray The nevus can be unilateral or bilateral.
    [Show full text]
  • Dermoscopy of Pigmented Skin Lesions (Part
    Dermoscopy of Pigmented Skin Lesions* (Part II) H. Peter Soyer,a MD; Giuseppe Argenziano,b MD; Sergio Chimenti, c MD; Vincenzo Ruocco,b MD aDepartment of Dermatology, University of Graz, Graz, Austria bDepartment of Dermatology, Second University of Naples, Naples, Italy cDepartment of Dermatology, University Tor Vergata of Rome, Rome, Italy * This CME article is partly reprinted from the Book and CD-Rom ’Interactive Atlas of Dermoscopy’ with permission from EDRA (Medical Publishing & New Media) -- see also www.dermoscopy.org Corresponding author: H. Peter Soyer, MD Department of Dermatology, University of Graz Auenbruggerplatz 8 - A-8036 Graz, Austria Phone: 0043-316-385-3235 Fax: 0043-0316-385-4957 E-mail: [email protected] Key words: dermoscopy, dermatoscopy, epiluminescence microscopy, incident light microscopy, skin surface microscopy, melanoma, pigmented skin lesions, clinical diagnosis 1 Dermoscopy is a non-invasive technique combining digital photography and light microscopy for in vivo observation and diagnosis of pigmented skin lesions. For dermoscopic analysis, pigmented skin lesions are covered with liquid (mineral oil, alcohol, or water) and examined under magnification ranging from 6x to 100x, in some cases using a dermatoscope connected to a digital imaging system. The improved visualization of surface and subsurface structures obtained with this technique allows the recognition of morphologic structures within the lesions that would not be detected otherwise. These morphological structures can be classified on
    [Show full text]