DOCSLIB.ORG

Recurrent Pigmented Macules After Q-Switched Alexandrite Laser Treatment of Congenital Melanocytic Nevus

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Recurrent Pigmented Macules After Q-Switched Alexandrite Laser Treatment of Congenital Melanocytic Nevus Recurrent Pigmented Macules after Q-Switched Alexandrite Laser Treatment of Congenital Melanocytic Nevus n SEONGHYANG SOHN,PHD, SANGEUN KIM,MD,AND WON HYOUNG KANG,MD,PHD Department of Dermatology and nLaboratory of Cell Biology, Institute for Medical Sciences, Ajou University School of Medicine, Suwon, Korea BACKGROUND. Q-switch-mode laser treatment of congenital TNF-alpha were determined histochemically in the original nevi nevi does not result in complete histological clearance, and many and RPM. In addition, one RPM was examined by electron patients have partial repigmentation within several months. In microscopy. addition, the number of recurrent pigmented macules (RPMs) RESULTS. Reduced pigmentation in the treated areas was seen in may increase, a major drawback to good cosmetic results. While all cases, but partial repigmentaion was seen as black spots the mechanism of recurrence is not known. within 6 months after the last QSAL treatment. Compared to OBJECTIVE. To help elucidate the mechanism of RPM develop- the original nevi, the RPMs had increased numbers of ment, we evaluated the expression of TNF-alpha and E- melanocytes in the epidermis and reduced nevomelanocytic cadherin on RPM after treatment of congenital nevi with a nests in the dermis. The expression of TNF-alpha and E- Q-switched alexandrite laser (QSAL). cadherin was downregulated in the RPMs compared to the METHODS. Thirteen Korean subjects with congenital nevi original nevi. Electron microscopy confirmed the increase in received QSAL treatment at intervals ranging from 2 to 6 melanocytes in the epidermis of RPMs. months (mean, 4.5 treatments). Two-millimeter punch biopsy CONCLUSION. Our findings suggest that the down-regulation of specimens were obtained at their first visit and from RPMs 3–6 E-cadherin and TNF-alpha may induce the proliferation of months after the last treatment. Expression of E-cadherin and melanocytes, resulting in the formation of RPMs. SEONGHYANG SOHN, PHD, SANGEUN KIM, MD, AND WON HYOUNG KANG, MD, PHD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. CONGENITAL MELANOCYTIC nevi are present in these lasers have been utilized to treat congenital 1% to 2% of newborn infants. Although these nevi are melanocytic nevi.2–7 Following Q-switched-mode laser histologically compound or intradermal, they may treatment, however, congenital melanocytic nevi do differ from acquired nevi by one or more features.1 For not show complete histologic clearance, and many example, nevus cells of congenital melanocytic nevi are patients have partial repigmentation within several present around and within hair follicles, in sweat ducts months after discontinuation of therapy. In addition, and glands, in sebaceous glands, in vessel walls, and in the number of recurrent pigmented macules has been the perineum of nerves, and they extend between found to increase in some patients. collagen bundles in single or double rows, as well as Although treatment of congenital nevi with the Q- into the deepest reticular dermis or the subcutis. In switched ruby laser has been found to result in contrast, nevus cells of acquired nevi do not show any histologic changes, these studies did not evaluate the of these features. recurrence of lesions.3,8 This is especially important In treating congenital melanocytic nevi, the primary because the mechanism of recurrence is not completely difficulty has been to obtain cosmetically good results known. Significantly exaggerated junctional activity without scarring or recurrence. Because treatment of has been demonstrated in recurrent nevi, suggesting benign pigmented lesions with Q-switched mode lasers that the latter arise from melanocytes located at the has been shown to result in a low incidence of scarring, dermoepidermal interface, possibly from sweat ducts, hair follicles, or peripheral epidermis.9 Recurrence of Address correspondence and reprint requests to: Won Hyoung Kang, nevi may be related to the interaction between MD, PhD, Department of Dermatology, Ajou University School of keratinocytes and melanocytes. The adhesion protein Medicine, 5 Wonchon-dong, Paldal-Ku, Suwon, Korea, 442-721, or E-cadherin, which is expressed on normal human 10 e-mail: [email protected]. epidermis, has been shown to have regulatory r 2004 by the American Society for Dermatologic Surgery, Inc. Published by Blackwell Publishing, Inc. ISSN: 1076-0512/04/$15.00/0 Dermatol Surg 2004;30:898–907 Dermatol Surg 30:6:June 2004 SOHN ET AL.: CONGENITAL NEVI TREATMENT WITH AN ALEXANDRITE LASER 899 functions in epidermal morphogenesis and in the Each process (i.e., sectioning, staining, and digital organization of normal skin structure.11 E-cadherin image taking) was performed simultaneously on the is also expressed in human melanocytes and acts as the biopsy specimens obtained from all patients before and prime mediator of melanocyte adhesion to keratino- after treatment. The stained area was measured under cytes in vitro.12 In addition, keratinocytes synthesize constant magnification (Â 200). tumor necrosis factor-a, a paracrine inhibitor of Statistical analysis was performed using Microsoft human melanocyte proliferation and melanogenesis.13 Excel software. Data on the original nevus and To determine the relationship between the expression recurrent pigmented macule were evaluated using of tumor necrosis factor-a and E-cadherin and the Student’s paired t test. Statistical significance was development of recurrent pigmented macule, we defined as a p value less than 0.05. treated 13 Korean patients with congenital melanocy- tic nevi with the Q-switched alexandrite laser and assayed protein expression immunohistochemically. Results Of the 13 patients examined, 3 were men and 10 were women. Their ages ranged from 3 to 46 years (mean, Materials and Methods 11.3 years; median, 8 years). Ten of the nevi were located on the face, with 1 each on the trunk, leg, and A total of 13 Korean subjects with congenital nevi ear lobe. The interval between the biopsy of recurrent were enrolled in the study. All subjects had Fitzpatrick pigmented macule and the last Q-switched alexandrite skin type III. All nevi were treated by Q-switched laser treatment ranged from 3 to 6 months (mean, 3.9 alexandrite laser (tatoo laser, model TL-1, Candela months; median, 3 months). The congenital melano- Corp., Wayland, MA) at a fluence of 8.0 J/cm2 and a cytic nevi were classified histologically (Table 2) as spot size of 3 mm, using a pulse duration of 100 nsec compound melanocytic nevi and intradermal nevi. and a wavelength of 755 nm. The interval between We observed reduced pigmentation in the treated treatments ranged from 2 to 6 months. The mean areas in all 13 cases, whereas recurrent pigmented number of Q-switched alexandrite laser treatments per macules were observed as multiple brown to black patient was 4.5, with a range of 1 to 10. Clinical spots within 6 months following the last Q-switched photographs were taken before each treatment session, alexandrite laser treatment (Figures 1 and 2). All 2 or 3 weeks after treatment, and 1 years after recurrent pigmented macule did not become fully detection of recurrent pigmented macule In addition, repigmented and did not grow together until 1 years 2-mm punch biopsy specimens were obtained before following their development. treatment and on the follow-up day at which recurrent Histologically, all recurrent pigmented macules pigmented macule was first observed. Tissues were showed reduced nevomelanocytic nests in the upper fixed in 10% formalin, stained with hematoxylin and and reticular dermis and replacement by subtle eosin, and examined by light microscopy. In addition, microscopic scars. Residual nevomelanocytes in the tissue sections were immunohistochemically stained dermis were observed in all recurrent pigmented using primary antibodies (Table 1). Recurrent pigmen- macules. The size and number of dermal nevus cell ted macule from 1 patient was also examined by nests were decreased in all 13 recurrent pigmented electron microscopy. macules, and 4 showed singly dispersed nevomelano- Samples from 12 patients were stained with anti- cytes in the reticular dermis (Figure 3B). body to E-cadherin, whereas samples from all 13 Using NKI-beteb (GP-100), an increased number of patients were stained with antibody to tumor necrosis melanocytes and lentiginous hyperplasia was detected factor-a. For the original nevus and recurrent pigmen- within the epidermis of 11 of 13 recurrent pigmented ted macule the ratio of stained epidermal area to macules. Staining for GP-100 was stronger in the measured epidermal area and staining intensity were epidermis of these 11 recurrent pigmented macules determined by a computed image analysis method.15 than in the epidermis of the original lesions (Figure Table 1. Primary Antibodies Used and Their Working Dilutions Stain Target Dilution Incubation Temperature Manufacturer GP-100 (NKI-beteb) Melanocyte 1:20 18 min 451C Monosan Antibody for E-cadherin Cadherin 1:100 Overnight Room Novacastra Antibody for tumor necrosis factor-a Tumor necrosis factor-a 1:100 Overnight Room HyCult 900 SOHN ET AL.: CONGENITAL NEVI TREATMENT WITH AN ALEXANDRITE LASER Dermatol Surg 30:6:June 2004 Table 2. Clinical Data and Histologic Type of 13 Patients undersurface of basal cells. In the suprabasal epider- (Biopsied Before and After Treatment) mis, staining for E-cadherin was localized uniformly around the periphery of the cells (Figure 4) but was Time on absent from the corneal layer. Membranous staining Follow-up n was also present in the outer root sheath cells of the Sex/Age Type of Number of Biopsy hair follicles. Membranous E-cadherin immunoreac- Patient (Years) Site Nevus Treatments (Months) tivity was present in the epidermis of all nevi, as well 1 F/4 Face Intradermal 5 6 as at the borders between epidermal nevus cell nests 2 F/3 Trunk Compound 1 2 and the surrounding keratinocytes. In nine recurrent 3 F/4 Face Intradermal 2 3 pigmented macules with junctional activities, the 4 M/5 Face Intradermal 3 6 staining was not uniformly membranous but more 5 F/5 Face Intradermal 7 3 heterogeneous.
Load more

Recommended publications
  • Clinical Features of Benign Tumors of the External Auditory Canal According to Pathology
    Central Annals of Otolaryngology and Rhinology Research Article *Corresponding author Jae-Jun Song, Department of Otorhinolaryngology – Head and Neck Surgery, Korea University College of Clinical Features of Benign Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea, Tel: 82-2-2626-3191; Fax: 82-2-868-0475; Tumors of the External Auditory Email: Submitted: 31 March 2017 Accepted: 20 April 2017 Canal According to Pathology Published: 21 April 2017 ISSN: 2379-948X Jeong-Rok Kim, HwibinIm, Sung Won Chae, and Jae-Jun Song* Copyright Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College © 2017 Song et al. of Medicine, South Korea OPEN ACCESS Abstract Keywords Background and Objectives: Benign tumors of the external auditory canal (EAC) • External auditory canal are rare among head and neck tumors. The aim of this study was to analyze the clinical • Benign tumor features of patients who underwent surgery for an EAC mass confirmed as a benign • Surgical excision lesion. • Recurrence • Infection Methods: This retrospective study involved 53 patients with external auditory tumors who received surgical treatment at Korea University, Guro Hospital. Medical records and evaluations over a 10-year period were examined for clinical characteristics and pathologic diagnoses. Results: The most common pathologic diagnoses were nevus (40%), osteoma (13%), and cholesteatoma (13%). Among the five pathologic subgroups based on the origin organ of the tumor, the most prevalent pathologic subgroup was the skin lesion (47%), followed by the epithelial lesion (26%), and the bony lesion (13%). No significant differences were found in recurrence rate, recurrence duration, sex, or affected side between pathologic diagnoses.
    [Show full text]
  • Short Course 11 Pigmented Lesions of the Skin
    Rev Esp Patol 1999; Vol. 32, N~ 3: 447-453 © Prous Science, SA. © Sociedad Espafiola de Anatomfa Patol6gica Short Course 11 © Sociedad Espafiola de Citologia Pigmented lesions of the skin Chairperson F Contreras Spain Ca-chairpersons S McNutt USA and P McKee, USA. Problematic melanocytic nevi melanin pigment is often evident. Frequently, however, the lesion is solely intradermal when it may be confused with a fibrohistiocytic RH. McKee and F.R.C. Path tumor, particularly epithelloid cell fibrous histiocytoma (4). It is typi- cally composed of epitheliold nevus cells with abundant eosinophilic Brigham and Women’s Hospital, Harvard Medical School, Boston, cytoplasm and large, round, to oval vesicular nuclei containing pro- USA. minent eosinophilic nucleoli. Intranuclear cytoplasmic pseudoinclu- sions are common and mitotic figures are occasionally present. The nevus cells which are embedded in a dense, sclerotic connective tis- Whether the diagnosis of any particular nevus is problematic or not sue stroma, usually show maturation with depth. Less frequently the nevus is composed solely of spindle cells which may result in confu- depends upon a variety of factors, including the experience and enthusiasm of the pathologist, the nature of the specimen (shave vs. sion with atrophic fibrous histiocytoma. Desmoplastic nevus can be distinguished from epithelloid fibrous histiocytoma by its paucicellu- punch vs. excisional), the quality of the sections (and their staining), larity, absence of even a focal storiform growth pattern and SiQO pro- the hour of the day or day of the week in addition to the problems relating to the ever-increasing range of histological variants that we tein/HMB 45 expression.
    [Show full text]
  • Acral Melanoma
    Accepted Date : 07-Jul-2015 Article type : Original Article The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma Running head: Dermoscopy of acral melanoma Word count: 3138, Tables: 6, Figures: 6 A. Lallas,1 A. Kyrgidis,1 H. Koga,2 E. Moscarella,1 P. Tschandl,3 Z. Apalla,4 A. Di Stefani,5 D. Ioannides,2 H. Kittler,4 K. Kobayashi,6,7 E. Lazaridou,2 C. Longo,1 A. Phan,8 T. Saida,3 M. Tanaka,6 L. Thomas,8 I. Zalaudek,9 G. Argenziano.10 Article 1. Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy 2. Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan 3. Department of Dermatology, Division of General Dermatology, Medical University, Vienna, Austria 4. First Department of Dermatology, Medical School, Aristotle University, Thessaloniki, Greece 5. Division of Dermatology, Complesso Integrato Columbus, Rome, Italy 6. Department of Dermatology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan 7. Kobayashi Clinic, Tokyo, Japan 8. Department of Dermatology, Claude Bernard - Lyon 1 University, Centre Hospitalier Lyon-Sud, Pierre Bénite, France. 9. Department of Dermatology and Venereology, Medical University, Graz, Austria 10. Dermatology Unit, Second University of Naples, Naples, Italy. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as Accepted doi: 10.1111/bjd.14045 This article is protected by copyright. All rights reserved. Please address all correspondence to: Aimilios Lallas, MD.
    [Show full text]
  • Lentigo Maligna Melanoma and Simulants Maui January 2020 Superficial Atypical Melanocytic Proliferations
    Superficial Atypical Melanocytic Proliferations II. Lentigo Maligna Melanoma and Simulants Maui January 2020 Superficial Atypical Melanocytic Proliferations • RGP Melanomas • SSM, LMM, ALM, MLM • Intermediate lesions • Dysplastic nevi, Atypical lentiginous proliferations in high CSD skin; Atypical Acral lentiginous nevi • Superficial atypical melanocytic proliferations • Pagetoid plaque-like Spitz nevi; pigmented spindle cell nevus (Reed) • Special site nevi (genital, breast, scalp, ear, flexural, etc). • Superficial atypical melanocytic proliferations of uncertain significance • Atypical/unusual/uncertain examples of all of the above Superficial Atypical Melanocytic Proliferations • RGP Melanomas • SSM, LMM, ALM, MLM • Intermediate lesions • Dysplastic nevi, Atypical lentiginous proliferations in high CSD skin; Atypical Acral lentiginous nevi • Superficial atypical melanocytic proliferations • Pagetoid plaque-like Spitz nevi; pigmented spindle cell nevus (Reed) • Special site nevi (genital, breast, scalp, ear, flexural, etc). • Superficial atypical melanocytic proliferations of uncertain significance • Atypical/unusual/uncertain examples of all of the above High CSD Melanomas and Simulants. D Elder, Maui, HI Jan 2020 Lentigo maligna melanoma Atypical lentiginous nevi/proliferations High CSD: Lentiginous Nevi and Lentigo Maligna Melanoma and Simulant(s) • Lentiginous Melanoma of Sun-Damaged Skin • LMM in situ • LMM invasive • Distinction from Dysplastic Nevi (Dysplastic Nevus-like Melanoma/Nevoid Lentigo Maligna • Lentiginous Nevi of
    [Show full text]
  • Incidence of New and Changed Nevi and Melanomas Detected Using Baseline Images and Dermoscopy in Patients at High Risk for Melanoma
    STUDY Incidence of New and Changed Nevi and Melanomas Detected Using Baseline Images and Dermoscopy in Patients at High Risk for Melanoma Jeremy P. Banky, MBBS; John W. Kelly, MDBS; Dallas R. English, PhD; Josephine M. Yeatman, MBBS, FACD; John P. Dowling, MBBS, FRCPA Objective: To determine the incidence of new, changed, Results: The incidence of new, changed, and regressed and regressed nevi and melanomas in a cohort of pa- nevi decreased with increasing age (PϽ.001), whereas tients at high risk for melanoma using baseline total body the incidence of melanomas increased (P=.05). The num- photography and dermatoscopy. ber of dysplastic nevi at baseline was positively associ- ated with the incidence of changed nevi (PϽ.001) and Design: Cohort study of patients at high risk for mela- melanomas (P=.03). The use of baseline photography and noma who underwent baseline cutaneous photography dermatoscopy was associated with low biopsy rates and between January 1, 1992, and December 31, 1997, and early detection of melanomas. The development of mela- had at least 1 follow-up visit by December 31, 1998. noma in association with a preexisting nevus was not di- rectly correlated with a change in a preexisting lesion Setting: Private practice rooms of 1 dermatologist in con- monitored by baseline photography. junction with a public hospital-based, multidisciplinary melanoma clinic in Victoria, Australia. Conclusions: Nevi are dynamic, and only a small per- centage of all new and changed melanocytic lesions are Patients: A total of 309 patients who had at least 1 of the following risk factors for melanoma: personal his- melanomas.
    [Show full text]
  • Things That Go Bump in the Light. the Differential Diagnosis of Posterior
    Eye (2002) 16, 325–346 2002 Nature Publishing Group All rights reserved 0950-222X/02 $25.00 www.nature.com/eye IG Rennie Things that go bump THE DUKE ELDER LECTURE 2001 in the light. The differential diagnosis of posterior uveal melanomas Eye (2002) 16, 325–346. doi:10.1038/ The list of lesions that may simulate a sj.eye.6700117 malignant melanoma is extensive; Shields et al4 in a study of 400 patients referred to their service with a pseudomelanoma found these to encompass 40 different conditions at final diagnosis. Naturally, some lesions are Introduction mistaken for melanomas more frequently than The role of the ocular oncologist is two-fold: others. In this study over one quarter of the he must establish the correct diagnosis and patients referred with a diagnosis of a then institute the appropriate therapy, if presumed melanoma were subsequently found required. Prior to the establishment of ocular to have a suspicious naevus. We have recently oncology as a speciality in its own right, the examined the records of patients referred to majority of patients with a uveal melanoma the ocular oncology service in Sheffield with were treated by enucleation. It was recognised the diagnosis of a malignant melanoma. that inaccuracies in diagnosis occurred, but Patients with iris lesions or where the the frequency of these errors was not fully diagnosis of a melanoma was not mentioned appreciated until 1964 when Ferry studied a in the referral letter were excluded. During series of 7877 enucleation specimens. He the period 1985–1999 1154 patients were found that out of 529 eyes clinically diagnosed referred with a presumed melanoma and of as containing a melanoma, 100 harboured a these the diagnosis was confirmed in 936 lesion other than a malignant melanoma.1 cases (81%).
    [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]
  • Cosmetic Light Therapies and the Risks of Atypical Pigmented Lesions
    Case Report Cosmetic light therapies Editor’s key points Light therapies, such as intense and the risks of atypical pulsed light therapy and laser therapy, are being used more often pigmented lesions for elective treatment of pigmented lesions because of their tolerability MD MHA MD FRCPC MD MPH Lauren Curry Natalie Cunningham Shweta Dhawan and risk reduction of scarring. ight therapies, including intense pulsed light (IPL) therapy and laser The risks of light therapies therapy, are increasingly used for elective treatment of pigmented are debated and not thoroughly lesions. These treatments are usually well tolerated and might result studied. Cases of pseudomelanoma, malignant melanoma, and Lin reduced risk of scarring compared to treatment with surgical excision. metastatic melanoma have been However, the associated risks of treating pigmented lesions with light thera- identified after light treatment of pies are debated and not well studied. pigmented lesions, but whether light therapies cause melanoma is Case yet to be determined. A 56-year-old healthy white woman was referred to a dermatologist for A biopsy should be considered in evaluation of an atypical pigmented lesion on her left cheek. It began as cases where diagnosis is unclear or a dark spot more than 10 years before and was treated as a “sunspot” or where repigmentation occurs following solar lentigo (SL) by an aesthetician with 1 session of IPL therapy. The light therapy to improve the primary lesion partially faded with treatment, but eventually repigmented, grew, care provider’s ability to diagnose and and developed areas of depigmentation in the 6 months before presenta- manage pigmented lesions.
    [Show full text]
  • Spindle Cell Melanocytic Tumors of Extracutaneous Sites Clinicopathological Analysis Of20 Cases of a Poorly Known Variant
    SHORT COURSE II REV ESP PATOL pseudoinclusions are sometimes evident and mild nuclear pleomor- Are the (spindle-shaped) tumor cells melanocytes phism is typical. Mitoses are either absent or extremely infrequent. It is fair to say that with few exceptions, this question of melanocyt- By definition dendritic cells are said not to be seen in this lesion. ic vs. nonmelanocytic nature of a tumor is readily answerable: the The growth pattern often presents a plexiform appearance, fas- main problems arise when the possibility of a melanocytic neo- cicles of nevus cells following the dermal appendages and neu- plasm is not considered at all. rovascular bundles. Perineural or endoneural extension is a very The listof cutaneous spindle cell tumors is long and, apart from common finding. Towards the base of the lesion the nevus often melanocytic tumors, includes neoplasms of fibroblasts, endotheli- adopts a single cell infiltrative growth pattern dissecting between the um, smooth muscle cells, histiocytes, keratinocytes and various collagen bundles. The nevus cell population is typically admixed with other cell types. The melanocytic nature of the tumor is generally densely pigmented melanophages and lymphocytic infiltrates are not obvious when a junctional component can be recognized or when uncommon. melanin, produced by the tumor cells, is detected. However, even As originally described, deep penetrating nevus was not believed when these features are absent, the pathologist is well advised to to be associated with any risk of recurrence or metastatic potential. consider the possibility of a melanocytic neoplasm, in order to The recent literature however casts some doubt on this viewpoint.
    [Show full text]
  • Challenges of Partial Biopsies in Large Diameter Atypical
    Volume 23 Number 4 | April 2017 Dermatology Online Journal || Letter DOJ 23 (4): 15 An incomplete picture: challenges of partial biopsies in large diameter atypical melanocytic lesions Lauren C Strazzulla1 BA, Hong Wu2 MD, Marissa Heller3 MD, Caroline C Kim4 MD Affiliations: 1The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, 2Department of Pathology, Harvard Medical School, Boston, Massachusetts, 3Dermatology Surgery; Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 4Pigmented Lesion Clinic; Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts Corresponding Author: Caroline C. Kim, MD, Department of Dermatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave. Shapiro 2, Boston, MA 02215, Email: [email protected] Abstract Large diameter atypical pigmented lesions (LDAPL) can be challenging to diagnose accurately using partial biopsies because of pathologic heterogeneity, while at the same time large excisions of these lesions confer significant morbidity to patients. Consequently, clinicians are often challenged by the management of these lesions. In this case, we describe an elderly patient with a history of multiple basal cell carcinomas, prior melanomas, and a family history of melanoma who presented with an irregularly pigmented brown and dark brown patch on his upper back. This lesion was evaluated with multiple partial incisional biopsies from the most atypical appearing areas of the lesion Figure 1A. Examination of the right upper back revealed a 3.6 x 2.4 identified on dermoscopy, each showing mild and cm irregularly pigmented brown broad patch. Two incisional shave moderate atypical melanocytes.
    [Show full text]
  • Pigmented Lesion Pathology: What You Should Expect from Your Pathologist, and What Your Pathologist Should Expect from You
    Pigmented Lesion Pathology: What You Should Expect From Your Pathologist, and What Your Pathologist Should Expect From You Matthew G. Fleming, MDa aAssociate Professor of Dermatology and Pathology, Medical College of Wisconsin, Milwaukee, WI Keywords: Melanoma, Nevus, Pathology aCorresponding author for proof and reprints: Matthew G. Fleming, MD Department of Dermatology Medical College of Wisconsin 8701 Watertown Plank Road Milwaukee, WI 53226 (414) 456-4072 (414) 456-6518 (fax) mfl[email protected] (email) The diagnosis and treatment of melanoma and related neoplasms is difficult and dangerous for all concerned. In the typical scenario, a lesion is identified by a dermatologist or other clinician as sufficiently atypical to warrant biopsy; a dermatopathologist or general pathologist renders the “gold standard” (i.e., histologic) diagnosis, and stages the lesion; and the patient is referred to a surgeon (and oncologist if necessary) for treatment appropriate to the stage of his disease. In this sequence, several things can go wrong. The patient may not seek care while the lesion is curable; the practitioner to whom he initially presents may fail to recognize it; the pathologist may misdiagnose it; and the surgeon may misinterpret and therefore fail to act appropriately on the pathologist’s report. These errors would usually lead to undertreatment, but overtreatment of, for example, a mildly atypical dysplastic or spitzoid lesion, can also lead to unnecessary morbidity and cost. That these problems are real, and bear especially on pathology, is attested by the experience of a large pathology insurer, that melanoma is responsible for more malpractice claims than any other diagnostic entity [1], a frequency disproportionate to the prevalence of this disease (13% of claims [1] but only 4-5% of cancers [2]).
    [Show full text]
  • Congenital Melanocytic Nevi: Where Are We Now?
    Congenital melanocytic nevi: Where are we now? Part II. Treatment options and approach to treatment Omar A. Ibrahimi, MD, PhD,a,b Ali Alikhan, MD,c and Daniel B. Eisen, MDd Farmington, Connecticut; Boston, Massachusetts; Rochester, Minnesota; and Sacramento, California CME INSTRUCTIONS The following is a journal-based CME activity presented by the American Academy of available for their efficacy or lack thereof; and formulate a rational treatment Dermatology and is made up of four phases: approach. 1. Reading of the CME Information (delineated below) Date of release: October 2012 2. Reading of the Source Article Expiration date: October 2015 3. Achievement of a 70% or higher on the online Case-based Post Test 4. Completion of the Journal CME Evaluation Ó 2012 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2012.06.022 CME INFORMATION AND DISCLOSURES Statement of Need: Technical requirements: The American Academy of Dermatology bases its CME activities on the Academy’s American Academy of Dermatology: core curriculum, identified professional practice gaps, the educational needs which d Supported browsers: FireFox (3 and higher), Google Chrome (5 and higher), underlie these gaps, and emerging clinical research findings. Learners should reflect Internet Explorer (7 and higher), Safari (5 and higher), Opera (10 and higher). upon clinical and scientific information presented in the article and determine the d JavaScript needs to be enabled. need for further study. Target Audience: Elsevier: Dermatologists and others involved in the delivery of dermatologic care. Technical Requirements This website can be viewed on a PC or Mac.
    [Show full text]