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Shades of Acquired Dermal Melanocytosis Erin Lowe DO, Alexa Broderick BS, Richard Miller DO, Michael Heaphy MD

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Shades of Acquired Dermal Melanocytosis Erin Lowe DO, Alexa Broderick BS, Richard Miller DO, Michael Heaphy MD Shades of Acquired Dermal Melanocytosis Erin Lowe DO, Alexa Broderick BS, Richard Miller DO, Michael Heaphy MD 1A 1B 1C Introduction Treatment ² Dermal melanocytoses are distinct melanocytic lesions characterized by a blue-gray ² Therapy options are the same for congenital and acquired dermal melanocytoses. discoloration of large portions of the skin. ² Laser is the treatment of choice, using selective photothermolysis to target the ² Subtypes include a wide variety of congenital and acquired, histologically chromophore melanin. indistinguishable entities characterized by an intradermal proliferation of fusiform pigment-bearing melanocytes in the absence of melanophages. ² Q-switched laser surgery with an extremely high power, short pulse duration (nanoseconds) is the preferred waveform because the melanin target molecules are very ² The most frequent dermal melanocytoses are of the congenital type and include nevus small with short thermal relaxation times. of Ota, nevus of Ito, and Mongolian spots. These are usually present at birth and occur 2A 2B 2C most frequently in Asian populations. ² The Q-switched ruby is preferred over the Q-switched alexandrite and Nd:Yag as it emits radiation with Increased absorption and selectivity for melanin. ² Acquired dermal melanocytoses (ADM) occurring later in life and in non-Asian patients are rare. Herein, we present four unusual cases of ADM. ² Frequency of treatments depends on the pigment intensity. Overall, after 4-8 treatments skin pigmentation is reduced dramatically or removed in 90% of cases, with a less than 1% risk of scarring. Case Series 1. 57 year-old African American male with acquired dermal melanocytoses of the upper ² Less successful treatment methods reported include superficial excision, bleaching agents, back. 3A 3B 3C chemical peels, and electric cauterization. 2. 62 year-old Caucasian male with acquired unilateral nevus of Ota with ocular involvement. References 3. 73 year-old African American female with acquired bilateral nevus of Ota (Hori’s 1. Harrison-Balestra C, GuGic D, Vincek V. Clinically distinct form of acquired dermal melanocytoses with nevus). review of published work. J Dermatol 2007 Mar;34(3):178-82. 2. Navarro N, Orland A, Garrido E, GarGia RJ, Ceballos E. Unusual acquired dermal melanocytoses on the trunk. Int J Dermatol. 2008 Mar;47(3):307-8. 4. 73 year-old Caucasian male with “patch-type” blue nevus of the anterior neck. 3. Rios-Martin JJ, Pinto-Morales W, Marcos-DominGuez A, Gonzalez-Campora R. Acquired nonfacial dermal melanocytosis. Actas DermosifilioGr. 2011 Sep;102(7):556-7. 4A 4B 4C 4. Rubin A, Van Laborde S, Stiller M. Acquired dermal melanocytosis: appearance durinG preGnancy. J Am Discussion Acad Dermatol. 2001 Oct;45(4):609-13. 5. Kosumi H, Miyauchi T, Nomura T, Suzuki S, OhGuchi Y, Nomura A, Shimizu H. DiaGnostic features of During embryogenesis, melanocytes are found diffusely throughout the dermis. By the acquired dermal melanocytoses of the face and extremities. Clin Exp Dermatol. 2018 Jun 27. Doi: 10.111/ced. end of gestation, these melanocytes have migrated to the dermoepidermal junction. Defect 13546. EPub ahead of print. in migration of pigmented neural crest cells result in deep melanin in the skin and associated 6. Jun JY, Byun HJ, Oh SJ, Oh SH, Park JH, Lee JH. Acquired dermal melanocytoses confined to the hand. Ann tyndall effect, appearing clinically as dermal melanocytoses. Such defects usually present at Dermatol. 2018 Jun;30(3):380-1. birth or appear within the first year of life, most commonly in Asian individuals. Congenitally 7. Kok WL, Chen Q, Lee SSJ, Chua SH, NG SK. A case series of imatinib-induced Generalized hypopiGmentation and proGression of existinG acquired dermal melanocytoses. J DermatoloG Treat. 2017 Dec;28(8):762-3. acquired nevus of Ota and Ito remain stable throughout life, while Mongolian spots generally 8. Chen X, ZhanG Q, Chen L. Acquired dermal melanocytoses on the back. Clin Exp Dermatol. 2015 Jan;40(1): regress within a few years. Four non-Asian patients presented with acquired dermal melanocytosis of 86-8. There are seldom reports of dermal melanocytoses acquired in non-Asian adults. The varying sites. Photos depict (A) clinical features; (B) H&E stain displaying 9. Tumbull JR, Assaf C, Zouboulis C, Tebbe B. Bilateral naevus of Ota: a rare manifestation in a Caucasian. J pathogenesis is uncertain but reactivation of ectopic latent dermal melanocytes has been very sparse but diffuse proliferation of small, spindled, dendritic Eur Acad Dermatol Venereol. 2004 May;18(3):353-5. 10. Lee JY, Lee JS, Kim YC. HistopatholoGical features of acquired dermal melanocytosis. Eur J Dermatol. 2010 suggested as a possible cause. The dormant dermal melanocytes may be reactivated by melanocytes with pigmented cytoplasm splayed between collagen bundles 20(3):345-8. exogenous agents such as solar radiation, local inflammation, trauma, drugs, hormone in the dermis; (C) Melan-A stain highlighting ectopic melanocytes in dermis. 11. Massi G, LeBoit PE (2014). HistoloGical diaGnosis of nevi and melanoma. New York: SprinGer. therapy with estrogen or progesterone, or other yet undefined stimuli. Of note, the 12. ImaGawa K, Suzuki S, Fujibayashi M, Kono T, Miyasaka M. Laser Treatment of Dermal Melanocytosis. individuals presented here were on no medications previously reported to induce ADM. ResearchGate.net. April 2015; 36(1):77-81 1. Harrison-Balestra C, Gugic D, Vincek V. Clinically distinct form of acquired dermal melanocytoses with review of published work. J Dermatol. 2007 Mar;34(3):178-82. 2. Navarro N, Orland A, Garrido E, Gargia RJ, Ceballos E. Unusual acquired dermal melanocytoses on the trunk. Int J Dermatol. 2008 Mar;47(3):307-8. 3. Rios-Martin JJ, Pinto-Morales W, Marcos-Dominguez A, Gonzalez-Campora R. Acquired nonfacial dermal melanocytosis. Actas Dermosifiliogr. 2011 Sep;102(7):556-7. Four patients presented with ADM. A depicts clinical features. B Histology 4. Rubin A, Van Laborde S, Stiller M. Acquired dermal melanocytosis: appearance during pregnancy. J Am Acad Dermatol. 2001 Oct;45(4):609-13. Four patients presented with ADM. A depicts clinical features. B Histology 5. Kosumi H, Miyauchi T, Nomura T, Suzuki S, Ohguchi Y, Nomura A, Shimizu H. Diagnostic features of acquired dermal melanocytoses of the face and with H&E staining. C Melanin A stain. Melanin A staining is used to highlight extremities. Clin Exp Dermatol. 2018 Jun 27. Doi: 10.111/ced.13546. EPub ahead of print. with H&E staining. C Melanin A stain. Melanin A staining is used to highlight 6. Jun JY, Byun HJ, Oh SJ, Oh SH, Park JH, Lee JH. Acquired dermal melanocytoses confined to the hand. Ann Dermatol. 2018 Jun;30(3):380-1. ectopic melanocytes in dermis. 7. Kok WL, Chen Q, Lee SSJ, Chua SH, Ng SK. A case series of imatinib-induced generalized hypopigmentation and progression of existing acquired ectopic melanocytes in dermis. dermal melanocytoses. J Dermatolog Treat. 2017 Dec;28(8):762-3. 8. Chen X, Zhang Q, Chen L. Acquired dermal melanocytoses on the back. Clin Exp Dermatol. 2015 Jan;40(1):86-8. 9. Tumbull JR, Assaf C, Zouboulis C, Tebbe B. Bilateral naevus of Ota: a rare manifestation in a Caucasian. J Eur Acad Dermatol Venereol. 2004 May; 18(3):353-5. 10. Lee JY, Lee JS, Kim YC. Histopathological features of acquired dermal melanocytosis. Eur J Dermatol. 2010 20(3):345-8. 11. Massi G, LeBoit PE (2014). Histological diagnosis of nevi and melanoma. New York: Springer. 12. Imagawa K, Suzuki S, Fujibayashi M, Kono T, Miyasaka M. Laser Treatment of Dermal Melanocytosis. Researchgate.net. April 2015; 36(1):77-81 .
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