DOCSLIB.ORG

Ear “Wart” Prompts Unkind Comments

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ear “Wart” Prompts Unkind Comments DERMADIAGNOSIS Ear “Wart” Prompts Unkind Comments n 8-year-old boy is re- ferred to dermatology for A evaluation and treat- ment of a “wart” on the inferior rim of his left helix that has been present (and unchanged) since birth. The lesion is asymptom- atic, and the boy’s biggest com- plaint is that it makes him the object of unkind comments from his siblings and friends. The patient’s mother claims the child is otherwise healthy; there is no history of seizure or other neu- rologic problems, and he does not have any medical conditions re- quiring treatment. The lesion has been treated, unsuccessfully, with a variety of wart remedies, includ- ing salicylic acid-based products and liquid nitrogen. Along the inferior rim of the left helix is a 5-cm linear collec- tion of soft, skin-colored papules that range in size from pinpoint to 2.5 mm. They are so small and flesh-toned as to easily escape de- a) Wart (verruca vulgaris) “d”) were possible differential tection unless specifically sought. b) Nevus sebaceous items, the former usually appears No other significant lesions are c) Trichofolliculoma much later in life and the latter is seen on the ear or elsewhere on d) Epidermal nevus usually more dry and rough to the the head or neck. touch. The child looks his stated age ANSWER and appears well developed and The correct answer is nevus seba- DISCUSSION well nourished. ceous (choice “b”), a rather com- Nevus sebaceous (NS) of Jadas- The most likely diagnostic ex- mon hamartomatous congenital sohn was first described in 1895 planation is tumor. The diagnosis was con- by a Swedish dermatologist who firmed by pathologic examination had seen a series of young pa- Joe R. Monroe, of a tiny sample from the most tients with hairless plaques in the MPAS, PA, practices papular portion of the lesion. scalp or on surrounding neck or at Dawkins Dermatology Clinic Given the lesion’s congenital facial skin. Pathologic exam con- in Oklahoma City. nature and complete lack of re- firmed them to be organoid nevi He is also the sponse to treatment, wart (choice representing an overgrowth of se- founder of the “a”) was quite unlikely. And al- baceous glands. Society of Dermatology though trichofolliculoma (choice Over time, it became clear that Physician Assistants. “c”) and epidermal nevus (choice NS affects all genders and races continued on page 17 >> clinicianreviews.com MAY 2016 • Clinician Reviews 13 DERMADIAGNOSIS >> continued from page 13 equally. For most patients, the le- tion, especially in larger scalp le- Most cases of NS in the scalp sions are of cosmetic concern due sions that are subject to years of are easy to diagnose by their pink to the lack of hair. But it has also excess UV exposure. This was the color, plaquish morphology, and been established that NS can de- driving force behind the com- mammillated hairless surface velop in areas, including the face, mon practice of removing NS at (coupled with congenital mani- ears, and neck, on which they puberty. We now know that al- festation). But a few, such as may be cosmetically significant though basal or squamous cell this patient’s ear lesion, require and difficult to remove. carcinoma, or even melanoma, biopsy for confirmation. As this Concern arose when reports can develop in longstanding NS, patient ages, he may feel the need began to surface that NS could the frequency is probably far less to have the rest of it surgically re- undergo malignant transforma- than previously thought. moved. CR clinicianreviews.com MAY 2016 • Clinician Reviews 17.
Load more

Recommended publications
  • Two Cases of Nevoid Basal Cell Carcinoma Syndrome in One Family
    221 Two Cases of Nevoid Basal Cell Carcinoma Syndrome in One Family Dong Jin Ryu, M.D., Yeon Sook Kwon, M.D., Mi Ryung Roh, M.D., Min-Geol Lee, M.D., Ph.D. Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea The nevoid basal cell carcinoma syndrome, or Gorlin-Goltz syndrome, is an autosomal dominant multiple system disorder with high penetrance and variable expressions, although it can also arise spontaneously. The diagnostic criteria for nevoid basal cell carcinoma syndrome include multiple basal cell carcinomas, palmoplantar pits, multiple odontogenic keratocysts, skeletal anomalies, positive family history, ectopic calcification and neurological anomalies. We report a brother and sister who were both diagnosed with nevoid basal cell carcinoma syndrome. (Ann Dermatol (Seoul) 20(4) 221∼225, 2008) Key Words: Basal cell carcinoma, Nevoid basal cell carcinoma syndrome, Odontogenic keratocyst INTRODUCTION cell carcinoma syndrome. The nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin-Goltz syndrome, is an auto- CASE REPORT somal dominant multiple system disorder with high 1 penetrance and variable expressions . However, Case 1 60% of patients with NBCCS are sporadic cases. It An 11-year-old male was referred to our depart- has an estimated prevalence of 1 in 60,000 with ment for the evaluation of multiple miliary sized 2 equal distributions among males and females . The pigmented macules on the palm and sole that had well-defined diagnostic criteria include cutaneous increased in number over several years. He had an anomalies, dento-facial anomalies, skeletal ano- operation for inguinal hernia at 3 years of age, but malies, positive family history, neurological ano- no other medical problems.
    [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]
  • Co-Occurrence of Vitiligo and Becker's Nevus: a Case Report
    Case Report Olgu Sunumu DOI: 10.4274/turkderm.71354 Turkderm - Arch Turk Dermatol Venerology 2016;50 Co-occurrence of vitiligo and Becker's nevus: A case report Vitiligo ve Becker nevüs birlikteliği: Olgu sunumu Ayşegül Yalçınkaya İyidal, Özge Çokbankir*, Arzu Kılıç** Ağrı State Hospital, Clinic of Dermatology, *Clinic of Pathology, Ağrı, Turkey **Balıkesir University Faculty of Medicine, Department of Dermatology, Balıkesir, Turkey Abstract Vitiligo is an acquired disorder with an unknown etiology in which genetic and non-genetic factors coexist. Melanocytes are destructed in the affected skin areas and clinically depigmented macules and patches appear on the skin. Becker's nevus (BN) appears as hyperpigmented macule, patch or verrucous plaques with sharp and irregular margins and often unilateral occurrence and with associated hypertrichosis in various degrees. Although its pathogenesis is unknown, it is suggested to represent a hamartomatous lesion harboring androgen receptors on the lesion. In this report, we present a 19-year-old male patient who developed vitiligo lesions and then BN adjacent to the vitiligo lesion in the right upper back portion of the body ten years after the initial vitiligo lesion. Keywords: Becker's nevus, vitiligo, co-occurrence Öz Vitiligo nedeni tam olarak bilinmeyen, genetik ve genetik olmayan faktörlerin birlikte rol oynadığı edinsel bir bozukluktur. Bu hastalıkta tutulan deride melanositler ortadan kalkar, klinik olarak depigmente makül ve yamalar belirir. Becker nevüs (BN) sıklıkla unilateral dağılım gösteren, keskin ama düzensiz sınırlı hiperpigmente makül, yama veya verrüköz plakların izlendiği, üzerinde değişik derecelerde hipertrikozun bulunduğu bir hastalıktır. Patogenezi belli olmamakla birlikte hamartamatöz bir lezyon olduğu ve üzerinde androjen reseptörlerinin arttığı ileri sürülmektedir.
    [Show full text]
  • Dermoscopy on Nevus Comedonicus: a Case Report and Review of the Literature
    Case report Dermoscopy on nevus comedonicus: a case report and review of the literature Grażyna Kamińska-Winciorek 1, Radosław Śpiewak 2 1The Center for Cancer Prevention and Treatment, Katowice, Poland Head: Beata Wydmańska 2Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland Head: Prof. Radosław Śpiewak MD. PhD Postep Derm Alergol 2013; XXX, 4: 252 –254 DOI: 10.5114/pdia.2013.37036 Abstract Nevus comedonicus (NC) is a very rare, benign hamartoma characterised by the occurrence of dilated, comedo-like openings, typically on the face, neck, upper arms, chest or abdomen. In uncertain cases, histopathological exami - nation confirms the diagnosis. The authors suggest dermoscopy as a rapid and useful method of initial diagnosis of nevus comedonicus based upon its distinctive dermoscopic features. The dermoscopy reveals numerous light- and dark-brown, circular or barrel-shaped, homogenous areas with prominent keratin plugs. Key words: dermoscopy, dermatoscopy, nevus comedonicus, epidermal nevus, acne vulgaris. Introduction a hypopigmented, slightly hypotrophic, linear spot of Nevus comedonicus (NC) is a benign hamartoma cha - 2 cm × 8 cm (Figure 1). The plugs could not be extracted racterised by the occurrence of dilated comedo-like open - mechanically. The dermoscopic examination revealed ings, with black or brown keratin plugs, typically localised the distinctive pattern consisting of dark, sharply demar - on the face, neck, upper arms, chest or abdomen. The diag - cated keratin plugs of 1–3 mm diameter, numerous struc - nosis of nevus comedonicus is relatively easy. In uncertain tureless, circular- and barrel-shaped, homogenous areas cases, a typical histopathological picture confirms the diag - with hyperkeratotic plugs of various shades of brown nosis.
    [Show full text]
  • The Role of Androgen Receptors in the Clinical Course of Nevus Sebaceus of Jadassohn Katherine S
    The Role of Androgen Receptors in the Clinical Course of Nevus Sebaceus of Jadassohn Katherine S. Hamilton, M.D., Sandra Johnson, M.D., Bruce R. Smoller, M.D. Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (KSH); and Departments of Dermatology (SJ, BRS) and Pathology (SJ), University of Arkansas for Medical Services, Little Rock, Arkansas During puberty, they usually enlarge and become Nevus sebaceus of Jadassohn (NSJ) is a benign, con- elevated, verrucous, or nodular and may appear genital hamartoma that often presents at birth, ap- brown (1, 2). In late childhood and adulthood, there pears to regress in childhood, and grows during is a significant risk of developing a secondary tu- puberty, suggesting possible hormonal control. We mor, the most common of which are syringocysta- studied 18 cases of NSJ from children and adults for denoma papilliferum and basal cell carcinoma (1, immunohistochemical evidence of androgen recep- 3). Myriad other cutaneous appendageal neoplasms tor expression. The lesions were evaluated for loca- have also been reported to arise within NSJ. tion and pattern of immunostaining, and these Androgen receptors (AR) are nuclear ligand–de- findings were compared between age groups, sexes, pendent transcription factors of the steroid super- and to androgen receptor expression in normal family that bind testosterone and dihydroxytestos- skin. Androgen receptor positivity was seen in the terone (4). AR have been identified in normal sebaceous glands, in eccrine glands with and with- cutaneous structures and in some epithelial tu- out apocrine change, and rarely in keratinocytes in mors. In normal skin, AR have been localized to the sebaceous nevi.
    [Show full text]
  • Choroidal Nevus Transformation Into Melanoma: Analysis of 2514 Consecutive Cases
    CLINICAL SCIENCES Choroidal Nevus Transformation Into Melanoma Analysis of 2514 Consecutive Cases Carol L. Shields, MD; Minoru Furuta, MD; Edwina L. Berman, BS; Jonathan D. Zahler, MD; Daniel M. Hoberman, BS; Diep H. Dinh, BS; Arman Mashayekhi, MD; Jerry A. Shields, MD Objective: To determine features that are predictive of halo absence (P=.009). A mnemonic device to recall risk growth of choroidal nevi into melanoma. factors of ocular melanoma is “To find small ocular mela- noma using helpful hints,” representing thickness, fluid, Methods: This was a retrospective medical record re- symptoms, orange pigment, margin, ultrasonographic hol- view of 2514 consecutive eyes; Kaplan-Meier estimates lowness, and halo absence. The median hazard ratio for and Cox regression analyses were used. those with 1 to 2 risk factors was 3; for 3 or 4 factors, 5; for 5 to 6 factors, 9; and for all 7 factors, 21. Results: The median tumor basal diameter was 5.0 mm and thickness was 1.5 mm. Nevus growth into mela- Conclusions: In an analysis of 2514 choroidal nevi, fac- noma occurred in 2%, 9%, and 13% of eyes at 1, 5, and tors predictive of growth into melanoma included greater 10 years, respectively. Factors predictive of growth into thickness, subretinal fluid, symptoms, orange pigment, melanoma by multivariable analysis included tumor thick- margin near disc, and 2 new features: ultrasonographic ness greater than 2 mm (PϽ.001), subretinal fluid hollowness and absence of halo. (P =.002), symptoms (P =.002), orange pigment (PϽ.001), tumor margin within 3 mm of the optic disc (P=.001), ultrasonographic hollowness (PϽ.001), and Arch Ophthalmol.
    [Show full text]
  • Differentiating Malignant Melanoma from Other Lesions Using Dermoscopy
    PRAXIS Differentiating malignant melanoma from other lesions using dermoscopy Ahmed Mourad Robert Gniadecki MD PhD DMSci ermoscopy (also called dermatoscopy, epilumi- nescent microscopy, or episcopy) is a noninvasive Figure 1. Image depicting proper dermoscopic technique: method of examining skin lesions using a hand- This is a polarized light dermoscope and does not require Dheld magnifying device (a dermoscope) equipped with a direct contact with the skin or application of oil. light source.1 Dermoscopy allows adequate visualization of the structures in the skin not only by magnifying them but also by eliminating the surface light reflection and scatter that obscures the deeper features.2,3 This arti- cle provides information on the dermoscopic features specific to malignant melanoma and other pigmented lesions that often resemble malignant melanoma via naked-eye examination (ie, benign melanocytic nevus [BMN], seborrheic keratosis, and dermatofibroma). Technique Before evaluating the lesion of interest using dermoscopy, the clinician should take an adequate history and evalu- ate the morphology and distribution of the lesion with the naked eye.1 Dermoscopy is then performed by apply- ing the dermoscope on the lesion of interest and looking through the lens to visualize the morphologic features of The presence of 2 or more of the above features sug- the skin lesion (Figure 1). Dermoscopy should never be gests a suspicious lesion that should be biopsied or that used alone, and the dermoscopic result should be corre- the patient should be referred for further assessment.4 lated with that of the naked-eye examination. The cost of a dermoscope ranges from a few hundred Conditions to a few thousand dollars.
    [Show full text]
  • Lumps & Bumps: Approach to Common Dermatologic Neoplasms
    Case-Based Approach to Common Dermatologic Neoplasms Patrick Retterbush, MD, FAAD Mohs Surgery & Dermatologic Oncology Associate Member of the American College of Mohs Surgery Private Practice: Lockman Dermatology January 27th 2018 Disclosure of Relevant Financial Relationships • I do not have any relevant financial relationships, commercial interests, and/or conflicts of interest regarding the content of this presentation. Goals/Objectives • Recognize common benign growths • Recognize common malignant growths • Useful clues & examination for evaluating melanocytic nevi and when to be concerned for melanoma/atypical moles • How to perform a basic skin biopsy and which method/type to choose • Basic treatment/when to refer Key Questions & Physical Examination Findings for a Growth History Physical Examination • How long has the lesion been • Describing a growth present? – flat or raised? • flat – macule (<1cm) or patch (>1cm) – years, months, weeks • raised – papule (<1cm) or plaque (>1cm) – nodule if deep (majority of lesion in • Has it changed? dermis/SQ) – Size – secondary descriptive features • scaly (hyperkeratosis, retention of strateum – Shape corneum) – Color • crusty (dried serum, blood, or pus on surface) • eroded or ulcerated (partial vs. full thickness – Symptoms – pain, bleeding, itch? epidermal loss) – Over what time frame? • color (skin colored, red, pigmented, pearly) • feel (hard or soft, mobile or fixed) • PMH: • size: i.e. 6 x 4mm – prior skin cancers • Look at the rest of the skin/region of skin • SCC/BCCs vs. melanoma
    [Show full text]
  • Oral and Maxillo-Facial Manifestations of Systemic Diseases: an Overview
    medicina Review Oral and Maxillo-Facial Manifestations of Systemic Diseases: An Overview Saverio Capodiferro *,† , Luisa Limongelli *,† and Gianfranco Favia Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; [email protected] * Correspondence: [email protected] (S.C.); [email protected] (L.L.) † These authors contributed equally to the paper. Abstract: Many systemic (infective, genetic, autoimmune, neoplastic) diseases may involve the oral cavity and, more generally, the soft and hard tissues of the head and neck as primary or secondary localization. Primary onset in the oral cavity of both pediatric and adult diseases usually represents a true challenge for clinicians; their precocious detection is often difficult and requires a wide knowledge but surely results in the early diagnosis and therapy onset with an overall better prognosis and clinical outcomes. In the current paper, as for the topic of the current Special Issue, the authors present an overview on the most frequent clinical manifestations at the oral and maxillo-facial district of systemic disease. Keywords: oral cavity; head and neck; systemic disease; oral signs of systemic diseases; early diagnosis; differential diagnosis Citation: Capodiferro, S.; Limongelli, 1. Introduction L.; Favia, G. Oral and Maxillo-Facial Oral and maxillo-facial manifestations of systemic diseases represent an extensive and Manifestations of Systemic Diseases: fascinating study, which is mainly based on the knowledge that many signs and symptoms An Overview. Medicina 2021, 57, 271. as numerous systemic disorders may first present as or may be identified by head and https://doi.org/10.3390/ neck tissue changes.
    [Show full text]
  • Topical Tacrolimus Brings Remission of Vitiligo and Halo Nevus in a Boy : a Case Report
    Chattagram Maa-O-Shishu Hospital Medical College Journal Volume 12, Issue 3, September 2013 Case Report Topical Tacrolimus Brings Remission of Vitiligo and Halo Nevus in A Boy : A Case Report Delwar Hossain1 Abstract Shirin Fatema2 Development of acquired idiopathic white patch on the skin is called vitiligo and ASM Mostaque Ahmed3* around a nevomelanocytic nevus is called halo nevus. Our patient had a halo nevus Jaynul Islam4 in the forehead and vitiligo elsewhere. Complete remission of his vitiligo and halo nevus was achieved with topical tacrolimus ointment without incurring any harm to 1Department of Dermatology and Venereology University of Science and Technology, Chittagong the patient. Chittagong, Bangladesh. Key words: Vitiligo; Halo nevus; Topical tacrolimus. 2Department of Gynecology and Obstetrics University of Science and Technology, Chittagong INTRODUCTION Chittagong, Bangladesh. Development of acquired idiopathic white patch on the skin and mucous membrane 3 is called vitiligo, and around a congenital or acquired nevomelanocytic nevus is Department of Pathology called halo nevus. Both of them could develop simultaneously in a patient1and could Chattagram Maa-O-Shishu Hospital Medical College 2-4 Chittagong, Bangladesh. be self-healing having an unpredictable course . 4Department of Histo and Cytopathology Navy Hospital, Chittagong, Bangladesh. CASE REPORT A boy of nine years came to us in September, 2011 with the complaint of multiple de-pigmented patches over right upper eye lid, left pina, left chest and around a congenital nevomelanocytic nevus over his right forehead. The nevus was asymptomatic and symmetric in color and shape with regular margin (Fig-1). A full mucocutaneous examination had been done. We did not get any abnormality in him apart from the de-pigmented patches as mentioned above.
    [Show full text]
  • Facial Nevus Spilus Mistakenly Treated As Melasma Tasleem Arif, Syed Suhail Amin
    2XU'HUPDWRORJ\2QOLQH Clinical Image Facial nevus spilus mistakenly treated as melasma Tasleem Arif, Syed Suhail Amin Postgraduate, Department of Dermatology, STDs and Leprosy, Jawaharlal Nehru Medical/College(JNMC), Aligarh Muslim University (AMU), Aligarh, India. Corresponding author: Dr. Tasleem Arif, E-mail: [email protected] A 17 year old male visited our dermatology outpatient department (OPD) with brownish hyperpigmentation over left side of the face. The patient had visited some physicians in the past for this hyperpigmentation and had been applying several demelanizing creams but with poor response to the treatment. On further enquiry, he revealed that this pigmentation has been since his childhood. There is no history of intensification of this pigmentation during summers. On examination, there is a large macule around the size of 7cm×5cm, slightly brownish in color involving major portion of the left check and submandibular area with serrated borders on the superior and medial sides of the macule (Fig. 1a). On this light brownish macular background, there are present multiple 1-2 mm dark brownish macules along Figure 1a: Speckled and lentiginous nevus on left side of the face in with some darker brownish papular lesions (nevi). a 17 year male. There was no pigmentation on the right side of the face (Fig. 1b). With such a history and further supported by cutaneous examination, a diagnosis of unilateral facial nevus spilus was made. Nevus spilus is also called as Speckled and lentiginous nevus. It is regarded as congenital melanocytic nevus. It remains usually lentiginous in early childhood and may develop palpable components at puberty in a ‘speckled’ distribution.
    [Show full text]
  • Blue Nevi and Melanomas Natural Blue BLUE NEVUS Blue Nevus (BN)
    KJ Busam, M.D. Paris, 2017 Blue Nevi and Melanomas Natural Blue BLUE NEVUS Blue Nevus (BN) • Spectrum of blue nevi – Common, Sclerosing, Epithelioid, Cellular, Plaque type blue nevi • Differential diagnosis – Melanoma ex BN or simulating BN – BN vs other tumors – Biphenotypic/collision lesions Common Blue Nevus Clinical: - Circumscribed small bluish macule/papule - Preferred sites: Scalp, wrist, foot Pathology: - Predominantly reticular dermal lesion - Pigmented fusiform and dendritic cells - Admixed melanophages - Bland cytology Common Blue Nevus Blue Nevus Sclerosing Blue Nevus Pigm BN Cellular Blue Nevus - 49 yo woman - Buttock nodule CBN Cellular Blue Nevus Thrombi and stromal edema Multinucleated giant melanocytes Cellular Blue Nevus Hemorrhagic cystic (“aneurysmal”) change Amelanotic Cellular Blue Nevus 19 yo man with buttock lesion Atypical CBN Plaque-Type Blue Nevus Plaque-type Blue Nevus Plaque Type Blue Nevus Mucosal Blue Nevus Conjunctival Blue Nevus Nodal Blue Nevus Combined epithelioid BN Blue Nevus • M Tieche 1906; Virchow Arch Pathol Anat “Blaue Naevus” • B Upshaw 1947; Surgery “Extensive Blue Nevus” (plaque-type BN) • A Allen 1949; Cancer “ Cellular Blue Nevus” Blue Nevus – Mutation Analysis Type of Lesion GNAQ GNA11 Number Common BN 6.7% 65% 60 Cellular BN 8.3% 72.2% 36 Amelanotic BN 0% 70% 10 Nevus of Ota 5% 10% 20 Nevus of Ito 16.7% 0% 7 TOTAL 6.5% 55% 139 Van Raamsdonk et al NEJM 2010; 2191-9 Blue Nevus – Mutation Analysis Type of Blue Nevus GNAQ Number Common Blue Nevus 40% 4/10 Cellular Blue Nevus 44% 4/9 Hypomelanotic
    [Show full text]