DOCSLIB.ORG

Acquired Blue Nevi in Older Individuals Retrospective Case Series from a Veterans Affairs Population, 1991 to 2013

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Acquired Blue Nevi in Older Individuals Retrospective Case Series from a Veterans Affairs Population, 1991 to 2013 Research Case Report/Case Series Acquired Blue Nevi in Older Individuals Retrospective Case Series From a Veterans Affairs Population, 1991 to 2013 Erik S. Cabral, MD; Frank W. Chen, BA; Barbara M. Egbert, MD; Susan M. Swetter, MD IMPORTANCE Apart from the atypical mole phenotype, development of new melanocytic nevi in older individuals is uncommon and considered worrisome for melanoma. We performed a retrospective case series in a Veterans Affairs population from 1991 to 2013 to characterize blue nevi (BN) by patient age at biopsy, location, self-reported duration, and relation to prior or subsequent development of cutaneous melanoma. Author Affiliations: Department of OBSERVATIONS A total of 204 BN were identified in 194 predominantly male patients Dermatology, Veterans Affairs Palo (90.7%) who had a mean (SD) age of 62.8 (14.4) years. Clinical duration of 10 years or less Alto Health Care System, Palo Alto, California (Cabral, Swetter); was reported by 90.3% of patients with available data (32.0%). Histopathologic examination Department of Pathology Services, classified 74.0% of BN as common, 1.5% as cellular, and 24.5% as combined type. No Veterans Affairs Palo Alto Health Care malignant BN were identified; however, 18 primary melanomas were diagnosed, most System, Palo Alto, California (Egbert); Department of Dermatology, (72.2%) prior to blue nevus biopsy, including 38.9% in situ and 61.1% with mean (SD) Breslow Pigmented Lesion and Melanoma thickness of 1.02 (0.99) mm. Program, Stanford University Medical Center, Stanford, California (Cabral, CONCLUSIONS AND RELEVANCE The later patient-reported onset of BN suggests a potential Chen, Egbert, Swetter); Bennett Surgical Center, Santa Monica, alternative mechanism of nevogenesis compared with common acquired nevi and differs California (Cabral). from prior reports of BN development in younger adults. The lack of association with Corresponding Author: Susan M. melanoma in older individuals suggests that most benign-appearing BN may be safely Swetter, MD, Department of observed, even in a cohort at higher risk for skin cancer. Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, 900 Blake JAMA Dermatol. 2014;150(8):873-876. doi:10.1001/jamadermatol.2013.7366 Wilbur Dr, W0103, Stanford, CA Published online April 30, 2014. 94305-5356 ([email protected]). lue nevi (BN) are benign pigmented lesions with rare ment alteration, to malignant entities, such as pigmented basal malignant potential. They are considered a subset of cell carcinoma or melanoma. B dermal dendritic melanocytic proliferations, which de- Apart from the setting of the atypical mole or dysplastic rive their dark blue or bluish black color from the scattering nevi syndrome, development of new melanocytic nevi after of light by dermal melanin, known as the Tyndall effect.1,2 The age 50 years is uncommon and raises concern about the diag- melanocytes in BN typically stain positive for Human Mela- nosis of cutaneous melanoma. Based on our clinical observa- noma Black-45 (HMB-45), suggesting that BN stem from la- tion of the increased frequency and later onset of BN in a pre- tent dendritic melanocytes trapped in the dermal layer dur- dominantly elderly population, we sought to characterize BN ing their migration from the neural crest to the epidermis.3 clinically and histopathologically to elucidate patient- There are 3 main histologic subtypes of BN: common (includ- reported age of onset, the relationship to prior, concomitant, ing sclerotic type), combined, and cellular. Common BN gen- or subsequent primary melanoma, and their malignant po- erally present as solitary and small (1-5 mm) dark blue mac- tential, including the proportion of cases identified as malig- ules or dome-shaped papules. Blue nevi are also commonly nant BN or blue nevus–like melanoma. observed as part of combined nevi, most often in conjunc- tion with a compound or intradermal nevus, and less fre- quently, with a Spitz or dysplastic nevus. Cellular BN are more Report of Cases likely than common BN to be elevated, larger in size, and have greater malignant potential.1 A retrospective review of BN identified from 1991 to 2013 Patients may report BN as an aesthetic concern because in the Veterans Affairs Palo Alto Health Care System they are often mistaken for cosmetic or traumatic tattoos. For (VAPAHCS) Pathology Service database was performed, the clinician, the differential diagnosis ranges from benign en- with clinical chart review to determine patient outcome, tities, such as common nevi, tattoo, or postinflammatory pig- reported duration of the lesion, and other clinical character- jamadermatology.com JAMA Dermatology August 2014 Volume 150, Number 8 873 Copyright 2014 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/28/2021 Research Case Report/Case Series Acquired Blue Nevi in Older Individuals istics. The VAPAHCS electronic medical record did not A total of 204 cases of biopsy-proven BN were identified become widely available until 1997, thereby limiting clinical in 194 patients who had a mean (SD) age of 62.8 (14.4) years, data annotation for 33 patients. Clinical outcome data were with most biopsies being performed to exclude the diagno- assessed through May 30, 2013. The study was approved by sis of melanoma based on patient report of short or Stanford University and VAPAHCS institutional review unknown duration of the lesion. Patients were predomi- boards. nantly male (90.7%) and white, typical of the VAPAHCS population, although race/ethnicity was not noted in all cases. The mean duration of patient follow-up was 9.0 years Table 1. Clinical and Histopathological Characteristics of 204 Blue Nevi in 194 Patients (range, 0-22 years). In terms of histologic subtypes, 151 of 204 BN (74.0%) Characteristic No. (%) were diagnosed as common, 50 of 204 (24.5%) were diag- Sex nosed as combined (BN with intradermal nevus in 84.0% Male 176 (90.7) and compound nevus in 16.0%, 2 of which were also noted Female 18 (9.3) to be mild to moderately dysplastic), and 3 of 204 (1.5%) as Age at diagnosis, mean (SD), y 62.8 (14.4) cellular. Most BN were located on the extremities (93 of 204 Pathologic diagnosis [45.6%]), followed by the head and neck (64 of 204 [31.3%]), Common 151 (74.0) and the back (35 of 204 [17.2%]). Of the 15 BN on the hands, Cellular 3 (1.5) 8 (53.3%) were on the dorsal surface, while only 2 of 9 BN on Combined 50 (24.5) the feet (22.2%) were located dorsally. For the 64 head and Body site neck BN, 33 (51.6%) were located on the scalp, 16 (25.0%) on Scalp 33 (16.2) the forehead-temple-eyebrow-eyelid region, 6 (9.4%) on the Posterior auricular region 1 (0.5) preauricular-cheek region, 3 (4.7%) on the ear, 2 (3.1%) in Forehead-temple-eyebrow-eyelid region 16 (7.8) the oral mucosa, 2 (3.1%) on the neck, and 1 each (1.6%) on Mucosal, conjunctiva 1 (0.5) the posterior auricular region and conjunctival mucosa. Cel- Preauricular-cheek region 6 (2.9) lular blue nevi were located on the scalp, upper back, and Ear 3 (1.5) dorsal hand. Mucosal, oral 2 (1.0) Clinical and histologic features are summarized in Table 1 Neck 2 (1.0) and representative histopathologic images are shown in the Arm 58 (28.4) Figure. Hand 15 (7.4) The estimated duration of the BN prior to biopsy diagno- sis was based on patient-reported onset of the lesion. Clinical Back 35 (17.2) duration was available for 65 BN in 62 patients, of whom 56 Chest 7 (3.4) (who had a mean [SD] age of 57.8 [15.9] years) reported acquir- Trunk 5 (2.5) ing the nevus 10 years or less prior to diagnostic biopsy. Nine Leg 11 (5.4) patients reported the lesion as being of “new” onset. Only 10 Foot 9 (4.4) patients reported a recent change in size or symptoms of the Figure. Representative Hematoxylin-Eosin–Stained Histopathologic Features A B A, Blue nevus, sclerotic type with dendritic melanocytes interspersed in dense collagen. B, Combined nevus with nevocellular intradermal nevus and dendritic melanocytes (original magnification ×10 for both). 874 JAMA Dermatology August 2014 Volume 150, Number 8 jamadermatology.com Copyright 2014 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/28/2021 Acquired Blue Nevi in Older Individuals Case Report/Case Series Research Table 2. Clinical and Histopathological Characteristics of 18 Melanoma in 16 Patients Diagnosed as Having Blue Nevi Patient No./ Blue Nevi Melanoma Breslow Depth, Timing of Melanoma Sex/Age, y Location Location mm Diagnosis, y 1/M/76 Trunk Nose 3.70 After, 10 2/M/50 Oral mucosa Back 0.79 After, 8 3/M/74 Right mid back Upper back 0.76 Before, 2 4/M/49 Left shoulder Left arm 1.90 Before, 3 5/M/75 Chest Trunk 0.30 Before, 0.5 6/M/76 Left arm Right forearm 0.25 Before, 3 7/M/74 Leg Chest MIS Same time 8/M/65 Temple Chest 0.60 Same time 9/M/79 Left side of back Left lower back 0.95 Before, 1 10/M/82 Back Arm MIS Same time 11/M/63 Mid back 1. Left lower back 1. MIS Before, 0.5 for both 2. Right cheek 2. 0.70 12/M/63 Scalp Back 0.45 Before, 9 13/M/79 Chest Arm MIS Before, 3 14/M/89 Back Neck MIS Before, 2 15/M/76 Left side of back 1. Left upper back 1. MIS Before, 1 for both 2.
Load more

Recommended publications
  • A Case of Intradermal Melanocytic Nevus with Ossification (Nevus of Nanta)
    197 A Case of Intradermal Melanocytic Nevus with Ossification (Nevus of Nanta) Young Bok Lee, M.D., Kyung Ho Lee, M.D., Chul Jong Park, M.D. Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea A 49-year-old woman presented with a 30-year history of asymptomatic plaque on her right temple. The histological examination revealed nests of nevus cells throughout the entire dermis. Bony spicules were seen just beneath the nevus cell nests in the lower dermis. Cutaneous ossification is an unusual event. Herein, we present a case of intradermal melanocytic nevus with unusual ossification (nevus of Nanta). To the best of our knowledge, this is the first such case report in the Korean literature. (Ann Dermatol (Seoul) 20(4) 197∼199, 2008) Key Words: Melanocytic nevus, Ossification INTRODUCTION drug intake or medical illness. The histological examination showed a dense proliferation of benign Ossification within the skin may occur in a nevus cells in the upper dermis. They were arranged variety of conditions, including pilomatricoma, basal in nests surrounding the hair follicles (Fig. 2). Bony cell carcinoma, appendageal and fibrous prolifera- spicules were seen in the lower dermis, underneath 1,2 tion, inflammation and trauma . The occurrence of the nevus cell nests. Some of them were compact ossification within a melanocytic nevus is an un- while others were surrounded by mature fatty tissue 3-5 usual event . (Fig. 3). Herein, we present a case of intradermal melano- cytic nevus with unusual ossification (nevus of Nanta). To the best our knowledge, this is the first such case report in the Korean literature.
    [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]
  • Oral Pathology
    Oral Pathology Palatal blue nevus in a child Catherine M. Flaitz DDS, MS Georgeanne McCandless DDS Dr. Flaitz is professor, Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Stomatology, University of Texas at Houston Health Science Center Dental Branch; Dr. McCandless has a private practice in The Woodlands, TX. Correspond with Dr. Flaitz at [email protected] Abstract The intraoral blue nevus occurs infrequently in children. This by the labial mucosa (1). Intraoral lesions have a predilection case report describes the clinical features of an acquired blue ne- for females in the third and fourth decades, in contrast to cu- vus in a 7 year-old girl that involved the palatal mucosa. A taneous lesions that normally develop in children. In large differential diagnosis and justification for surgical excision of this biopsy series, only 2% of the oral blue nevi are diagnosed in oral lesion are discussed. (Pediatr Dent 23:354-355, 2001) children and adolescents (1). Similar to their cutaneous coun- terpart, most oral lesions are acquired; however, there are ith the exception of vascular entities, neoplastic isolated reports of congenital examples. lesions with a blue discoloration are an unusual find Clinically, most lesions present as a solitary blue, gray or Wing in children. Although the blue nevus is a blue-black macule or slightly raised nodule that measures less relatively common finding of the skin in the pediatric popula- than 6 mm in size. The margins are often regular but indis- tion, only a few intraoral examples are documented in the tinct and the surface is smooth.
    [Show full text]
  • Identification of HRAS Mutations and Absence of GNAQ Or GNA11
    Modern Pathology (2013) 26, 1320–1328 1320 & 2013 USCAP, Inc All rights reserved 0893-3952/13 $32.00 Identification of HRAS mutations and absence of GNAQ or GNA11 mutations in deep penetrating nevi Ryan P Bender1, Matthew J McGinniss2, Paula Esmay1, Elsa F Velazquez3,4 and Julie DR Reimann3,4 1Caris Life Sciences, Phoenix, AZ, USA; 2Genoptix Medical Laboratory, Carlsbad, CA, USA; 3Dermatopathology Division, Miraca Life Sciences Research Institute, Newton, MA, USA and 4Department of Dermatology, Tufts Medical Center, Boston, MA, USA HRAS is mutated in B15% of Spitz nevi, and GNAQ or GNA11 is mutated in blue nevi (46–83% and B7% respectively). Epithelioid blue nevi and deep penetrating nevi show features of both blue nevi (intradermal location, pigmentation) and Spitz nevi (epithelioid morphology). Epithelioid blue nevi and deep penetrating nevi can also show overlapping features with melanoma, posing a diagnostic challenge. Although epithelioid blue nevi are considered blue nevic variants, no GNAQ or GNA11 mutations have been reported. Classification of deep penetrating nevi as blue nevic variants has also been proposed, however, no GNAQ or GNA11 mutations have been reported and none have been tested for HRAS mutations. To better characterize these tumors, we performed mutational analysis for GNAQ, GNA11, and HRAS, with blue nevi and Spitz nevi as controls. Within deep penetrating nevi, none demonstrated GNAQ or GNA11 mutations (0/38). However, 6% revealed HRAS mutation (2/32). Twenty percent of epithelioid blue nevi contained a GNAQ mutation (2/10), while none displayed GNA11 or HRAS mutation. Eighty-seven percent of blue nevi contained a GNAQ mutation (26/30), 4% a GNA11 mutation (1/28), and none an HRAS mutation.
    [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]
  • 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]
  • 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]
  • 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]
  • 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]
  • Pediatric Dermatology- Pigmented Lesions
    Pediatric Dermatology- Pigmented Lesions OPTI-West/Western University of Health Sciences- Silver Falls Dermatology Presenters: Bryce Lynn Desmond, DO; Ben Perry, DO Contributions from: Lauren Boudreaux, DO; Stephanie Howerter, DO; Collin Blattner, DO; Karsten Johnson, DO Disclosures • We have no financial or conflicts of interest to report Melanocyte Basic Science • Neural crest origin • Migrate to epidermis, dermis, leptomeninges, retina, choroid, iris, mucous membrane epithelium, inner ear, cochlea, vestibular system • Embryology • First appearance at the end of the 1st trimester • Able to synthesize melanin at the beginning of the 2nd trimester • Ratio of melanocytes to basal cells is 1:10 in skin and 1:4 in hair • Equal numbers of melanocytes across different races • Type, number, size, dispersion, and degree of melanization of the melanosomes determines pigmentation Nevus of Ota • A.k.a. Nevus Fuscocoeruleus Ophthalmomaxillaris • Onset at birth (50-60%) or 2nd decade • Larger than mongolian spot, does not typically regress spontaneously • Often first 2 branches of trigeminal nerve • Other involved sites include ipsilateral sclera (~66%), tympanum (55%), nasal mucosa (30%). • ~50 cases of melanoma reported • Reported rates of malignant transformation, 0.5%-25% in Asian populations • Ocular melanoma of choroid, orbit, chiasma, meninges have been observed in patients with clinical ocular hyperpigmentation. • Acquired variation seen in primarily Chinese or Japanese adults is called Hori’s nevus • Tx: Q-switched ruby, alexandrite, and
    [Show full text]
  • Clinical Pigmented Skin Lesions Nontest-June 11
    Recognizing Melanocytic Lesions James E. Fitzpatrick, M.D. University of Colorado Health Sciences Center No conflicts of interest to report Pigmented Skin Lesions L Pigmented keratinocyte neoplasias – Solar lentigo – Seborrheic keratosis – Pigmented actinic keratosis (uncommon) L Melanocytic hyperactivity – Ephelides (freckles) – Café-au-lait macules L Melanocytic neoplasia – Simple lentigo (lentigo simplex) – Benign nevocellular nevi – Dermal melanocytoses – Atypical (dysplastic) nevus – Malignant melanocytic lesions Solar Lentigo (Lentigo Senilis, Lentigo Solaris, Liver Spot, Age Spot) L Proliferation of keratinocytes with ↑ melanin – Variable hyperplasia in number of melanocytes L Pathogenesis- ultraviolet light damage Note associated solar purpura Solar Lentigo L Older patients L Light skin type L Photodistributed L Benign course L Problem- distinguishing form lentigo maligna Seborrheic Keratosis “Barnacles of Aging” L Epithelial proliferation L Common- 89% of geriatric population L Pathogenesis unknown – Follicular tumor (best evidence) – FGFR3 mutations in a subset Seborrheic Keratosis Clinical Features L Distribution- trunk>head and neck>extremities L Primary lesion – Exophytic papule with velvety to verrucous surface- “stuck on appearance” – Color- white, gray, tan, brown, black L Complications- inflammation, pruritus, and simulation of cutaneous malignancy L Malignancy potential- none to low (BCC?) Seborrheic Keratosis Seborrheic Keratosis- skin tag-like variant Pigmented Seborrheic Keratosis Inflamed Seborrheic Keratosis Café-au-Lait
    [Show full text]