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Melanosis Circumscripta Praecancerosa (Dubreuilh)

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Melanosis Circumscripta Praecancerosa (Dubreuilh) View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector MELANOSIS CIRC[JMSCRIPTA PRAECANCEROSA (DUBRETJILIH) A NON-NEVOID PIIEMELANOMA DISTINCT FROM JUNCTION NEVUS* YUTAKA MISHIMA, Ml). Melanosis circumscripta praecancerosa of Du-monly black and by extension it may exceed the breuilh or infective senile freckle of Hutchinsonsize of the palm. The borders of the lesion are is a relatively uncommon lesion from which ma-irregular because the progression is not uniform lignant melanoma develops frequently. It is thethroughout the pigmented patch. Sometimes, while one part of the lesion is progressing, another purpose of this paper to examine the criteria bypart may show signs of regression. At the onset of which it can be distinguished from junction nevusmalignant transformation one observes thickening and to identify it as a non-nevoid prccanccrosis ofor induration in one portion of the patch which adult mclanocytcs. often produces pea to cherry-sized papules. It may become verrueous and may ulcerate and bleed CLINICAL REVIEW easily. The discoloration and thickness of the plaque is not uniform. The malignant melanoma arising from a pig- Mieseher (5) states that malignant melanomas mented plaque was first described clinically byoccur in about 30 per cent of the cases which Hutchinson. He named this pigmented plaqueincidence is considerably higher than that of infective pigment patch resembling superficialmalignant melanoma arising from junction nevus. melanosis (1) (1892) and lentigo-melanosis (2)On the other hand, Dubreuilh's melanosis is much (1894). less common than junction nevus. Dubreuilh gave it the name lentigo malin des Dubreuilh (4) observed an average period of vieillards (3) (1894) and mélanose circonscriteten years between the onset of the premalignant précancéreuse (4) (1912). Bayet (1895) termed itlesion and the development of malignant mela- "lentigo infectieux" and Miescber (5, 6) (1928)noma. Klauder and Beerman (15) recorded an called it "priicanceröse Melanose"; Hazen (7),average interval of 13 years; Mieseher (5), 29 "acquired mole"; Deckner (8) and Kumer andyears; Shaw (21), 31 years. In our group of 7 eases Lang (9), "tardive nevus"; Sachs (10), "junctionthe duration of the lesion was from 1 to 10 years nevus" and Allen (11), "dermoepidermal nevus".at the time of diagnosis. There were no malignant Becker, Sr. (12) termed it "lentigo maligna"changes in this lapse of time. classifying it as one type of junction nevus. Dubreuilh and Miescher stated that the Dubreuilh, Reese, Becker, Sr., Miescher,malignant melanoma is slow to develop from the Klauder-Beerman, and others reported a total ofpigmented lesion on the face, and lymph node about 50 cases. The following Table 1 shows theinvolvement does not occur early. Miescher localization and age of the patient at its onset. believed that generalization is very rare in the Dubreuilh's melanosis usually starts as a pin-case of facial lesions. Both authors agree that head sized, dark brown sepia spot. It is less com-on the extremities, malignant transformation de- velops more rapidly and generalization is also *Fromthe Departments of Dermatology, Wayne State University College of Medicine andmore frequent. Detroit Receiving Hospital (Hermann Pinkus, Klauder and Beerman (15) commented that M.D., Chairman) and the Detroit Institute ofafter appearance of the melanoma, particularly Cancer Research (William L. Simpson, M.D., Sci-on the face, regional lymph node involvement and entific Director), Detroit, Michigan. further metastasis is longer delayed than in the Supported in part by research grant RG-4435 and C-2072 from the National Institutes of Health,eases of malignant melanoma arising from junction U. S. Public Health Service, and in part by re-nevus. Dubreuilh's melanosis occurs frequently search contract DA-49-007-MD-584 from the Re-in older people, therefore it would appear many search and Development Division, Office of thepersons afflicted with this on the face may die of Surgeon General, Department of the Army. Abridgement of a portion of a thesis submittedother causes before malignant change takes place. by Dr. Mishima to the Faculty of the Postgraduate Reese (17—20) stated that Dubreuilh's melanosis School of Medicine, University of Tokyo, in partial of the conjunctiva pursues a more malignant fulfillment of the requirements for the degree ofcourse than that of the face and is more liable to Doctor of Philosophy in Dermatology and Syphi-undergo a malignant change than in the case of lology. Received for publication August 11, 1959. junction nevus. 361 TABLE 1 Clinical data on melanosis circumscripta praecancerosa Dubrenilh Klauder-Beerman *Dubreuilh (4) Becker. Sr. (12, 14) Miescher (6) Reese (17) Mishima C Face 17 9 2 2 1 1 4 Ear 1 Eyelid 2 C Conjunctiva 4 1 17 Eyelid and conj 3 Mucous membrane.. 2 z Scrotum 1 0) Trunk 1 Extremities 7 1 4 1 Nucha 1 1 onset Age at between 18— be- between 19— average between 35- 65 average 40—50 40 48 between 30— 68 yrs.; tween 51; average about 70 70; average yrs. yrs. yrs. 66; average average 40 34—81 39 yrs. yrs. 56 yrs. 45 yrs. yrs. C * Of 35 cases C reported by Dubreuilh, 30 cases were compiledfrom the following author's reports: Boussion (1903), Bayet (1895), Thévenin (1898), Lamarque (1888), Hutchinson (1892, 1893), Claisse et Dartigues (1899), Nicolas et Durand (1909), Fox, W. (1911). In Dubreuilh's series the cases were almost equally distributed among males and females. TABLE 2 Clinical picture of melanosis circumscripta praecancerosa Dubreuilh Case Age and Tumor Diameter Age at Beginning Clinical Diagnosis Recent Growth Remarks z No. Race Sex Site of (mm.) (Duration) Before Biopsy C 02 _____ 02 1. White 54—M 1. cheek 18 x 21 48 yrs. old Melanotic freckle Quick growth and darker Dark brown with mottling. (4 yr.) within 1 yr. 2. White 60—M r. temple 12 x 11 57 yrs. old Senile keratosis Lately itching Brown papillomatous plaque (3 yr.) freckle 3. White 67—F r. cheek 24 x 19 66 yrs. old Melanotic freckle Recent darkening Large melanotic with hy- (1 yr.) perpigmentation at one edge reddish ele- 4. Japanese 52—M pre-auric- 16 x 11 42 yrs. old Pigmented seb- Within 4 mos. quick doubling \Terrucous, brown, ular (10 yr.) orrheic kera- growth, also heat flashes vated plaque on which 4 small tosis and itching during last 2 papular tumors are present. wks. 5. White 33—M r. arm (lat- 10 x 7 31 yrs. old 1. Pigmented No recent enlargement Dark brown; black pigmented eral sur- (2 yr.) nevus lesion, with slight elevation of ma- .5mm. face) 2. Possible C lignant mela- 01 noma 6. White 40—F post nuchal 13 x 8 37 yrs. old Junction nevus Late quick growth Flat, dark nevus area (3 yrs.) with 7. White 31—M shoulder 15 x 12 30 yrs. old Malignant mela- Few weeks before became Small, flat, pigmented lesion was sus- (1 yr.) noma larger and more papular a pole center, which pected to be undergoing activa- tion. 364 THEJOURNAL OF INVESTIGATIVE DERMATOLOGY Fin. 1 (A). A 67 year old female. Lesion of one year's duration with recent darkening of color FIG. 1 (B). A 54 year old male with lesion of 3 years' duration. Both cases were confirmed histologically as Dubreuilh's melanosis circumscripta praecancerosa and treated by surgical excision. Of Dubreuilh's 35 cases only three were fatal.neighboring cells. The nucleus of these cells is One of the patients who succumbed had con-large, vesicular and the protoplasm is light and junctival involvement and two had lesions of thehoneycombed. These cells may be pigmented or extremities. Involvement of lymph nodes wasentirely pigment free. Mitosis is absent. seen in only one patient who was well two years Corsi (24) pointed out the presence of large after their removal. pagetoid cells in Dubreuilh's melanosis which at Miescher (23) (1957) reported a case of morbusfirst might lead one to think that one was dealing Paget on the male genitals which had an intensivewith Bowen's disease, but closer examination pigmentation and resembled Dubreuilh's mela-showed these cells are in fact malignant melano- nosis. Steigleder (24) (1958) described a case ofblasts. Stout (25) noted that Paget cells sometimes Dubreuilh's melanosis on the scrotum and shafthad some resemblance to malignant melanoma of the penis which clinically and histologicallycells. resembled Miescher's case, however he classified Becker, Sr. (12) divided junction nevus and it as a superficial premalignant melanosis andjunctional activity into 3 distinct groups: 1.) pointed out that this is easily confused withquiescent, smooth, pigmented nevus, 2.) active, Paget's disease when it occurs in the genitalsmooth, pigmented nevus, 3.) lentigo maligna. region. Becker called Dubreuilh's melanosis, lentigo maligna, and noted lentigo maligna was the HISTOPATIIOLOGIC REVIEW advanced stage of junction nevus which had a Dubreuilh's melanosis has been described as alocation in the pathogenetic pathway from premelanomatous lesion or malignant melanomaquiescent junction nevus to malignant mela- in situ, the next step of which is penetration intonoma. He considered lentigo maligna different the dermis and the establishment of malignantfrom quiescent and active nevus in three respects: 1.) individual cells of the lesion show malignant melanoma.Klauder and Beerman (15) described the anaplasia rather than benign growth; 2.) the characteristic feature of the lesion as a change inmalignant cells are being worked through the the region of the basal cells, which is the precursorepidermis to the surface to be cast off with the of the segregation phenomenon of nevus cells.stratum corneum, and the dopa reaction is They adopted this from Dubreuilh, and addedstrongly positive in all these cells; 3.) round cell that individual cells of the basal layer seeminfiltration is present in the superficial dermis.
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