Fewer melanocytic nevi found in children with active atopic dermatitis than in children without dermatitis

OBJECTIVE

To investigate the effects of atopic diseases on nevus development during childhood.

DESIGN

A descriptive survey of nevi in a cohort of 8- and 9-year-old children combining a skin examination and a validated questionnaire regarding atopic dermatitis, allergic rhinoconjunctivitis, and bronchial asthma.

SETTING

Fifty-one primary schools in Sweden.

PARTICIPANTS

A total of 788 children born in 1992 participated in 1999 in a prevalence study of allergic diseases. The present study was restricted to the 545 children from that study who were still living in the community, and 515 (94%) of them participated. The cumulative incidence of atopic dermatitis, allergic rhinoconjunctivitis, and bronchial asthma was 24%, 12%, and 13%, respectively, from birth to age 7 years as reported by questionnaire; 3% reported all 3 diagnoses.

RESULTS

Children with reported atopic dermatitis and findings of active dermatitis on examination had fewer nevi (median, 4; mean, 7.4) than children with no reported atopic disease and no active dermatitis found on examination (median, 9; mean, 11.2) (P<.001). Children who developed active atopic dermatitis after the questionnaire was filled out (ie, during the last 2 years) had fewer nevi than children with no atopic disease (median, 3; mean, 5.3) (P<.001). There was no difference in nevus number between the children with bronchial asthma or allergic rhinoconjunctivitis and children with no atopic disease.

CONCLUSION

Children with atopic dermatitis had few melanocytic nevi, which suggests that the proinflammatory cytokine network in the atopic skin might inhibit melanocyte growth and/or progression to nevi.

Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy

BACKGROUND

Dermoscopy has improved the sensitivity and specificity of clinical diagnosis of melanoma from 60% to over 90%. However, in order not to miss melanoma a certain percentage of suspicious but benign lesions has to be excised.

OBJECTIVES

To evaluate the dermoscopic changes and the rates of excision in benign melanocytic naevi and cutaneous malignant melanoma in long-term follow-up of high-risk patients using digital dermoscopy.

METHODS

Digital dermoscopic images of 2015 atypical melanocytic naevi in 196 high-risk patients were analysed retrospectively. Among others, the following data were collected for each naevus: changes in surface area, overall architecture, dermoscopic patterns and distribution of pigmentation. All tumours suspicious for melanoma or showing asymmetrical changes were excised.

RESULTS

During a median follow-up time of 25 months 128 (6.4%) of all naevi showed changes in size or architecture. Eighty-six per cent of all changes in patients who attended more than one visit were observed at the first follow-up visit. Thirty-three lesions showing changes were excised and two melanomas in situ and 31 melanocytic naevi were diagnosed.

CONCLUSIONS

Follow-up examinations using digital dermoscopy revealed unchanged morphology in the large majority of melanocytic naevi. Excisions were only performed in cases of asymmetrical growth, asymmetrical changes of pigmentation, or development of dermoscopic features indicative of melanoma. The ratio of 33 lesions excised in order to identify two melanomas in situ seems reasonable and may be further reduced in future.

Phacomatosis pigmentokeratotica: a 20-year follow-up with malignant degeneration of both nevus components

Phacomatosis pigmentokeratotica is a rare syndrome defined by the association of an organoid nevus occasionally with sebaceous differentiation, a speckled lentiginous nevus, and other extracutaneous anomalies. The disorder is a consequence of the so-called twin spot genetic mechanism. We describe the first occurrence involving malignant degeneration of both nevus components, giving rise to three basal cell carcinomas over the sebaceous nevus and a malignant melanoma of the superficial spreading type over the speckled lentiginous nevus. This observation, in concert with the other instances reported in the literature, points to the need for adequate patient follow-up to ensure early detection and treatment of any possible associated malignant degeneration.

Combined Mastocytoma-Junctional Nevus

A unique combined mastocytoma-junctional nevus presented as a 4-mm dark brown macule in the axilla of a 57-year-old white female. Histopathologic examination revealed a proliferation of mast cells partially or completely filling the dermal papillae, hyperpigmentation of the basal keratinocytes and mildly increased basal melanocytes. Overlying the mast cell proliferation, pigmented junctional nevus nests were present. The mast cells were strongly positive with Giemsa stain and mast cell tryptase immunohistochemical stain; nevomelanocytic cells were negative. Nevomelanocytes were strongly immunoreactive for S100, HMB-45, Mart-1, and tyrosinase; mast cells were negative. The clinicopathologic features suggested a synchronous proliferation of 2 cell types in the same small cutaneous field rather than a collision tumor. While the cutaneous mast cells probably originated as a disseminated clone, it is postulated that local mast cell growth factor induced nevomelanocytic proliferation and modulated mast cell growth. In fact, the tumor exhibited strong immunoreactivity for the mast cell growth factor receptor (CD117) in mast cells, basal melanocytes, and nevus nests. The incidence of dual mast cell-melanocytic tumors appears to be very low, as only 3 total cases have now been reported. However, since in patients with multiple mastocytomas only a small fraction of lesions are biopsied, the true incidence may be higher than supposed.

Transpupillary thermotherapy for subfoveal choroidal neovascularization associated with choroidal nevus

PURPOSE

To describe a patient with classic subfoveal choroidal neovascularization (CNV) associated with choroidal nevus, which was successfully treated using transpupillary thermotherapy.

DESIGN

Interventional case report.

METHODS

A 53-year-old woman underwent ophthalmologic evaluation, including fluorescein and indocyanine green angiography. Clinical and angiographic data were prospectively analyzed to evaluate visual acuity changes and angiographic evolution.

RESULTS

Three months after transpupillary thermotherapy, visual acuity had improved from 20/100 to 20/40. Fluorescein and indocyanine green angiograms showed absence of leakage from CNV. Final visual acuity was 20/32 after a 15-month follow-up.

CONCLUSIONS

Transpupillary thermotherapy may be a viable option for subfoveal CNV associated with CN, although further studies are needed to establish the correct setting.

Carbon dioxide laser therapy for an inflammatory linear verrucous epidermal nevus: a case report

The treatment of an inflammatory linear verrucous epidermal nevus (ILVEN), an uncommon type of epidermal nevus, is still controversial. The use of laser therapy is a recently reported method. Although various results have been reported with the use of the laser in the treatment epidermal nevis, the authors have not seen any report on the use of the carbon dioxide laser in ILVEN treatment. They present case of ILVEN treated with the carbon dioxide laser. All symptoms (erythema, excoriation, granulation, and pruritus) disappeared. Instead, a pale pigmentation was seen.

Malignant melanoma of pleura in a patient with giant congenital ?bathing suit? hairy nevus

An unusual case of malignant melanoma of the pleura in a patient with "bathing-suit" type of giant congenital hairy nevus is presented. The treatment advocated and the outcome are discussed.

Ocular manifestations and surgical management of lid coloboma in a Chinese infant with linear nevus sebaceous syndrome

An 8-month-old Chinese girl with linear nevus sebaceous syndrome had a right upper lid coloboma and right superior scleral ectasia. At 20 months old, successful surgical repair of the lid coloboma was performed with particular attention paid to the sclera ectasia.

Risk of melanoma arising in large congenital melanocytic nevi: a systematic review

Large congenital melanocytic nevi are cutaneous lesions regarded by many as premalignant; estimates of malignancy incidence range from 0 to 42 percent. Given the often complex and extensive nature of large congenital melanocytic nevi resection and reconstruction, the risk of malignant transformation is a crucial factor that surgeons and families must weigh when deciding whether or not to excise the lesion. The authors conducted a systematic analysis of data from the existing literature to critically evaluate the published studies and to establish a crude incidence rate for the risk of malignant melanoma transformation in large congenital melanocytic nevi. After a comprehensive literature search, they analyzed data from eight studies (containing a total of 432 large congenital melanocytic nevi patients) of sufficient scientific quality. Twelve patients (2.8 percent) in this sample developed cutaneous malignant melanoma during the reported follow-up periods. Using a subset of this data and comparing the incidence rates to those of the Surveillance, Epidemiology, and End Results population-based database using a standardized morbidity ratio, the authors found that the large congenital melanocytic nevi patients had an increased risk of melanoma (standardized morbidity ratio, 2599; 95 percent confidence interval, 844 to 6064) compared with the general population. Regarding treatment before developing melanoma in the 12 patients, 50 percent were observed before diagnosis, 17 percent had partial excision, 8.3 percent had dermabrasion, 8.3 percent had a chemical peel, and 17 percent did not have any treatment information. These combined data are clinically useful when consulting with the parents of children with large congenital melanocytic nevi and in the management of older patients with existing lesions. This study shows that there is a significantly increased risk of melanoma in large congenital melanocytic nevi patients. The data also reveal the need for a standardized definition of large congenital melanocytic nevi and a long-term, prospective outcomes study to determine the true lifetime risk of melanoma in patients with and without surgical excision.

Number of acquired melanocytic nevi in patients with melanoma and control subjects in Japan: Nevus count is a significant risk factor for nonacral melanoma but not for acral melanoma

BACKGROUND

Epidemiologic studies have suggested that number of acquired melanocytic nevi is a risk factor for melanoma development in Japanese as it is in white populations. However, there are only a few population-based studies on acquired nevi in Asian populations, and no epidemiologic study on relationship between number of acquired nevi and melanoma in Japanese populations has been reported.

OBJECTIVE

The purpose of this study was to assess number, size, and distribution of acquired melanocytic nevi in a Japanese population. Particular attention was paid to evaluation of relationship between number of acquired nevi and development of nonacral or acral malignant melanoma.

METHODS

In all, 82 patients with malignant melanoma and 600 control subjects were included in this study. All participants were Japanese. The number of acquired melanocytic nevi, 2 mm or larger in diameter, on the whole body except the scalp and genital areas was counted by experienced dermatologists. The participants were divided into 5 age categories (0-19, 20-39, 40-59, 60-79, and >80 years old) for the statistical analyses. This categorization adjusted the age and sex distribution between patients with melanomas and control subjects in 40- to 59-, 60- to 79-, and over 80-year-old groups.

RESULTS

In the control Japanese population, the number of acquired melanocytic nevi on the whole body increased with age in 0- to 19-year-old age group and reached the highest number, 6.7 +/- 8.1/person, in 20- to 39-year-old group. In patients with nonacral melanoma, the number of acquired nevi on the whole body in 40- to 59- and 60- to 79-year-old groups was significantly higher than that of the corresponding control group. In contrast, the rate of individuals who had acquired nevi on soles, palms, and nail apparatus was not significantly different between acral melanoma group and the control group in 40- to 59- and 60- to 79-year-old groups.

CONCLUSION

This study has revealed that a large number of acquired melanocytic nevi is a risk factor for the development of nonacral melanoma in Japanese and white populations. However, acquired nevi on soles, palms, and nail apparatus do not seem to be a risk factor for acral melanoma in Japanese populations.

Bathing trunk naevus and neurofibromatosis type 1: a unique association of Friedrich's ataxia

A 15-year-old male presented with history of progressive instability of gait for last 6 months. General examination revealed multiple subcutaneous nodules all over the body. There was a large pigmented naevus over the lower back area along with a subcutaneous bosselated swelling over right arm. Neurological examination revealed features of gait ataxia. Plantar reflexes were extensor on both sides. Skin biopsy from the pigmented naevus showed features of melanocytic naevus. Electrophysiological studies of both common peroneal and sural nerves revealed features of axonal neuropathy. With the above clinical and laboratory findings a diagnosis of neurofibromatosis type 1 accociated with bathing trunk naevus and Friedrich's ataxia was entertained.

Genital lentigines and melanocytic nevi with superimposed lichen sclerosus: a diagnostic challenge

BACKGROUND

Benign pigmented lesions of the genitalia, such as genital lentigines and melanocytic nevi, often show clinical and histopathologic features highly suggestive of malignant melanoma (MM). Superimposed changes of lichen sclerosus (LS) may cause real concern and lead to an erroneous diagnosis of MM.

OBJECTIVE

This study was performed to assess clinicopathologic characteristics of genital lentigines and melanocytic nevi with associated LS.

METHODS

We performed a retrospective review of 5 cases.

RESULTS

Histopathologic sections of the 2 cases of genital lentigines with concurrent changes of LS showed a lichenoid lymphocytic infiltrate and pigment incontinence with melanophages in a fibrosed papillary dermis, features reminiscent of completely regressed MM. The 3 cases of genital melanocytic nevi and superimposed LS were sharply circumscribed, relatively symmetric, but revealed confluent nests varying in size and shape and pagetoid upward spread of melanocytic nests and single melanocytes. Changes of LS extended beyond the melanocytic proliferation.

CONCLUSION

Genital lentigines and melanocytic nevi with associated LS may show features that mimic MM.

Neurocutaneous melanosis associated with Dandy—Walker malformation and a meningohydroencephalocele

Neurocutaneous melanosis and Dandy-Walker malformation are both forms of rare congenital neurodysplasia. Interestingly, 8 to 10% of patients with neurocutaneous melanosis also harbor an associated Dandy-Walker malformation, indicating that these developmental abnormalities share a common origin. The authors describe a case of neurocutaneous melanosis associated with Dandy-Walker malformation and an occipital meningohydroencephalocele with a giant melanotic nevus. Multiple congenital liver masses were also observed in the infant. The occipital nevus was totally excised, and ventriculoperitoneal and cyst-peritoneal shunts were created to prevent subsequent hydrocephalus. Findings in this case support the possibility that excessive melanocytes hinder normal mesenchymal development, causing Dandy-Walker malformation and an occipital meningocele.

Is High Mole Count a Marker of More Than Melanoma Risk?

BACKGROUND

The number of melanocytic nevi is the best single marker of increased melanoma risk. In a previous study, adults with severe eczema were reported to have significantly fewer nevi than adults without eczema.

OBSERVATIONS

In a nested case-control design within a randomized, controlled interventional trial of additional sun protection vs standard care in 269 children, a history of eczema was reported by the parents of 44 (16%) of the children. More nevi were found in children with a parental report of previous eczema diagnosis than in children without reported eczema (median, 7.5 nevi vs 5.0 nevi; P =.01). Eczema diagnosis was most significantly associated with more melanocytic nevi in children with lightly pigmented skin (8.5 nevi vs 6.0 nevi; P <.001). In multivariate logistical regression analysis, including assessment of hair color, sun protection practices, and study assignment (intervention vs standard care), eczema status remained significantly predictive of nevi number in children (P <.001).

CONCLUSIONS

In contrast to a previous study that associated severe eczema with fewer nevi in adults, in the present study children with a reported history of eczema had more nevi than children without a reported history of eczema.

[Melanocytic nevi as one of the risk factors of melanoma malignum]

The paper presents the contemporary view on the melanocytic nevi and their role in the pathogenesis of skin malignant melanoma. There is a strong relationship between the presence of the melanocytic naevi and the incidence of melanoma malignum. Therefore dermatologists should pay close attention to patients from the risk group, with many common melanocytic naevi and atypical melanocytic naevi, family history of melanoma, bright fair skin, with history of sun burns. These patients should be thoroughly and regularly checked up. Examination should include photographic surveillance and dermatoscopy and every suspected mole should be excised with further histological examination. This kind of procedure intensifies the possibility of early recognition of melanoma malignum of the skin, which is crucial for successful treatment of this dangerous disease.

Painful spitz naevus sole of foot

A 21-year-old student of sports science presented with a 12-month history of a painful nodule on the sole of her left foot, which severely constrained her sporting activities. She was otherwise well. On examination there was a bluish pink 7-mm nodule on the arch of her left foot (Fig. 1). It was firm, exquisitely tender and she walked with a slight limp. The lesion was curetted and sent for histological diagnosis. The specimen showed a symmetrical wedge-shaped compound melanocytic lesion reaching the margins of the biopsy. The overlying epidermis was acanthotic and hyperkeratotic. Junctional nests were present and there was clefting between them and the epidermis (Fig. 2). Near the nests were eosinophilic globules (Kamino bodies) and pigment-laden macrophages. The lesion consisted of a mixture of large spindle and epithelioid cells with abundant eosinophilic cytoplasm and plump nuclei with prominent nucleoli. There were a few mitoses but none was atypical. Single epithelioid melanocytes were present deep within the lesion (outlier cells) and there was maturation with depth in the dermis. The histological features were those of Spitz naevus. There was significant reduction in the severity of her pain after curettage but the pain subsequently recurred. In view of this and possible incomplete excision, the scar was re-excised with a narrow margin. Histology confirmed complete excision of the residual naevus. Her symptoms have since subsided.

Number of Satellite Nevi as a Correlate for Neurocutaneous Melanocytosis in Patients With Large Congenital Melanocytic Nevi

BACKGROUND

Patients with large congenital melanocytic nevi (LCMN) are at risk for neurocutaneous melanocytosis (NCM). Patients with LCMN on the posterior axis or in conjunction with many satellite melanocytic nevi seem to represent subgroups at greatest risk.

OBJECTIVE

To determine the relationship between LCMN location, number of satellite nevi, and risk of NCM.

DESIGN

Descriptive survey study.

SETTING

An Internet Web-based registry of patients with LCMN, maintained by a nevus support group (Nevus Outreach Inc).

PARTICIPANTS

Individuals with LCMN or their guardians visiting the Nevus Outreach Web site were provided the opportunity to complete the questionnaire.

OUTCOME MEASURES

Location of LCMN, number of satellite nevi, and NCM as assessed by patient self-report.

RESULTS

A total of 379 patients with LCMN were evaluated, 26 of whom had NCM. A significantly higher percentage of patients with NCM had their LCMN on the posterior axis compared with patients without NCM (96% and 70%, respectively). Patients with NCM had significantly more satellite melanocytic nevi compared with non-NCM patients (median, 68.5 and 18, respectively). Furthermore, patients with LCMN and more than 20 satellites had a 5.1-fold (95% confidence interval, 1.9-14.0) increased risk for NCM compared with LCMN patients with 20 or fewer satellites. Logistic regression analysis, controlling for age, sex, number of satellite nevi, and LCMN location, identified number of satellite nevi as the only significant risk factor for NCM.

CONCLUSIONS

The presence of large numbers of satellite nevi is the most important risk factor for NCM in patients with LCMN. Although location of the LCMN on the posterior axis was a moderate risk factor for NCM in univariate analysis, the strength of the relationship was attenuated in the multivariate analysis.

Extensive speckled lentiginous nevus associated with giant congenital melanocytic nevus: an unusual example of twin spotting?

A 15-year-old boy had an unusual combination of giant congenital melanocytic nevus on his back and a large speckled lentiginous nevus arranged in a checkerboard pattern on the dorsal and lateral aspects of his trunk. The two pigmentary nevi showed distinguishing features both clinically and histopathologically. The speckled lentiginous nevus was not noted at birth but became visible during childhood. We hypothesize that this uncommon co-occurrence may represent a further example of twin spotting and may be categorized as a new, distinct type of phacomatosis.

Schimmelpenning-Feuerstein-Mims syndrome with hypophosphatemic rickets

The Schimmelpenning-Feuerstein-Mims syndrome (SFM syndrome) is a rare and variable multisystem defect consisting of congenital, extensive linear nevus sebaceus and associated abnormalities in different neuroectodermal organ systems. We present the history of a 52-year-old female patient with disproportionate hyposomia and asymmetric constitution. From birth she suffered from a right-sided, extensive nevus sebaceus following Blaschko's lines extending on the scalp, neck, right arm and trunk. At the age of 5 years, she developed a generalized growth retardation, along with deformations of bones. At the age of 11, hypophosphatemic rickets was diagnosed causing this growth retardation. Moreover, the patient developed a precocious puberty at the age of 9 years. When we saw the patient 40 years after the diagnosis had been made, phosphaturia had returned to normal. Specific therapy of hypophosphatemic rickets is straightforward and efficient in preventing late complications like growth retardation. We suggest to conduct appropriate laboratory tests in early childhood in patients with an extensive systematized sebaceous nevus or with additional signs of growth retardation or skeletal involvement, in order to exclude hypophosphatemic rickets associated with SFM syndrome.

Histologic features of melanocytic nevi seen in association with mycosis fungoides

BACKGROUND

Many different tumors have been reported to occur simultaneously as collision lesions. To date, no such events have been reported between mycosis fungoides (MFs) and melanocytic neoplasms.

METHODS

Two cases are presented in which patches of MF were superimposed on melanocytic nevi. In addition, 967 biopsies of MF from 411 patients were identified in an 8-year retrospective database search. Patient pathology history summaries were reviewed to identify inflamed nevi, atypical nevi, and melanoma submitted for histologic evaluation from this population.

RESULTS

The occurrence of MF in a congenital nevus was associated with a halo phenomenon restricted to the affected region of the nevus in one patient. In the other patient, nests of two morphologies (lymphocytic and melanocytic) in the same biopsy presented a potentially confusing histologic picture. No other cases of MF superimposed on a nevus were identified in 967 biopsies from 411 patients with a histological diagnosis of MF seen over the past 8 years. In this population, 57 biopsies of melanocytic lesions were identified from 28 patients, including three atypical nevi and three melanomas.

CONCLUSIONS

The presence of MF superimposed on a nevus is rare and may lead to confounding histologic features or the development of a halo nevus phenomenon.

A patient with extensive blue rubber bleb nevi associated with multiple congenital anomalies: an overlap or a new syndrome?

We report a case of a 13 year old boy with non-familial, multiple blue rubber bleb nevi (BRBN). He also had additional dysmorphic anomalies including a low hairline, low set ears, narrow nares, ptosis, hypotelorism, a high arched palate and downward slanting of the outer canthi. Skeletal deformities included a short, slightly webbed neck, kyphosis, cubitus valgus, non-traumatic luxation of the head of the right radius and a short left little and index fingers. He had no evidence of gastrointestinal lesions or bleeding, congenital heart or renal disease or enchondromata. The boy was mentally slow compared to his peers. He had normal chromosomes. The absence of gastrointestinal bleeding or iron deficiency anaemia is inconsistent with Bean's syndrome and the lack of enchondromata in this patient militates against the diagnosis of classical Maffucci syndrome. Some of his physical features are obviously similar to those observed in a Noonan's syndrome yet the presence of extensive BRBN would be an extremely unusual finding. Since the overall picture does not fit into any of the classical categories mentioned above, the constellation of his features has yet to find a specific syndrome. It may, however, represent an overlap between them or, possibly, a new syndrome.

Photodynamic therapy for choroidal neovascularization secondary to choroidal nevus

PURPOSE

To describe a patient treated with photodynamic therapy for subfoveal choroidal neovascularization secondary to choroidal nevus.

DESIGN

Interventional case report.

METHODS

A 61-year-old woman presented with subfoveal choroidal neovascularization secondary to choroidal nevus and best-corrected visual acuity of 20/50. The choroidal neovascularization was treated with two verteporfin photodynamic therapy sessions, separated by 3 months.

RESULTS

The choroidal neovascularization was occluded after two sessions. Best-corrected visual acuity improved to 20/25 and remained stable throughout an 18-month follow-up.

CONCLUSION

Photodynamic therapy seems to be an effective treatment for subfoveal choroidal neovascularization secondary to choroidal nevus.

Genetische Beratung und DNA-Testung für Patienten mit erhöhtem Melanomrisiko

Risikofaktoren für die Entwicklung maligner Melanome sind vielfältig. Sie sind sowohl durch genetische Faktoren als auch durch Umwelteinflüsse bedingt. Ein gut dokumentiertes genetisches Risiko für die Entwicklung eines Melanoms ist eine Mutation im CDKN2A-Gen, welches auf dem Chromosom 9 lokalisiert ist. Dieses Tumorsuppressor-Gen ist für die Regulation des Zellzyklus mitverantwortlich, und eine Mutation in diesem Gen führt auch gehäuft zu familiären Pankreaskarzinomen. Die Penetranz dieser Mutation wird durch UV-Energie mitbeeinflusst. Eine weitere Risikokonstellation ist eine Variante des atypischen familiären Nävussyndroms, welche auf dem Chromosom 1p36 codiert. Patienten mit Xeroderma pigmentosum weisen eine gestörte DNA-Reparaturfähigkeit auf, weshalb sich bereits in frühem Lebensalter bei dieser autosomal rezessiv vererbten Krankheit zahlreiche maligne Hauttumoren inklusive maligne Melanome entwickeln können. Neue Daten haben eine gestörte DNA-Reparaturfähigkeit auch bei Patienten mit sporadischen Melanomen dokumentiert. Konstitutionelle Risiken sind rotblonde Haare und blaue Augen. Der wichtigste Umweltfaktor, der besonders bei genetischer Prädisposition das Risiko einer Melanomentstehung weiter erhöht, ist die UV-Exposition. Wiederholte Sonnenbrände vor dem 15. Lebensalter, aber auch eine hohe kumulative UV-Belastung gehen mit einem erhöhten Melanomrisiko einher. Die wichtigsten präventiven Maßnahmen sind die regelmäßige Untersuchung des ganzen Integumentes bei Patienten mit familiärem dysplastischem Nävussyndrom. Alle Menschen sollen, unabhängig von ihrem Risikoprofil, einen konsequenten Sonnenschutz durchführen, der nicht nur das Auftragen von Sonnencreme, sondern auch das Tragen von Hut, Hemd, Hose und Sonnenbrille beinhaltet. Eine direkte Sonnenexposition ist während der Mittagsstunden zu vermeiden. In der heutigen Zeit ist es möglich geworden, im Rahmen von Studien DNA-Analysen bei Patienten mit familiären malignen Melanomen durchzuführen. Vor- und Nachteile der genetischen Beratung werden diskutiert.

Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma

BACKGROUND

Some melanomas form on sun-exposed body sites, whereas others do not. We previously proposed that melanomas at different body sites arise through different pathways that have different associations with melanocytic nevi and solar keratoses. We tested this hypothesis in a case-case comparative study of melanoma patients in Queensland, Australia.

METHODS

We randomly selected patients from among three prespecified groups reported to the population-based Queensland Cancer Registry: those with superficial spreading or nodular melanomas of the trunk (n = 154, the reference group), those with such melanomas of the head and neck (n = 77, the main comparison group), and those with lentigo maligna melanoma (LMM) (n = 75, the chronic sun-exposed group). Each participant completed a questionnaire, and a research nurse counted melanocytic nevi and solar keratoses. We calculated exposure odds ratios (ORs) and 95% confidence intervals (CIs) to quantify the association between factors of interest and each melanoma group.

RESULTS

Patients with head and neck melanomas, compared with patients with melanomas of the trunk, were statistically significantly less likely to have more than 60 nevi (OR = 0.34, 95% CI = 0.15 to 0.79) but were statistically significantly more likely to have more than 20 solar keratoses (OR = 3.61, 95% CI = 1.42 to 9.17) and also tended to have a past history of excised solar skin lesions (OR = 1.87, 95% CI = 0.89 to 3.92). Patients with LMM were also less likely than patients with truncal melanomas to have more than 60 nevi (OR = 0.32, 95% CI = 0.14 to 0.75) and tended toward more solar keratoses (OR = 2.14, 95% CI = 0.88 to 5.16).

CONCLUSIONS

Prevalences of nevi and solar keratoses differ markedly between patients with head and neck melanomas or LMM and patients with melanomas of the trunk. Cutaneous melanomas may arise through two pathways, one associated with melanocyte proliferation and the other with chronic exposure to sunlight.

Numerous, small, darkly pigmented melanocytic nevi: the cheetah phenotype

BACKGROUND

The presence of multiple atypical nevi or numerous melanocytic nevi increases the risk for the development of cutaneous melanoma.

OBJECTIVE

We sought to describe a distinct clinical phenotype characterized by numerous (>100), small (< or =4 mm), darkly pigmented melanocytic nevi that are uniform in color.

METHODS

Biopsy specimens from 6 patients (3 men and 3 women; age range, 44 to 81 years) with this clinical phenotype were reviewed and compared with a database of melanocytic lesions analyzed by the Yale Dermatopathology Laboratory (YDL) in the year 2000.

RESULTS

Of the 6 patients, 4 had multiple primary melanomas develop (n = 2-4), ranging from in situ to 1.0 mm in depth. The other 2 patients each had 1 nevus with severe cytologic atypia. When compared with the YDL database, our patients were more likely to have the following pigmented lesions: junctional melanocytic nevi, junctional lentiginous nevi, junctional nevi with cytologic atypia, and simple lentigines (P <.001).

CONCLUSIONS

The longitudinal evaluation of patients with this phenotype can be challenging because similar-appearing pigmented lesions (small and uniformly dark-brown to black) had a range of histologic diagnoses from simple lentigo to junctional lentiginous nevus to thin melanoma.

The transformation rate of moles (melanocytic nevi) into cutaneous melanoma: a population-based estimate

BACKGROUND

Moles, or melanocytic nevi, are both markers of an increased risk of cutaneous melanoma and direct precursor lesions. Recent strategies to reduce the burden of advanced disease have focused on early detection and ongoing surveillance of moles for malignant degeneration. Inherent in this approach is the notion that moles exhibit a certain risk of transformation into melanoma; however, this risk is unknown.

OBJECTIVE

To estimate the risk of moles transforming into cutaneous melanoma.

DESIGN

We first constructed a model of transformation based on the assumption that the minimal number of moles turning into cutaneous melanoma per year is roughly equivalent to the number of melanomas diagnosed each year with associated nevic components. The annual risk was then calculated as the number of mole-associated melanomas diagnosed in 1 year (stratified by 10-year age groups) divided by the number of moles in a the same 10-year age group. We also estimated the cumulative risk during the lifetime of an individual mole by using a modification of the standard life table method.

RESULTS

The annual transformation rate of any single mole into melanoma ranges from 0.0005% or less (ie, </=1 in 200,000) for both men and women younger than 40 years to 0.003% (about 1 in 33,000) for men older than 60 years. The rate is similar between men and women younger than 40 years but becomes substantially higher for men older than 40 years. For a 20-year-old individual, the lifetime risk of any selected mole transforming into melanoma by age 80 years is approximately 0.03% (1 in 3,164) for men and 0.009% (1 in 10,800) for women.

CONCLUSIONS

The risk of any particular mole becoming melanoma is low, especially in younger individuals. However, since moles can disappear, ones that persist into old age have an increased risk of malignant degeneration. For young people with innumerable moles and no other associated risk factors, systematic excision of benign-appearing lesions would be of limited benefit.

Becker's nevus with ipsilateral breast hypoplasia: improvement with spironolactone

Ipsilateral breast hypoplasia is a rare abnormality in Becker's nevus. The pathogenesis of the breast hypoplasia is not understood, but an increased level of androgenic receptor in the affected area may play a role. We report a case of Becker's nevus with ipsilateral breast hypoplasia. Spironolactone, an anti-androgenic agent, was tried for treatment of the hypoplasia, and, one month later, breast enlargement was seen in only the hypoplastic breast with Becker's nevus. This finding supports the theory that breast hypoplasia in Becker's nevus is related to an increase in androgenic receptor.

[Pigmented nevus and preventive surgery of skin melanoma]

Modern clinical views on the role of nevus in occurrence of melanoma were enlighted. The main positions of diagnostic-therapeutic algorithm of preventive surgery of the skin melanoma were substantiated. Methods of surgical interventions, variants of morphological conclusions and tactic of treatment after the operation performance were suggested. Particular role of oncologist and pathomorphologist in establishing of diagnosis and choice of correct tactic of treatment was underlined.

A case of giant congenital nevocytic nevus with neurotization and onset of vitiligo

The authors report the case of a 21-year-old woman with a giant congenital nevocytic nevus (GCNN) who developed vitiligo at the age of 16 years on skin areas remote from the GCNN. This is the first reported case of GCNN developing neurotization combined with vitiliginous changes within the GCNN lesion. Treatment with PUVA achieved repigmentation of the vitiligo lesions, except for the hypochromic areas within the area of the nevus that were shielded from UVA radiation.

A rare association of epidermal nevus syndrome and ainhum-like digital constrictions

Epidermal nevus syndrome is an unusual occurrence of epidermal nevi with central nervous system (CNS), eye, and skeletal developmental abnormalities. We report an as yet undocumented association of generalized epidermal nevus with striate keratoderma, ainhum-like digital constriction, and autoamputation of the right fifth toe in a 10-year-old girl. The excellent response to oral acitretin with softening of the constrictions is also highlighted.

Intramucosal naevus with pseudoepitheliomatous hyperplasia in the gingiva: a case report

This article describes the unusual case of an intraoral pigmented naevus with pseudoepitheliomatous hyperplasia of the gingiva. A 62-year-old man presented with an almost coal-black pigmented and partly white, spotted, dome-shaped swelling on the lingual gingiva of the mandible. Histologically, the lesion consisted of clusters of round-shaped naevus cells containing melanin granules, reactive with both S-100 immunohistochemical stain and Masson-Fontana silver stain, and pseudoinvasive squamous nests, reactive with cytokeratin. The pathogenesis of the present lesion and problems encountered in its differential diagnosis are discussed.

Giant congenital melanocytic nevi in a patient with brain structural malformations and multiple lipomatosis

We present a 9-year-old boy diagnosed from birth with giant congenital melanocytic nevi. He had central structural brain malformations of hemimegalencephaly of the right frontotemporal lobe and left occipitoparietal lobe, choroid plexus hypertrophy, and a Dandy-Walker variant. In addition, he developed multiple lipomatoses. These lesions were cutaneous except for two at the cerebellopontine angles, which were present from birth. This patient represents a rarely documented example of two histopathologies resulting in serious complications. The diagnostic issues and histopathologic process are discussed.

[Choroidal nevi associated with serous macular detachment]

PURPOSE

To describe the aspect and progression of choroidal nevi associated with macular serous detachment and to analyze different treatments.

MATERIAL

and methods: Twelve posterior choroidal nevi were associated with subretinal fluid. The fovea was detached in 11 cases. Tumor thickness was 2 mm or less.

RESULTS

No treatment was given in 6 cases and spontaneous subretinal fluid regression was observed in 3 of these 6 cases. Success was also observed in 2 of 3 cases treated with corticotherapy, but subretinal fluid recurred. Gas injection was performed in 1 case and transpupillary thermotherapy in 2 others, all 3 with successful definitive drying of the nevus. Visual acuity decreased in 6 cases (in 3 untreated cases and in 3 cases treated with corticotherapy), remained stable in 3 cases, and increased in 3 cases (in 1 untreated case, in 1 gas injection case, and in 1 case after thermotherapy). Tumor growth was observed in 3 cases, on the average 2 years after diagnosis (25%).

CONCLUSION

Subretinal fluid is rarely observed with choroidal nevi and its progression is variable. Various treatments in addition to observation such as corticotherapy, gas injection, transpupillary thermotherapy seem effective in stabilizing or improving visual function. Supervision is nevertheless needed to detect tumor growth that can be frequent in these nevi associated with subretinal fluid.