Epidermolytic hyperkeratosis associated with melanocytic nevi: a report of 53 cases

Epidermolytic hyperkeratosis (EH) is a unique histopathologic alteration of the skin characterized by hyperkeratosis with perinuclear vacuolization of keratinocytes primarily in the stratum granulosum and the stratum malpighii. It is seen as an incidental finding in a variety of conditions, benign and malignant, as well as sporadic and familial. Recently, it has been reported that EH may be associated with dysplastic nevi (nevus with architectural disorder [NAD]). Cases of melanocytic nevi with epidermolytic hyperkeratosis were retrieved from the files of a referral dermatopathology laboratory over a 6-year period. We present a series of 53 cases of EH in both ordinary nevi and NAD. Epidermolytic hyperkeratosis identified in association with NAD accounted for 46 cases or 86.8% of the total lesions while ordinary nevi represented 7 or 13.2% of total cases. Our study confirms that the incidence of EH is higher in association with dysplastic nevi than in ordinary melanocytic nevi and may serve as a marker for NAD, but with lower sensitivity and only moderate specificity.

Melanocytoma inducing compressive optic neuropathy: the ocular morbidity potential of an otherwise invariably benign lesion

PURPOSE

The purpose of this article is to document a case of melanocytoma of the optic nerve head inducing compressive optic neuropathy; to provide a summarized clinical review; and to reflect on the potential ocular morbidity aspects of this relatively benign insult.

METHODS

We present a case report of a 32-year-old Hispanic woman with constant esotropia, inert tractional Toxacara granuloma in the right eye, and a jet-black lesion engulfing the left eye optic nerve head, with accompanying disk edema.

RESULTS

A diagnosis of melanocytoma of the optic nerve with secondary compressive optic neuropathy was made on the basis of the clinical presentation. Patient education and quarterly follow-up visits to monitor the lesion were the recommended management.

CONCLUSION

Although optic nerve head melanocytoma can be considered benign, it has the underlying potential to promote ocular morbidity. Our case report highlights the potential impact of melanocytoma on optic nerve head anatomy. The potential for even subtle changes in the visual fields from this condition becomes significant in a monocular patient. This is exemplified in this case, by the presence of a co-existing Toxacara granuloma and related amblyopia in the contralateral eye.

Melanocytic proliferations associated with lichen sclerosus

OBJECTIVES

To describe the clinicopathologic features of melanocytic proliferations associated with lichen sclerosus (LS) and to compare these findings with those in controls.

DESIGN

Cohort study.

SETTING

Academic and private practice dermatology and dermatopathology services.

PATIENTS

Cases of melanocytic proliferations associated with LS and consecutive controls with persistent (recurrent) melanocytic nevi, persistent malignant melanomas, and compound melanocytic nevi.

MAIN OUTCOME MEASURES

Diagnostic criteria and disease recurrence.

RESULTS

Eleven patients, all female, with a mean age of 40 years (range, 8-83 years), presented with pigmented lesions clinically suspected to be malignant melanoma or atypical melanocytic nevi affecting the vulva (7 patients), perineum (3 patients), or chest (1 patient). Lichen sclerosus was first identified in the biopsy specimen and subsequently confirmed clinically. In 10 cases, a melanocytic nevus was superimposed on LS (overlying or entrapped by sclerosis), whereas LS was found at the periphery of vulvar malignant melanoma. After complete excision, no recurrences have been reported for the melanocytic nevi in LS (mean follow-up, 29 months; range, 4-60 months). Compared with control lesions, the LS melanocytic nevi most closely resembled persistent melanocytic nevi and could be distinguished from persistent malignant melanoma histologically. Melanocytes, nevoid or malignant, proliferating contiguously with fibrotic or sclerotic collagen, contained abundant melanin, diffusely expressed HMB-45, and had a higher Ki-67 labeling index than ordinary melanocytic nevi. However, persistent malignant melanoma exhibited mitotic figures, significantly higher Ki-67 labeling index, and deep dermal HMB-45 expression compared with LS melanocytic nevi and persistent melanocytic nevi.

CONCLUSIONS

Melanocytic nevi occurring in LS have features in common with persistent melanocytic nevi and can mimic malignant melanoma. An "activated" melanocytic phenotype is seen in LS melanocytic nevi, implicating a stromal-induced change.

Acquired leukoderma in congenital pigmented nevus associated with vitiligo-like depigmentation

We report a 6-year-old boy who developed depigmentation within a congenital melanocytic nevus at the age of 3 years. During the following months a halo phenomenon and vitiligo-like lesions distant from the nevus appeared. A thorough search for malignant melanoma was negative. A second patient, a 45-year-old woman, had a large congenital nevus on the trunk with marked satellitosis. At the age of 20 years, partial regression of the large nevus occurred and, in addition, halos developed around almost all smaller nevi. Repeated searches for associated malignant melanoma were negative. We review the rare cases of halo congenital nevi and emphasize that depigmentation is not necessarily associated with malignant degeneration.

Optical coherence tomography in the diagnosis of subclinical serous detachment of the macula secondary to a choroidal nevus

We present a case in which optical coherence tomography (OCT) aided in the diagnosis of subretinal fluid (SRF) secondary to a choroidal nevus. A patient with a raised lesion above the left optic disc and distorted central vision was referred to our unit because of suspected choroidal melanoma. Fundus fluorescein angiography and slit-lamp investigation did not indicate any areas of SRF; however, OCT showed serous detachment in the macular area. The lesion was treated with laser photocoagulation and, when reviewed at four weeks post-treatment, repeat OCT scans showed that the area of SRF had cleared. In this case OCT was able to detect a subclinical serous detachment in the macula. This may have important implications in the monitoring of patients with small suspicious lesions.

[Increasing pigmentation in Schmidt syndrome (polyglandular autoimmune syndrome type II]

An 18-year old man presented with increasing pigmentation in multiple nevi as well as so-called "eruptive nevi" over a 24 month period. The first excisional biopsy was from a plantar nevus which showed melanocytic hyperplasia. Following excisions of both hyperpigmented and newly appearing nevi showed only increased pigmentation. Two years after the first examination Addison-like hyperpigmentation was noticed in typical locations. Both Addison disease and Hashimoto thyroiditis were then confirmed by elevated serum levels of ACTH, TSH, and decreased levels of cortisol and L-thyroxine. This confirmed the diagnosis of Schmidt syndrome as part of polyglandular autoimmune disease (PGAS) type II. After another 18 months of treatment with hormone substitution of L-thyroxine and hydrocortisone, the hyperpigmentation resolved and the hyperpigmented nevi decreased in number.

Epidermal naevus and segmental hypermelanosis associated with an intraspinal mass: overlap between different mosaic neuroectodermal syndromes

The epidermal naevus syndrome is a neurocutaneous syndrome characterised by the association of epidermal naevi with central nervous system, skeletal, ocular or cardiovascular abnormalities. We report on a 1.75-year-old boy who presented with spastic diparesis, a partial paresis of the left forearm and macrocephaly. He had a large epidermal naevus along the cervical spine and a segmental hypermelanosis. MRI studies revealed a large intraspinal mass extending from the lower cervical to the upper thoracic spine. The condition of our patient demonstrates the overlap of the epidermal naevus syndrome with well-defined mosaic neuroectodermal phenotypes such as encephalocraniocutaneous lipomatosis, Feuerstein-Mims syndrome and Proteus syndrome.

CONCLUSION

we recommend evaluation of all patients with large epidermal naevi, especially in the head and neck region, for the presence of central nervous system abnormalities or neoplasms.

[Diffuse melanocytic nevus of the iris and absolute glaucoma]

BACKGROUND

Ferry et al. (8) showed that 35 % of eyes which have been enucleated because of a clinically suspected malignant iris lesion did not reveal a histologically malignant iris tumor.

PATIENT

A 43-year old male presented with a blind, painful left eye, which has developed over a time period of 6 months. Ophthalmologic examination revealed the presence of pigmented iris stromal lesions associated with diffuse pigmentation of the chamber angle and the development of absolute glaucoma. A diffuse iridociliary malignant melanoma (ring melanoma) was suspected and the blind painful eye was enucleated. Histologic examination revealed the presence of a benign melanocytic lesion, i.e. a spindle cell nevus of the iris with surface plaques causing diffuse extension of the chamber angle, trabecular meshwork, Schlemm's canal, and the ciliary body.

CONCLUSION

The malignant potential of iris lesions may be difficult to assess on clinical grounds only. Histologically, benign melanocytic proliferation may cause diffuse extension into the ciliary body as well as the chamber angle leading to an increase in intraocular pressure. In order to reach a final diagnosis a biopsy of the lesion is necessary.

Pseudohypopyon of orange pigment overlying a stable choroidal nevus

PURPOSE

To report an unusual case of orange pigment pseudohypopyon overlying a choroidal nevus.

METHODS

Observational case report. A 45-year-old man presented with best-corrected visual acuity of 20/25 and metamorphopsia in the right eye secondary to localized subfoveal fluid. The detachment displayed a peculiar appearance of layered orange pigment, like a pseudohypopyon in its inferior aspect. Closer inspection revealed an underlying choroidal nevus and no choroidal neovascular membrane.

RESULTS

After 31 months of follow-up without treatment, the size of the nevus and visual acuity remained stable and metamorphopsia continued to resolve as the orange pigment and the subretinal fluid disappeared completely.

CONCLUSION

An otherwise stable choroidal nevus can display overlying clumps of orange pigment and rarely massive accumulation of orange pigment in the form of a pseudohypopyon. Orange pigment pseudohypopyon can spontaneously resolve with preserved visual acuity.

Late normalization of melanocytomalytic intraocular pressure elevation following excision of iris melanocytoma

BACKGROUND

Melanocytoma of the iris is a rare tumor which may sometimes undergo necrosis that could result in elevated intraocular pressure through pigment dispersion. Only nine similar patients have been previously reported.

METHODS

A 27-year-old woman presented with a dark brown iris stromal mass located between the 4 and 8 o'clock positions in the inferior quadrant. Her left visual acuity was 20/60. The tumor encroached on the lens and caused focal cataract. There was massive pigmented debris over the iridocorneal angle and the intraocular pressure was 42 mmHg.

RESULTS

Fine needle aspiration biopsy did not suggest malignancy. A wide sector iridectomy was performed and histopathological examination of the lesion revealed melanocytoma of the iris. There was no ciliary body involvement. In the postoperative period, intraocular pressure, which persisted in the mid-twenties, was successfully lowered with topical dorzolamide and betaxolol drops. These drugs were continued for 2 years while the angle pigmentation gradually disappeared. There has been no documented glaucomatous damage to the optic nerve and visual fields. A year after the cessation of the drops, the left intraocular pressure stabilized and did not rise above 15 mmHg. Her left visual acuity remained 20/25.

CONCLUSION

In contrast to previously reported cases, the normalization of intraocular pressure in this patient took 26 months, a period that could be associated with the self-clearing process of pigment from the iridocorneal angle. Close follow-up with medical treatment averted a pressure lowering surgical procedure in this case.

Giant congenital melanocytic naevus and symptomatic thoracic arachnoid cyst

A 43-year-old female with multiple congenital naevi presented with a 5-year history of right upper quadrant pain. Magnetic resonance imaging demonstrated a large epidural thoracic arachnoid cyst. This case highlights the need to consider that the management of patients with giant congenital melanocytic naevus is variable depending on the age of the patient, the location of lesions and the presence of complications such as neurocutaneous melanosis. The value of magnetic resonance scanning as a screening device is discussed.

Large melanocytic nevi in hereditary epidermolysis bullosa

Large melanocytic nevi occurring in areas of former blistering in patients with hereditary epidermolysis bullosa (EB) pose a problem to the clinician with regard to prognosis and therapy because they may show clinical and histopathologic features strikingly resembling malignant melanoma. To investigate clinical and histologic criteria as well as the biologic behavior of these nevi, pigmented lesions of 12 patients (EB simplex, n = 1; junctional EB, n = 7; dystrophic EB, n = 4) of the Austrian EB registry were analyzed. Clinically, the nevi are up to palm sized, are initially very dark, and may exhibit stippled pigmentation and irregular borders that outline areas of former blisters. Over time they usually lose pigment, the surface gets papillomatous, and finally they acquire a shagreen-like appearance. Histopathologically, the nevi frequently exhibit a compound congenital or persisting nevus/pseudomelanoma pattern. Despite this combination of features, no malignant transformation of the nevi has been seen by us even after 20 years of prospective surveillance. Because nevi with these criteria do not fit in any of the known categories, we suggest the term EB nevi.

Central nervous system imaging and congenital melanocytic naevi

AIM

To establish the prevalence of central nervous system (CNS) abnormalities on magnetic resonance imaging (MRI) in a population of children with congenital melanocytic naevi (CMN) over the head and/or spine, and to compare this with clinical findings.

METHODS

Forty three patients identified from outpatient clinics underwent MRI of the brain and/or spine. These were reported by a paediatric radiologist and findings compared with the clinical picture.

RESULTS

Nine patients had abnormal clinical neurology, seven had abnormal findings on MRI, and six had both abnormal clinical and radiological findings. Only three of the abnormal MRIs showed features of intracranial melanosis. Three others showed structural brain abnormalities: one choroid plexus papilloma, one cerebellar astrocytoma, and one posterior fossa arachnoid cyst; the first two of these have not previously been described in association with CMN. The last abnormal MRI showed equivocal changes requiring reimaging.

CONCLUSIONS

The prevalence of radiological CNS abnormality in this group of children was 7/43. Six of these developed abnormal clinical neurological signs within the first 18 months of life, but two did not do so until after the MRI. Two of the CNS lesions were operable; for this reason we support the routine use of early MRI in this group.

Central retinal vascular obstruction secondary to melanocytoma of the optic disc

A 35-year-old black man developed abrupt visual loss in his left eye. Ophthalmic examination revealed a deeply pigmented mass obscuring the optic disc, hemorrhagic retinopathy, and signs of central retinal vascular obstruction. Fluorescein angiography disclosed sluggish filling of the retinal blood vessels; ultrasonography disclosed an acoustically solid mass in the optic nerve head. Cytopathologic findings of a fine needle aspiration biopsy specimen demonstrated probable benign tumor cells, but melanoma could not be excluded. Histopathologic findings in the enucleated eye revealed a large, necrotic melanocytoma of the optic disc and hemorrhagic necrosis of the retina secondary to obstruction of the central retinal artery and vein. Melanocytoma of the optic nerve can undergo spontaneous necrosis and induce central retinal vascular obstruction. Abrupt visual loss in a patient with a melanocytoma does not necessarily imply malignant transformation.

Malignant melanoma in children and congenital melanocytic nevi: DNA content and cell cycle analysis by flow cytometry

Malignant melanoma (MM) in children, although a rare neoplasm, can occur within a preexisting congenital melanocytic nevus (CMN). All the potential risk factors for this phenomenon are not well known, but increases in S phase and G2 + M phase of cell cycle, DNA aneuploidy, and cell cycle abnormalities in precursor lesions might be among the risk factors. Using paraffin-embedded tissue, we performed a retrospective analysis of DNA content, aneuploidy, and cell cycle by flow cytometry. Two groups of patients were analyzed: 28 children with CMN who did not developed MM, and 6 patients who further developed MM. In this second group, three patients had four biopsies done before the appearance of MM and in two patients biopsies were done after the appearance of MM. All CMN not associated with MM exhibited diploid cells only, their S phase was 11.5% (+/- 3.8), and their G2 + M phase was 2.5% (+/- 2.2). Among those patients who developed MM, 3/6 had an S phase > 15.5 and a G2 + M phase > 2.3 prior to the appearance of MM. Two out of six patients had a tetraploid DNA when MM developed and died with a disseminated MM. They had an S phase > 15.5 and their G2 + M phase was > 2.5. We propose that evaluation of DNA content and cell cycle by flow cytometry is a useful method to supplement biopsy findings in children with CMN who have lesions suspicious of developing a MM.

Periorbital congenital melanocytic nevus associated with ankyloblepharon

We report periorbital congenital melanocytic nevus associated with ankyloblepharon in a 2-month-old boy. This unusual presentation may be explained by the assumption that the development of the congenital melanocytic nevus (CMN) in utero was related to the failure of normal eyelid separation, which occurs around the 20th week of gestation.

Polythelia within Becker's naevus

We report a case of accessory mammary tissue of type 2a (or polythelia) entirely localized within a Becker's naevus of mixed type in a 32-year-old Caucasian woman. Polythelia was congenital in origin while Becker's naevus appeared during puberty. Renal ultrasonographic studies, laboratory examinations and other instrumental investigations were either normal or negative. Although the association of accessory mammary tissue with Becker's naevus has previously been reported--also in the form of mammorenal and acromammorenal syndromes--this is the first case characterized by an anatomic overlap between the two anomalies. It may be the expression of a common disturbance acting early in embryogenesis in the specific developmental fields involved.

Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis

OBJECTIVE

To determine the risk for developing malignant melanoma and neurocutaneous melanocytosis (NCM) in patients with large congenital melanocytic nevi.

DESIGN

Follow-up data suitable for calculations were available on 160 patients in the New York University Registry of Large Congenital Melanocytic Nevi who had been free of known melanomas or NCM when entered into the Registry. The cumulative 5-year life-table risks for developing melanoma and NCM were calculated. The relative risk for developing melanoma, using a control general population reference group, was determined.

RESULTS

The 160 patients (median age at entry: 14 months) were followed prospectively for an average of 5.5 years. Three extracutaneous melanomas developed: 2 were in the central nervous system (CNS) and 1 was retroperitoneal. The 5-year cumulative life-table risk for developing melanoma was 2.3% (95% confidence interval [CI]:.8-6.6) and the relative risk was 101 (95% CI: 21-296). No melanoma occurred within a large congenital melanocytic nevus. Four patients developed manifest NCM, 2 with CNS melanomas. The 5-year cumulative life-table risk for developing NCM was 2.5% (95% CI:.8-7.2). Ten patients were excluded from the calculations because of preexisting disease on entry into the Registry: 5 with manifest NCM and 5 with melanomas (3 in large congenital melanocytic nevi, 1 in nonnevus skin, and 1 unknown primary).

CONCLUSIONS

Patients with large congenital melanocytic nevi are at increased risk for developing melanomas. There is also a significant increased risk for developing NCM. The high incidence of CNS involvement may influence decisions concerning treatment of the large congenital melanocytic nevi.

Malignant melanoma in the thymus

A case of malignant melanoma in the thymus is reported. Diagnostic imaging demonstrated a left anterior mediastinal mass in a patient with giant pigmented nevus without malignant change. Histologic and cytologic specimens obtained from the tumor revealed that the tumor was malignant melanoma. Surgery revealed malignant melanoma in the left lobe of the thymus. Many cell nests of pigmented nevi were observed throughout the thymus. The malignant melanoma was thought to have originated from the nevocellular nevus in the thymus. This is the first report of malignant melanoma in the thymus.

Hypercalcemia in a patient with malignant melanoma arising in congenital giant pigmented nevus. A case of increased serum level of parathyroid hormone-related protein

We describe a 43-year-old Japanese female who developed hypercalcemia associated with malignant melanoma. The patient underwent three resections of tumors on her groin and buttock secondary to a bathing trunk congenital nevus, and the histopathological findings showed benign congenital nevi. At the age of 42 years, she developed a malignant melanoma under the giant pigmented nevus in her groin. Fourteen months after the diagnosis of melanoma, she developed metastases to the lung, para-aortic lymph nodes and bones accompanied by hypercalcemia resulting from a remarkable increase in the serum level of parathyroid hormone-related protein (PTHrP). The patient died from acute renal and respiratory failure. In addition, we analyzed serum levels of calcium and PTHrP in 19 patients with advanced malignant melanoma. Seven patients had hypercalcemia, and 3 had increased serum levels of PTHrP.

Phacomatosis pigmentokeratotica: speckled-lentiginous nevus in association with nevus sebaceus

We report a case of a congenital nevus sebaceus with numerous brown macules and papules in the left auricular region. In the same lesion, pigmented basal cell carcinomas developed later in life. Additionally, on the left side of the neck, both shoulders and the left arm, features of nevus spilus with melanocytic and blue nevi were present. Such a combination of nevus sebaceus with melanocytic lesions may be explained by the concept of twin spotting and represent another case of phacomatosis pigmentokeratotica.

Pigmentary traits, modalities of sun reaction, history of sunburns, and melanocytic nevi as risk factors for cutaneous malignant melanoma in the Italian population: results of a collaborative case-control study

BACKGROUND

To the authors' knowledge, limited data are available from Mediterranean populations concerning risk factors for malignant melanoma. A few Italian case-control studies have produced conflicting results regarding the association between malignant melanoma and pigmentary traits, sunburns, and melanocytic nevi.

METHODS

A case-control study was conducted within the framework of the Italian Group for Epidemiologic Research in Dermatology (GISED). Twenty-seven centers in the north and south of Italy participated. A total of 542 cases and 538 controls were entered onto the study. A standardized questionnaire was administered to cases and controls. Cases and controls also were examined by trained dermatologists who were required to count the number of melanocytic nevi (those measuring > or = 2 mm and > 6 mm in greatest dimension, separately) and to make judgments regarding pigmentary traits.

RESULTS

In the multivariate analysis, eye and skin color, propensity to sunburn, history of sunburns before age 15 years, and solar lentigines all were associated with malignant melanoma. In addition, the risk of melanoma increased with the number of melanocytic nevi > or = 2 mm. Nevi > 6 mm in greatest dimension had effects on risk that appeared to be independent from the effects of smaller nevi (2-6 mm).

CONCLUSIONS

The results of the current study largely are similar to those obtained in northern European countries, the U.S., and Australia and provide further evidence of the importance of selected pigmentary traits, sun exposure, and the number of melanocytic nevi in the risk of cutaneous malignant melanoma.

Melanocytoma of the left optic nerve head and right retrobulbar optic neuropathy compressed by a tuberculum sellae meningioma

A 40-year-old woman had a highly pigmented, slightly elevated tumor on the left optic disc. She had no visual disturbance in the left eye. The tumor was stationary for 5 years. At age 45 years, she complained of decreased visual acuity in the right eye. Magnetic resonance imaging showed a right-shifted homogeneous lesion at the tuberculum sellae. Histopathologic study of the excised lesion revealed interlacing bundles of spindle-shaped fibroblast-like cells with whorl formation. We believe that a relationship between melanocytoma of the optic nerve head and a tuberculum sellae meningioma may exist rather than a chance occurrence, as previously suggested by others.

Multiple fibroepithelial basal cell carcinoma of Pinkus associated with seborrheic keratosis in a nevoid distribution

We describe a patient with multiple fibroepithelial basal-cell carcinoma (FEBCC) associated with seborrheic keratosis distributed in a neviform fashion on the left side of the body and clinically resembling skin tags.

Atopic dermatitis and melanocytic naevi

A study was performed to test the clinical impression that adults with severe atopic dermatitis (AD) have a low number of common naevi (CN). The number of CN > or = 2 mm was investigated in 51 Caucasian patients aged 20-63 years with severe AD since early childhood. The control group consisted of 379 randomly selected subjects, aged 30-50 years, investigated in an earlier study. Patients with AD had a significantly (P < 0.0001) lower total body count of CN (mean 9, median 5) compared with the control group (mean 67, median 53). It was also found that in the AD group there was a significant (P < 0.001) negative correlation between serum IgE and number of CN [r(s) = -0.50, 95% CI (-0.69; -0.24)]. The explanation for the low number of naevi that we have found in this highly selected subgroup of AD patients is not known. The atopic inflammation in the skin, genetics and treatment used for eczema are possible factors that may influence the formation of melanocytic naevi.

Posterior scleral choristoma in the organoid nevus syndrome (linear nevus sebaceus of Jadassohn)

PURPOSE

To highlight the association of posterior osseous and/or cartilaginous ocular choristomas with epibulbar choristomas and the nevus sebaceus of Jadassohn.

DESIGN

Small case series.

PARTICIPANTS

Four patients with the organoid nevus syndrome.

METHODS

Clinical and histopathologic studies in four patients with epibulbar lesions and nevus sebaceus of Jadassohn.

MAIN OUTCOME MEASURES

Ophthalmoscopic findings of peripapillary lesions. Computed tomographic and ultrasonographic characteristic of posterior scleral lesions. Ocular histopathologic findings in one globe from one of the study subjects.

RESULTS

Three patients had the triad of posterior osseous/cartilaginous ocular choristomas, anterior epibulbar choristomas, and nevus sebaceus of Jadassohn and one patient had anterior epibulbar choristomas and posterior osseous/cartilaginous ocular choristomas. Ultrasonography and computed tomography were valuable in detecting scleral ossification or epibulbar cartilage or both. The ophthalmoscopic findings were similar to those of a choroidal osteoma.

CONCLUSIONS

The presence of posterior osseous/cartilaginous ocular choristomas in a patient with epilepsy or epibulbar lesions or both suggests the diagnosis of nevus sebaceus of Jadassohn. Osseous/cartilaginous ocular choristomas should be suspected in patients with nevus sebaceus of Jadassohn and peripapillary hypopigmented fundus lesions.

Melanocytic nevi in children treated with growth hormone

There is concern that growth hormone (GH) therapy may influence the growth of melanocytic nevi. In a review of the experience of the National Cooperative Growth Study, we found no excess of skin cancer in children who were treated with GH. We also reviewed our experience in 90 children with GH deficiency and 24 with Turner syndrome. We found no difference in the nevi count between control subjects and children with GH deficiency, even after many years of GH therapy. Nor was there any relation between the duration of therapy and the nevi count. Children with Turner syndrome had more nevi, but there was no relation to the duration of GH therapy. These findings and the absence of a greater frequency of skin cancer in acromegaly are reassuring. It is unlikely that GH therapy has a significant influence on nevi count or the risk of skin cancer.

Trichoepithelioma associated with cellular blue nevus

BACKGROUND

Epithelial elements, such as trichoepithelioma, are occasionally associated with melanocytic nevi.

OBJECTIVE

A case of trichoepithelioma in association with cellular blue nevus is reported.

METHODS AND RESULTS

A solitary, pigmented nodule was removed from the scalp of a middle-aged woman. Histopathologic examination demonstrated a circumscribed cellular blue nevus within which were embedded epithelial strands and cystic structures consistent with trichoepithelioma.

CONCLUSION

Trichoepitheliomas have been described in relation to common acquired nevi, but an association with a blue nevus is rare. The intimate admixture of trichoepithelioma within the nodule of a nevus supports the concept of epithelial induction by melanocytic nevi.

Photocoagulation of iris nevus to control recurrent hyphema

PURPOSE

To report a case of recurrent hyphema caused by an iris nevus that was successfully treated with photocoagulation.

METHOD

Case report. In a 30-year-old woman with recurrent hyphema secondary to an iris nevus, photocoagulation was applied to the iris nevus.

RESULTS

Before photocoagulation of the iris nevus, the patient had increasing frequency of hyphema episodes. After treatment, no hyphema episodes occurred during 13 months of observation.

CONCLUSION

Photocoagulation of the surface of an iris nevus may prevent recurrent hyphema.

Maternal and child constitutional factors and the frequency of melanocytic naevi in children

This study examined the association between numbers of benign melanocytic naevi in 7-year-old children in Oxfordshire born in 1988-9 with their mother's arm naevus count, and maternal and child pigmentation factors. We believe this is the first time that the relationship between child and maternal naevus counts has been reported. A high naevus count in the child was associated with male sex (P = 0.009), freckling (P = 0.001) and propensity of the child to burn in the sun (P = 0.05). A low naevus count was observed in red-haired children (P = 0.02). The strongest association of child's naevus count was with a high maternal arm naevus count, independent of the child's pigmentation factors (trend P < 0.0001). Maternal pigmentation factors were not associated with child's naevus count independent of the child's own pigmentation factors. Maternal arm naevus counts may be a better predictor of child naevus count than the child's own pigmentation factors and children. There has not been examination, however, of the relationship between naevus counts in children and those in their parents. We therefore conducted a study of the occurrence of naevi in children aged 7-8 years in Oxfordshire, examining, in addition to sex and pigmentation factors in the child, the relationship of maternal pigmentation factors and maternal naevus counts with naevi in their offspring.

Naevi as a risk factor for basal cell carcinoma in Caucasians: a Danish case-control study

The number of melanocytic naevi in Caucasians is related to previous exposure to the sun and is a well-documented major risk factor for cutaneous malignant melanoma. Basal cell carcinoma, which is the most common form of skin cancer, has also been shown to be related to exposure to the sun. To investigate whether the number of common naevi is a risk factor for basal cell carcinoma in Caucasians we performed whole-body counting of naevi > or =2 mm in a Danish case-control study with 145 cases of primary basal cell carcinoma and 119 controls matched on age, gender and place of residence. Naevi were recorded according to size and body region and the skin phototype was assessed. There was no correlation between self-reported skin type and the number of naevi. Females with basal cell carcinoma had more naevi than did female controls (median number of naevi: 65 and 32, respectively) while males with basal cell carcinoma did not differ from male controls (median number of naevi: 48 and 43, respectively). Female cases had more small size naevi (2 mm), intermediate size naevi (3-4 mm) and large size naevi (> or =5 mm) than did female controls. Females with basal cell carcinoma had a substantially higher number of naevi on the arms and the legs than did female controls, but also had more naevi on the trunk. For females, the risk for basal cell carcinoma increased with increasing number of naevi. Naevi were not a risk factor for basal cell carcinoma in males.

Ciliary body melanocytoma with anterior segment pigment dispersion and elevated intraocular pressure

PURPOSE

To discuss a case in which melanocytoma of the ciliary body presented with widespread pigment dispersion and elevated intraocular pressure (IOP).

METHODS

A 64-year old woman presented with increased IOP and persistent anterior segment inflammation in her right eye. She had undergone a trabeculectomy for uncontrolled IOP before presentation. Slit-lamp examination, gonioscopy, and ultrasound biomicroscopy revealed a ciliary body mass with extension into the subconjunctiva in addition to widespread pigmentary dispersion in the anterior segment. Enucleation of the right eye was performed for histopathologic evaluation, as a diagnosis of ciliary body melanoma was made on clinical examination.

RESULTS

Histopathologic findings were diagnostic of a melanocytoma of the ciliary body with necrosis and focal malignant transformation with extension of melanocytoma cells and melanophages into the subconjunctival space, trabecular meshwork, and anterior chamber angle.

CONCLUSION

Melanocytoma of the ciliary body is a rare intraocular tumor that may present with pigment dispersion and secondary elevated IOP. Careful examination of the anterior segment is imperative in such cases.

Clinical and histopathologic findings of iris nevus (Cogan-Reese) syndrome

PURPOSE

To report a case of Cogan-Reese syndrome.

METHOD

Case report. A 37-year-old man presented with Cogan-Reese syndrome.

RESULTS

Visual acuity was 0.5 in the right eye and 1.0 in the left eye. There were corneal edema and pigmented nodules on the anterior surface of the iris, iris atrophy and ectropion uvea in the right eye. The intraocular pressure was 42 mmHg in the right eye and there was glaucomatous optic atrophy of the optic disk. Trabeculectomy with mitomycin C has been performed as the intraocular pressure did not decrease with the maximum medical treatment. Electron microscopic examination of the trabeculum and the iris tissue revealed a lot of melanocytic cells in the stroma.

CONCLUSION

Trabeculectomy with mitomycin C might be effective in Cogan-Reese cases with glaucoma resistant to medical treatment.

Clear cell acanthoma presenting as polypoid papule combined with melanocytic nevus

We report on a case of clear cell acanthoma that developed above a preexisting melanocytic nevus. Although melanocytic nevi can be complicated by the presence of several different types of epithelial or appendageal tumors, there have been no reported case of clear cell acanthoma combined with a nevus. Interestingly, in this case the clear cell acanthoma had a polypoid configuration, an unusual finding.