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McTighe SP, Taylor EA, Allbritton J, Lewin-Smith MR. Localized Cutaneous Argyria at the Site of a Prior Melanoma Excision Confirmed by Scanning Electron Microscopy With Energy Dispersive X-ray Analysis. Am J Dermatopathol 2024; 46:155-158. [PMID: 38153266 DOI: 10.1097/dad.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT Localized cutaneous argyria is a rare condition caused by the accumulation of silver particles in the skin, leading to blue-gray discoloration. Argyria may mimic melanoma and lead to misdiagnosis. We present a patient with a history of melanoma that developed a blue-gray nodule at a prior melanoma graft. The diagnosis was confirmed using scanning electron microscopy and energy dispersive x-ray analysis. These techniques differentiate argyria from melanoma and can be performed on formalin-fixed, paraffin-embedded, tissue sections. Health care providers should be alert that argyria may mimic recurrent melanoma in patients unaware of silver exposure.
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Affiliation(s)
- Shane P McTighe
- Dermatologist, Martin Army Community Hospital, Fort Moore, GA
| | | | - Jill Allbritton
- Dermatopathologist/Dermatologist, The Joint Pathology Center, Silver Spring, MD; and
| | - Michael R Lewin-Smith
- Dermatopathologist/Dermatologist, The Joint Pathology Center, Silver Spring, MD; and
- Senior Environmental Pathologist, The Joint Pathology Center, Silver Spring, MD
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Gill P, Richards K, Cho WC, Nagarajan P, Aung PP, Ivan D, Curry JL, Prieto VG, Torres-Cabala CA. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. Ann Diagn Pathol 2021; 54:151776. [PMID: 34214703 DOI: 10.1016/j.anndiagpath.2021.151776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Localized cutaneous argyria is a rare cutaneous disorder that has been associated with occupational exposure, dental procedures, topical agents, acupuncture, earrings, and nasal piercings. In this paper, we review the current literature on localized cutaneous argyria, highlight its clinical and histologic diagnostic features, and then discuss the clinical and histological differential diagnoses for blue-gray skin and black dermal pigment, respectively. We also discuss the utility of ancillary techniques, such as deeper histologic levels, special stains, darkfield microscopy, and advanced micro-analytical techniques in helping diagnose localized cutaneous argyria. Furthermore, we emphasize that a thorough clinical history and astute clinico-pathologic correlation can be the most important diagnostic techniques in correctly diagnosing this rare disorder. Our review aims serve as a reminder to clinicians and pathologists of the importance of including localized cutaneous argyria in the clinical and histological differential diagnosis of pigmented lesions.
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Affiliation(s)
- Pavandeep Gill
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Kristen Richards
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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3
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Clinical and Forensic Aspects of the Different Subtypes of Argyria. J Clin Med 2021; 10:jcm10102086. [PMID: 34068024 PMCID: PMC8152497 DOI: 10.3390/jcm10102086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Argyria encompasses the different cosmetic alterations that can develop if enough silver particles deposit in a specific tissue, typically in the skin, ranging from localized dark-blue macules to a generalized slate-gray/bluish tinge following systemic absorption. This work aims to fully review the state of the art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic features of argyria. Argyria has been diagnosed in a wide range of ages, both sexes and varied ethnicities, with no known individual predisposing factors. Ultraviolet radiation with subsequence increases of melanin production aggravates the discoloration due to a reduction in the silver deposits. Physical examination and silver exposure in the anamnesis can be highly suggestive of the diagnosis, but a histopathological analysis with Energy-Dispersive X-ray Spectroscopy is required to unequivocally determine the discoloration etiology. Safe and effective treatment has only been accomplished with laser techniques, though only a few cases have been reported and with limited follow-up time. In conclusion, argyria typically has an occupational or iatrogenic etiology. It should be suspected when a patient presents with typical skin or eye lesions. A seemingly viable treatment modality, with laser technology, is finally within the horizon.
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Abstract
ABSTRACT A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish-black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow-brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called "pseudo-ochronosis." This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature.
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Hong SG, Jo SY, Heo EP, Ro KW. Localized Cutaneous Argyria Mimicking Blue Nevus after Wearing Earrings. Ann Dermatol 2019; 31:666-668. [PMID: 33911667 PMCID: PMC7992596 DOI: 10.5021/ad.2019.31.6.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/19/2022] Open
Abstract
Localized cutaneous argyria is a rare condition in which the skin changes into blue-grey spots due to the absorption of silver. The lesions need to be differentiated from other pigmentary disorders and require radiographic and histological examination for more accurate diagnosis. Scanning electron microscopy and energy dispersive x-ray spectroscopy can be a confirmatory tool in the evaluation of silver elements in biopsy tissue. This report shows the localized cutaneous argyria in earlobe of a 21-year-old woman who wears silver earrings for 10 years.
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Affiliation(s)
- Seung Gi Hong
- Department of Dermatology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Young Jo
- Department of Dermatology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Phil Heo
- Department of Dermatology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ki Woong Ro
- Department of Dermatology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Hadrup N, Sharma AK, Loeschner K. Toxicity of silver ions, metallic silver, and silver nanoparticle materials after in vivo dermal and mucosal surface exposure: A review. Regul Toxicol Pharmacol 2018; 98:257-267. [DOI: 10.1016/j.yrtph.2018.08.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/30/2022]
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García-Martínez P, López Aventín D, Segura S, Gómez-Martín I, Lloreta J, Ibáñez J, Elvira JJ, Pujol RM. In vivo reflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria. Br J Dermatol 2016; 175:1052-1055. [PMID: 26997486 DOI: 10.1111/bjd.14571] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
Abstract
Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy-dispersive X-ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy (RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity.
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Affiliation(s)
- P García-Martínez
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain.
| | - D López Aventín
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - S Segura
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - I Gómez-Martín
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - J Lloreta
- Department of Pathology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
| | - J Ibáñez
- Institut de Ciències de la Terra Jaume Almera, CSIC, Barcelona, Spain
| | - J J Elvira
- Institut de Ciències de la Terra Jaume Almera, CSIC, Barcelona, Spain
| | - R M Pujol
- Department of Dermatology, Hospital del Mar, Passeig Marítim, 25-29, ES-08003, Barcelona, Spain
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Kwon IH, Ahn HH, Ryu HJ, Rhyu IJ. Sudden appearance of black macules on palmar aspect of two university chemistry students. Int J Dermatol 2015; 55:e167-9. [PMID: 26518909 DOI: 10.1111/ijd.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/23/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- In Hyuk Kwon
- Department of Dermatology, College of Medicine Korea University, Seoul, Korea.
| | - Hyo Hyun Ahn
- Department of Dermatology, College of Medicine Korea University, Seoul, Korea
| | - Hwa Jung Ryu
- Department of Dermatology, College of Medicine Korea University, Seoul, Korea
| | - Im Joo Rhyu
- Department of Anatomy, College of Medicine Korea University, Seoul, Korea
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Catalano S, Roberts V, Boos M, Norris R, Treat JR. Blue scalp discoloration in infants caused by exogenous source. Pediatr Dermatol 2015; 32:e95-7. [PMID: 25690855 DOI: 10.1111/pde.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A blue patch on the vertex scalp of an infant has a broad differential diagnosis, including vascular malformations, melanocytic lesions, trauma, and exogenous or endogenous pigmentation. We present two cases of infants who developed blue patches on the scalp. Extensive examination including MRI and biopsy was recommended for one of the patients to further characterize the lesion and its possible medical implications. In both, the blue discoloration had been due to repetitive contact with the sticker on a tub of baby wipes that had rubbed off onto the scalp. We present these infants to highlight this exogenous and benign cause of blue pigmentation and help practitioners avoid unnecessary examination.
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Affiliation(s)
- Sarah Catalano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Markus Boos
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Section of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robin Norris
- Division of Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - James R Treat
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Section of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Enei ML, Paschoal FM, Valdés R. Argyria mimicking a blue nevis: dermoscopy features. An Bras Dermatol 2014; 88:452-5. [PMID: 23793194 PMCID: PMC3754384 DOI: 10.1590/abd1806-4841.20132022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 09/10/2012] [Indexed: 11/23/2022] Open
Abstract
Argyria is a rare disease caused by prolonged skin contact with silver. Localized cases have been described regarding the use of topical medications, and trauma with objects containing this metal such as acupuncture needles and jewelry. Clinically, a macule or a patch, round or oval, appears in the infected area, with a characteristic bluey-gray color. To our knowledge this is the first time that this clinical condition has been described through the use of dermoscopy.
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Abstract
We report 2 cases of patients who presented with blue macules clinically suspicious for blue nevi. One patient had no documented history of trauma or silver exposure, and the other reported exposure to silver over 30 years ago. Microscopic examination revealed a dermal population of brown-black globules predominantly adhering to collagen fibers. In both cases, no melanocytic proliferation was identified by immunohistochemistry. Analysis of the skin biopsies with scanning electron microscopy and energy dispersive x-ray spectroscopy demonstrated the presence of silver and selenium. These findings were diagnostic of localized cutaneous argyria. Our case reports highlight the importance of including localized cutaneous argyria in the differential diagnosis of pigmented lesions.
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13
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Affiliation(s)
- Kyle T. Amber
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
| | - Caroline Y. Winslow
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
| | - Andrew Styperek
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
| | - Peter H. Schwartz
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
| | - Michael I. Shiman
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
| | - George Elgart
- Department of Dermatology and Cutaneous Surgery; University of Miami; Miller School of Medicine; Miami FL USA
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Localized Cutaneous Argyria: A Report of 2 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Saager RB, Hassan KM, Kondru C, Durkin AJ, Kelly KM. Quantitative near infrared spectroscopic analysis of Q-Switched Nd:YAG treatment of generalized argyria. Lasers Surg Med 2013; 45:15-21. [PMID: 23322674 DOI: 10.1002/lsm.22084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Generalized argyria is a blue-gray hyperpigmentation of the skin resulting from ingestion or application of silver compounds, such as silver colloid. Case reports have noted improvement after Q-Switched Neodymium-Yttrium Aluminum Garnet laser (1,064 nm QS Nd:YAG) laser treatment to small surface areas. No reports have objectively monitored laser treatment of generalized argyria over large areas of skin, nor have long-term outcomes been evaluated. STUDY DESIGN/MATERIALS AND METHODS An incremental treatment plan was developed for a subject suffering from argyria. A quantitative near infrared spectroscopic measurement technique was employed to non-invasively analyze tissue-pigment characteristics pre- and post-laser treatment. Post-treatment measurements were collected at weeks 1, 2, 3, and 4, and again at 1 year. RESULTS Immediate apparent removal of pigment was observed with 1 Q-switched 1,064 nm Nd:YAG laser treatment (3-6 mm spot; 0.8-2 J/cm(2) ) per area. Entire face, neck, upper chest, and arms were treated over multiple sessions. Treatments were very painful and general anesthesia was utilized in order to treat large areas. Near-infrared spectroscopy was used to characterize and quantify the concentration of silver particles in the dermis based on the absorption features of the silver particles as well as the optical scattering effects they impart. We were able to estimate that there was, on average, 0.042 mg/ml concentration of silver prior to treatment and that these levels went below the minimum detectable limit of the instrument post-treatment. There was no recurrence of discoloration over the 1-year study period. CONCLUSION QS 1,064 nm laser treatment of argyria is a viable method to restore normal skin pigmentation with no evidence of recurrence over study period. Quantitative spectroscopic measurements: (1) confirmed dyspigmentation was due to silver, (2) validated our clinical assessment of no recurrence up to 1-year post-treatment, and (3) indicated no collateral tissue damage with treatments.
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Affiliation(s)
- Rolf B Saager
- Beckman Laser Institute and Medical Clinic, University of California-Irvine, Irvine, California 92617, USA
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Garcias-Ladaria J, Hernandez-Bel P, Torregrosa-Calatayud JL, Martínez-Aparicio A. Localized cutaneous argyria: a report of 2 cases. ACTAS DERMO-SIFILIOGRAFICAS 2012; 104:253-4. [PMID: 22938996 DOI: 10.1016/j.ad.2012.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/13/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022] Open
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Rumayor Piña A, Martínez Martínez M, Toral Rizo VH, Ajudarte Lopes M, Paes de Almeida O. Cutaneous amalgam tattoo in a dental professional: an unreported occupational argyria. Br J Dermatol 2012; 167:1184-5. [PMID: 22540268 DOI: 10.1111/j.1365-2133.2012.11021.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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