Pseudomelanoma after dermabrasion

Dermoscopic Aspects of Traumatized Nevi After Dermabrasion

BACKGROUND

Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma.

OBJECTIVE

The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion.

METHODS

Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion.

RESULTS

The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures.

CONCLUSION

Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.

The recurrent nevus phenomenon: a history of challenge, controversy, and discovery

CONTEXT

The diagnosis of recurrent nevus poses a potential challenge to practicing pathologists. Although most recurrent nevi show uniform microscopic findings and pose no great diagnostic difficulty, a few cases exhibit some histopathologic features similar to, and in some cases indistinguishable from, melanoma. Historically, the term pseudomelanoma has been used in the literature to describe such recurrent nevi, although this label has the potential for confusion and is no longer the favored term for recurrent pigmented melanocytic nevi.

OBJECTIVE

To describe historical, histopathologic, and immunohistochemical features of recurrent pigmented melanocytic nevi and to review briefly the literature surrounding the mechanism of recurrence.

DATA SOURCES

Published peer-reviewed literature and the authors' personal experience.

CONCLUSIONS

Recognition of the histopathologic pattern of recurrent nevi leads the pathologist to the correct diagnosis in most cases; however, in particularly challenging specimens or in circumstances in which there is insufficient clinical history, immunohistochemical studies have proved helpful in distinguishing recurrent nevi from melanoma.

The role of surgery in the management of congenital melanocytic naevi in children: a perspective from Great Ormond Street Hospital

Recent advances in research have prompted this review of the role of surgery in the management of congenital melanocytic naevi (CMNs). Good data on the incidence of neurological and malignant complications of CMNs have re-fuelled the debates on whether surgery decreases the risk of malignant melanoma and whether early surgery is advantageous. We conclude the following: 1) untreated CMNs can lighten spontaneously, sometimes dramatically, 2) routine surgery has not been demonstrated to reduce the risk of malignancy and is, therefore, for cosmetic reasons only, 3) early surgery has not been shown to be advantageous and carries increased anaesthetic risk and 4) there is some evidence that surgical intervention may adversely affect the behaviour of the CMN cells. Our current practice is based on the following guidelines: 1) patients are treated in a multidisciplinary-team setting which includes the specialties of paediatric dermatology, plastic surgery and neuroradiology with access to neurology, neurosurgery and oncology, 2) serial photographs are taken at yearly intervals to assess spontaneous lightening. 3) all routine surgery is delayed for at least the first year. 4) patients with facial CMNs (either the principal lesion or large satellites) are offered surgery for cosmetic reasons, 5) patients with a single, easily excisable CMN are offered surgery for cosmetic reasons and 6) all families are made aware of the possibility of spontaneous lightening and the possibility that surgery may have effects on the behaviour of naevus cells.

Great Ormond Street Hospital for Children Registry for Congenital Melanocytic Naevi: prospective study 1988-2007. Part 2--Evaluation of treatments

BACKGROUND

The treatment of congenital melanocytic naevi (CMNs) has become controversial as better data on complications have been published.

OBJECTIVES

To determine the longer-term risks and benefits of surgery in treatment of CMNs.

METHODS

In this 19-year prospective study, 301 families completed yearly questionnaires about treatments and CMN changes. Forty per cent of CMNs were > 20 cm projected adult size (PAS) or multiple CMNs.

RESULTS

Girls were more likely to have had surgical treatments. There were no significant effects of treatment on the incidence of adverse clinical outcomes, although the numbers for melanoma were small. The majority of untreated CMNs lightened spontaneously during the follow-up period. Surgical treatment and satellites at birth were independently significantly associated with reported darkening of the CMN over the follow-up period. However there was no absolute measurement of final colour. Surgical treatment was associated with decreasing hairiness of the CMN over the follow-up period. PAS was associated with increasing hairiness. Excision with tissue expanders and PAS were significantly associated with an increased incidence of new satellite lesions. A proportion of patients reported new pigmentation in previously unaffected skin at the edge of a treated area, the majority after complete excision. There was a high level of satisfaction with surgery in the < 20 cm group and in those with facial CMNs. This was significantly reduced with increasing PAS.

CONCLUSIONS

There is no evidence here that surgery reduces the incidence of adverse clinical outcomes in childhood. The natural history of the majority of untreated CMNs is to lighten spontaneously, whereas some treatments may cause adverse effects.

Dermabrasion of large congenital melanocytic naevi in neonates

We describe our findings in a series of 12 patients with large congenital melanocytic naevi treated with dermabrasion between the first and fourteenth week of life. Postoperative follow-up ranged from 1-16 years. In all but two cases dermabrasion resulted in an appreciable and stable reduction of the hyperpigmentation, possibly by reducing the number of pigmented cells in the epidermis. In six of our 12 patients, reconstruction using grafts and flaps was done to improve the aesthetic result. Seven years after dermabrasion, one patient developed a minimal deviation melanoma in the treated area, but his subsequent clinical course has been uneventful.