Locally invasive cellular blue nevus of the scalp

Dural Melanoma Associated with Ocular Melanosis and Multiple Blue Nevi

Background:

Primary meningeal melanomas of the central nervous system (CNS) are a rare malignant process with the majority originating from the leptomeninges. Primary dural melanomas have been reported to occur in isolation or in conjunction with Nevus of Ota. The association of primary dural melanoma with multiple cutaneous blue nevi has not been reported previously.

Objective:

To describe a case of a 41-year-old Asian woman patient with a primary dural melanoma that arose in association with ocular melanosis and multiple cutaneous blue nevi. The patient is alive almost more than 8 years after subtotal and subsequent total resection of her primary tumor. Primary dural melanomas, Nevus of Ota, and blue nevi are discussed in relation to their coexistence and potential for intracranial melanoma.

Conclusion:

CNS melanoma is regarded as an extremely aggressive disease with poor prognosis. This case and previous reports of dural melanomas occurring in isolation or with Nevus of Ota have demonstrated relatively prolonged survival after surgical intervention. We conclude that dural melanomas are less aggressive tumors requiring surgical extirpation only.

Congenital neurocristic tumor presenting as an isolated calvarial defect in an infant: case report

In infants, the presence of a cranial defect may be due to a variety of traumatic, inflammatory, neoplastic, and congenital abnormalities. Differentiation between these possible etiologies is facilitated by clinical presentation, patient history, and physical examination. Congenital cutaneous neural crest-derived lesions are unlikely to be considered in a patient presenting with an asymptomatic cranial defect without overlying mass or skin pigmentation. The authors present an unusual case of a 2-month-old infant with an asymptomatic calvarial defect with normal overlying skin. Pathology of the excised tissue showed features consistent with a congenital neurocristic tumor: a pigmented, neural crest-derived hamartomatous tumor that typically presents as a melanotic skin lesion.

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Melanomas arising in association with blue nevi or mimicking cellular blue nevi comprise a relatively rare and heterogeneous group of melanomas. It remains controversial which prognostic indicators predictive of outcome in conventional cutaneous melanomas are applicable to this type of melanoma. Here, we describe the clinical and histopathologic features of 24 melanomas arising in association with blue nevi and correlate these with clinical outcome. The mean patient age was 49 years (range: 23-85) with a slight female predominance (15 females:9 males). The most common anatomic locations included the head and neck region (50%), the trunk (21%), and the buttock/sacrococcygeum (17%). Histologically, the tumors were typically situated in the mid to deep dermis with variable involvement of the subcutis, but uniformly lacked a prominent intraepithelial component. The mean tumor thickness (defined as either the standard Breslow thickness or, if not available due to the lack of orientation or lack of epidermis, the largest tumor dimension) was 20.9 mm (range: 0.6-130 mm). The mean mitotic figure count was 6.5/mm(2) (range: 1-30/mm(2)). Perineural invasion was common (38%). Follow-up was available for 21 cases (median 2.1 years). The median overall survival, recurrence-free survival, time to local recurrence, and time to distant recurrence were 5.2, 0.7, 2.6, and 1.6 years, respectively. Logistic regression analyses demonstrated a significant association between tumor thickness and recurrence-free survival (hazard ratio=1.02 per mm; P=0.04) and reduced time to distant metastasis (hazard ratio=1.03 per mm; P=0.02) with a similar trend toward reduced time to local recurrence (hazard ratio=1.02 per mm; P=0.07). No other parameters (age, anatomic location, mitotic figures, lymphovascular or perineural invasion, or type of associated blue nevus) emerged as significant. In addition, we provide a comprehensive review of 109 cases of melanoma blue nevus type described in the English literature and summarize our findings in this context.

Malignant blue nevus arising in a giant congenital cellular blue nevus in an infant

Giant congenital blue nevus (GCBN) is rare and usually occurs on the scalp. Malignant blue nevus (MBN) is also rare and has a poor prognosis. We report a case of MBN arising in a GCBN on the back. There have been three previous reports of MBN associated with GCBN on the trunk; our case had the earliest onset of MBN arising in a GCBN.

Malignant blue nevus: a case report and molecular analysis

Malignant blue nevus is a rare melanocytic tumor that is described by some authors as a variant of malignant melanoma, whereas others regard it as a distinct entity. To our knowledge no molecular studies of this tumor have been performed, although the molecular pathogenesis of conventional melanomas has been extensively described. We present a case of malignant blue nevus that developed in a 15-cm congenital blue nevus on the back of a 41-year-old man. Subsequent regional lymph node and lung metastases developed within 1 and 29 months, respectively. We performed a molecular analysis for loss of heterozygosity on microdissected samples from the spectrum of benign to malignant blue nevus, using a panel of eight genes (MTS1, MXI1, CMM1, p53, NF1, L-myc hOGG1, and MCC), many of which are commonly associated with conventional melanomas. No loss of heterozygosity was detected, despite informativeness in seven genes. We suggest that malignant blue nevus may represent a distinct entity with a different molecular pathway to tumorigenesis than that of conventional melanomas.

Cellular blue nevus of the scalp infiltrating the underlying bone: case report and review

Cellular blue nevi (CBN) are benign tumors of the skin derived from dermal melanocytes histologically characterized by increased cellularity and often by a dual cell population of nevoid cells. CBN rarely tend to invade the underlying tissues. Only six cases of CBN of the scalp invading the skull have been reported. A new case of a CBN infiltrating the underlying bone is presented. The patient, a 23-year-old woman, had a large hairless area on her right parietal scalp, present since the early months of life. Her past medical history included, on the same site, the presence, at birth, of a raised, dark, soft and hairless mass that was subsequently electrodesiccated. Radiographs of the skull showed an area of osteolysis underlying the cutaneous lesion. Histologic examination of a biopsy specimen revealed a CBN of the scalp infiltrating the underlying bone. Surgical resection of the entire lesion was planned. There were no other anomalies or malignancies. The patient is currently being followed in our clinic.

Cutaneous Blue Nevi: Classification and Malignant Degeneration

MM Al-Qattan, MF Stranc, BJ Anderson. Cutaneous blue nevi: classification and malignant degeneration. Can J Plast Surg 1994;2(3):130-132. A case of malignant melanoma arising in a congenital giant blue nevus on the arm of a 72-year-old male is reported. The literature is reviewed and a classification of cutaneous blue nevi presented. Malignant degeneration of different types of blue nevi is also discussed.

Invasive naevus of Ota

A slowly invasive naevus of Ota was followed for 50 yrs. During this time multiple biopsies were considered to be benign cellular blue naevus. The left globe, orbit, frontal bone and meninges were excised to achieve clearance.

Giant alopecic nodule of the scalp: unusual presentation of a cellular blue naevus in an adult

A giant cellular blue naevus of the scalp is described in a man with presentation in the third decade of life. In contrast with previous reports of children with this condition, there was no abnormality of the underlying skull bones and no evidence of malignancy.

Malignant blue nevus

To elucidate the histologic features and biologic behavior of malignant blue nevus (MBN), 12 cases were analyzed in which the tumor showed no junctional activity and arose in a blue nevus background. Seven patients were men and five were women; their mean age was 48.8 years. Eight lesions were on the scalp, and no patient had a family history of melanoma. The histologic appearance of most lesions was a nodule or nodules of malignant cells in a blue nevus. Mitoses were present in all lesions with atypical forms in eight; however the mitotic rate exceeded two per ten high-power fields in only one lesion. Four lesions had necrosis, and four had a heavily pigmented malignant component. Four patients had recurrences; ten patients had metastases, and eight died of their disease. Therefore MBN is an aggressive neoplasm.