Localized argyria with pseudo‐ochronosis

Localized Cutaneous Argyria at the Site of a Prior Melanoma Excision Confirmed by Scanning Electron Microscopy With Energy Dispersive X-ray Analysis

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.

Hypothetical Mechanism of Skin Argyria

Introduction. Argyria is an acquired skin condition that appears after the exposure or consumption of silver, leading to blue or grey coloration of the skin and mucosa. The aim of the present work was to draw researchers’ attention to two aspects of the argyria that until now have not received enough consideration. They are: (1) the process of delivering silver compound from the gastrointestinal tract to the skin and (2) the possibility for silver chloride to participate in this process along with the silver proteinates. Methodology. Illustrative experiments included the observation of color change (visual and using UV-Vis spectrometry) under different light exposure conditions of silver chloride sol in a sweat-simulating solution, in vials and under pig skin (in direct contact). Results and Discussion. A hypothetical mechanism based on a perspiration system for delivering the silver compounds from the gastrointestinal tract to the skin for argyria was proposed. It was also proposed not to completely exclude the partial participation of silver chloride along with the silver proteinates in this process.

Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions

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.