Nevus of Ota: clinical aspects and management

Clinicopathologic profiles of canine ocular melanosis: A comparative study between cairn terriers and non-cairn terriers

OBJECTIVES

To identify canine breeds at risk for ocular melanosis and to compare the clinical and histologic features between affected Cairn Terriers (CTs) and non-Cairn Terriers (NCTs).

DESIGN

Relative risk (RR) analysis and retrospective cohort study of dogs histologically diagnosed with ocular melanosis.

PROCEDURES

The COPLOW archive was searched for globe submissions diagnosed with ocular melanosis. Six hundred fifty globes were included, and RR analysis was performed to identify at-risk NCT breeds. A cohort of 360 CT and NCT globes diagnosed from 2013 to 2023 were included in the retrospective cohort study. Clinical data were collected from submission forms, medical records, and follow-up surveys. One hundred fifty-seven submissions underwent masked histologic review. Immunohistochemical staining for CD204 was performed to determine the predominance of melanophages in affected uvea from five NCTs.

RESULTS

At-risk NCT breeds included the Boxer, Labrador Retriever, and French Bulldog. Glaucoma was the reported reason for enucleation in 79.4% of submissions. At enucleation, clinical features less prevalent in NCTs than CTs included pigmentary abnormalities in the contralateral eye (33.7% vs. 63.1%, p = .0008) and abnormal episcleral/scleral pigmentation in the enucleated globe (25.4% vs. 53.6%, p = .0008). Histologic involvement of the episclera was also less frequent in NCTs than in CTs (39.7% vs. 76.9%, p = .008). Concurrent melanocytic neoplasms arising in melanosis were more common in NCTs (24.4%) than CTs (3.9%). Melanophages were not predominant in any samples evaluated immunohistochemically.

CONCLUSIONS

Several popular NCT breeds carry risk for ocular melanosis, and some clinicopathologic disease features may differ from those described in CTs.

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Q-Switched Nd:YAG Laser to Manage Hyperpigmentation in Asians: A Multicenter Study

(1) Introduction: In cosmetic dermatology, benign hyperpigmentation is a prevalent issue. Solar lentigo and other melanoses are bringing patients to the attention of physicians more and more often. The Q-switched 1064/532-nanometer (nm) laser is the gold standard device to treat these conditions. A new generation of these machines, able to shorten pulse duration to hundreds of picoseconds, has emerged showing better preliminary results. In order to treat hypermelanoses in Asians, we used a Q-switched laser with a picosecond pulse. (2) Methods: A retrospective recruitment of 31 Asian individuals requesting treatment for melanosis was conducted at Catanzaro’s Magna Graecia University, University of Rome Tor Vergata and Villa Bella Antiaging. Although they might have varied, the treatment settings were typically as follows: for dermic lesions, a pulse wavelength of 1064 nm with a duration of 450 picoseconds (ps) was used, and for epidermal lesions, a pulse wavelength of 532 nm with a duration of 370 ps was used. Up to four laser treatments were carried out, each at least 30 days apart. During a three-month follow-up after the final session, patient satisfaction was evaluated using a visual analogue scale (VAS). Images taken prior to laser treatments and thereafter were compared, and the aesthetic effect was scored on a five-point scale by two blinded specialists. (3) Results: Of the 31 patients recruited, 25 (80.6%) were female and 6 were male (19.4%). The average stated age was 48.96 ± 13.68. During the dermatological examination, all patients were found to have nearly completely removed melanosis, with a mean VAS score of 7.03 ± 1.35 and a five-point evaluation scale of 2.71 ± 0.78. Conclusions: The Q-switched 1064/532 nm laser can be seen as a safe and effective option to treat benign hypermelanosis in Asian patients. Compared to other technologies, the use of a picosecond pulse appears to promise superior outcomes. To validate the results of this investigation, however, a clinical trial comparing the many commercially accessible therapy options is required.

Disorders of hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders

Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation.

[Physiologic hyperpigmentation on darker skin]

Many, even common, normal variations and nuances of skin of color are less frequently described or often misinterpreted as pathological. Recognizing these physiologic changes is gaining relevance in our increasingly diverse patient population and enables the physician to encourage the acceptance by the patients as well as to manage our resources wisely. Therefore, we explain common hyperpigmentation on dark skin such as demarcation lines, mucosal hyperpigmentation, melanonychia striata, and circumscribed dermal melanocytosis. The aim of this article is to facilitate the classification of these phenomena in clinical practice.

An update on ophthalmological perspectives in oculodermal melanocytosis (Nevus of Ota)

PURPOSE

To provide a review of the literature on oculodermal melanocytosis (ODM) with a focus on the diagnostic and therapeutic implications of multimodal imaging techniques in the management of ophthalmic complications.

METHODS

The authors carried out a literature search on PubMed, Medline, and Scopus of English language articles published on ODM through August 2021. This review presents traditional and novel diagnostic methods in the diagnosis and follow-up of patients with particular emphasis on addressing the role of imaging in the management of the ophthalmic complications of the condition towards improving current practice patterns.

RESULTS

ODM is a rare, prevalently unilateral, congenital condition that presents with brown or blue/gray flat asymptomatic lesions of the skin, mucosae, episclera/sclera, and uvea localized within the territory of distribution of the ophthalmic and mandibular branches of the trigeminal nerve. Glaucoma and predisposition to uveal melanoma are the main ophthalmic complications. Diagnosis and management are through comprehensive opthalmological examination and traditional imaging methods such as ultrasonography and fluorescein/indocyanine green angiography as pigmentation of the fundus can conceal subtle retinal and choroidal alterations. Anterior segment optical coherence tomography and ultrasound biomicroscopy are used to evaluate the anterior segment and the ciliary body in the presence of glaucoma or melanoma of the anterior uveal tract. Fundus autofluorescence and retinal pigment epithelium (RPE) alterations are of aid in the differential diagnosis between choroidal nevi and melanoma. Enhanced depth imaging spectral domain optical coherence tomography offers outstanding in vivo evaluation of the dimensions and details of tumors or nevi and surrounding choroidal tissues and small choroidal melanomas may show distortions of the retinal and sub-retinal profile, presence of intra and sub-retinal fluid, abnormalities of the RPE, and compression of the choriocapillaris.

CONCLUSIONS

Novel multimodal imaging techniques are significant in the diagnosis and management of the ophthalmic complications of ODM. Fundus autofluorescence and enhanced depth spectral domain optical coherence tomography have adjunctive value in the detection of early-stage melanoma and differential diagnosis between nevi and melanoma. Awareness of current and emerging imaging techniques can propagate improved standardized definition and assessment of the complications of ODM.

Primary orbital melanoma: A report of a case and comprehensive review of the literature

Purpose: To review the clinical features and treatment-associated outcomes of primary orbital melanoma among cases reported in the literature and to present a case treated with orbital exenteration and post-operative radiotherapy.Methods: Case reports and case series on primary orbital melanoma published in the literature between 1980 and 2020 were reviewed. Data collected included patient demographics, presenting ocular symptoms, diagnostic imaging, histology, management, and outcomes.Results: Eighty-eight cases of primary orbital melanoma were reviewed. The average age at presentation was 45 years and 58% of patients were male. The most common presenting symptoms and signs were proptosis (73%), decreased visual acuity (32%), pain (14%), diplopia (15%), and palpable mass (9%). Imaging frequently showed a well-circumscribed enhancing lesion. Diagnosis was made by histology in all cases, and orbital blue nevus was identified in 42%. In the majority of cases, treatment consisted of orbital exenteration (54%) or excision (38%). Adjuvant radiotherapy was given in 47% of cases. For the 72 patients with reported outcomes, 36% had metastases, 15% had local recurrence, and 32% died of metastatic disease. Patients who received surgery and radiotherapy had improved survival compared to those who received surgery alone (p = .01). There was no difference in survival between those who underwent orbital exenteration or excision (p = .16).Conclusions: Primary orbital melanoma is a rare malignancy and should be considered in patients with a history of unilateral proptosis and a well-defined orbital mass on imaging. Surgery remains the mainstay of treatment. Adjuvant radiotherapy may improve patient survival.

Plexiform neurofibroma with nevus of ota-rare presentation

Plexiform neurofibroma (PNF) is a rare form of neurofibromatosis type 1 which is rarely seen isolated. This generally spreads along the peripheral nerve and may affect some nervous rami. This is a poorly circumscribed and locally invasive tumor. About 21% of patients with NF-I are affected with PNFs. The nevus of Ota also called oculodermal melanocytosis is a macular discoloration of the face. It is most commonly found in the Japanese and very rare in the Indian subcontinent. It is unilateral oculodermal melanosis along the first two branches of the trigeminal nerve. We hereby present a very rare case of occurrence of isolated PNF (not associated with neurofibromatosis type 1) along with nevus of ota of the left side of the face in a 28-year-old female with thorough radiographic work up.

Treatment of nevus of Ota with 1064 nm picosecond Nd:YAG laser: A retrospective study

Nevus of Ota has been successfully treated by lasers. Currently, 1064 nm picosecond Nd:YAG lasers have become available for the treatment of pigmented disorders. However, there are few studies concerning the application of 1064 nm picosecond Nd:YAG laser in nevus of Ota. This study aimed to evaluate the efficacy and safety of a 1064 nm picosecond Nd:YAG laser for the treatment of nevus of Ota. We conducted a retrospective analysis of Chinese patients with nevus of Ota who had been treated with a 1064 nm picosecond Nd:YAG laser. Those who had any other laser treatment during the period of picosecond laser treatment were excluded. Via a visual analog scale for percentage of pigmentary clearance in standard photographs, the treatment efficacy was assessed by three blinded physician evaluators. A total of 16 subjects were included in this retrospective study. The average age at the beginning of treatment was 16.87 years old (range of 4 months to 59 years), and all patients were of Fitzpatrick skin type IV. Total treatment ranged from 1 to 5 sessions. A 1064 nm picosecond Nd:YAG laser with a mean fluence of 1.8-4.3 J/cm² was used at 3-12 month intervals. The mean efficacy score for all 16 patients was 2.56 after one session, and the mean efficacy score of 13 patients who completed two sessions and nine patients who completed three sessions were 3.15 and 3.51, respectively. Postinflammatory hyperpigmentation after treatment was only observed in 1 (1/16, 6.25%) patient. The 1064 nm picosecond Nd:YAG laser is an effective and safe approach for treating nevus of Ota.

Combination of 1064-nm Q-switched neodymium-doped yttrium-aluminum-garnet laser with Modified Jessner's peel for the treatment of Nevus of Ota: A case series of seven patients

1064-nm Q-switched Nd: YAG (neodymium-doped yttrium-aluminium-garnet) laser is widely used for the treatment of Nevus of Ota but multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Modified Jessner's solution has been used for the treatment of facial pigmentation but repetitive chemical peeling can cause irritation and post-inflammatory hyperpigmentation. In this series, we evaluated seven patients who were treated with a combination of 1064-nm Q-switched Nd: YAG laser and Modified Jessner's peel for eight sessions with 85.7% patients showing more than 50% reduction in pigmentation. The added therapeutic benefit of the combination helped to achieve a significant reduction in pigmentation faster with a lesser number of sessions and reduced cost.

Long-Term Follow-Up for Q-Switched Nd:YAG Treatment of Nevus of Ota: Are High Number of Treatments Really Required? A Case Report

Objective: Q-switched laser is considered a gold standard treatment for Nevus of Ota (NO). We report how few laser sessions in long intervals of time may achieve satisfying outcomes reducing the rate of possible procedure-linked side effects such as burning, cornea injuries, or hyperpigmentation. Background: NO represents a congenital dermal melanocytosis in the trigeminal distribution majorly occurring in Asian individuals. Multiple reports have shown efficacy and safety of Q-switched laser for the treatment of this condition, but they were based on an empiric regimen, often leading to unnecessary overtreatments. At the best of our knowledge, no long-term follow-up observations of single laser sessions have been conducted to assess the proper intervals and number of treatments. Materials and methods: A 36-year-old Asian woman, Fitzpatrick skin type IV with clinical diagnosis of NO, was treated with 1064 nm 6 ns Q-switched laser one session per year for a total of two sessions. Clinical result was valued by two physicians independently using standardized and polarized light. No use of general anesthesia or sedation was needed in our experience. Corneal shields have been used. Results: After only two sessions of the Q-switched laser performed 1 year apart, the result was excellent with a 95% of clinical response. No side effect was observed. Conclusions: In our experience, Q-switched Nd:YAG laser is an effective treatment for NO with no necessity of high number of treatments. A larger population is needed to confirm this preliminary result.

Naevus of Ota: clinical characteristics and proposal for a new ocular classification and grading system

INTRODUCTION

Naevus of Ota is a congenital condition that may involve the skin, eyeball and even intracranial structures usually in the distribution of the ophthalmic and maxillary divisions of the trigeminal cranial nerve. The purpose of this study was to summarise our experience with the ocular clinical presentation, imaging, outcome, treatment of complications and to offer a new classification of patients with naevus of Ota.

METHODS

We retrospectively reviewed the patients' medical records and the following parameters were retrieved and analysed: demographics, clinical presentation complications and treatment of complications. Imaging characteristics of patients with naevus of Ota were compared with images from the same period of time of 57 age-matched and gender-matched patients without naevus of Ota (control group).

RESULTS

The series was composed of 40 patients (18 males, 22 females) whose mean age at diagnosis was 35.27 years (range 0.5-77 years). Thirty-three patients (82.5%) were type I naevus of Ota according to the Tanino classification, three patients (7.5%) were type II, one patient (2.5%) was type III and three patient (7.5%) were type IV (bilateral naevus of Ota). We further classified all cases in according to the ocular involvement extent. Three patients developed malignant transformation to choroidal melanoma and four patients developed glaucoma.

CONCLUSIONS

In this study, a new clinical classification based on the involved ocular component and extent of the involvement (in quadrants) of the globe is suggested first. Further studies are needed to assess whether our clinical ocular classification can assist in identifying patients at risk for developing glaucoma and malignant transformation.

Oculodermal Melanocytosis: Nevus of Ota in a Dog

This report describes the clinical presentation, diagnosis, and histopathologic features of oculodermal melanocytosis in a young dog. A 3-year-old male neutered Labrador Retriever presented with conjunctival and scleral hyperpigmentation of the right eye, with concurrent ipsilateral cutaneous hyperpigmentation involving the right side of the face. Initial skin and conjunctival biopsies revealed an accumulation of histologically benign melanocytes within the dermis and conjunctival stroma, respectively. Enucleation was elected 19 months later by the referring veterinarian due to the progression of ocular pigmentation with concurrent marked corneal lipidosis and the suspicion of a scleral mass. On gross and histopathologic examination of the globe, there was marked panuveal melanocytosis with extension into the sclera, bulbar conjunctiva, and connective tissue surrounding the optic nerve, as well as sharply demarcated ipsilateral hyperpigmentation of the facial skin. The findings are characteristic of oculodermal melanocytosis (nevus of Ota), a dermal melanocytic hamartoma presenting as cutaneous facial hyperpigmentation that corresponds to the distribution of the ophthalmic and maxillary branches of the trigeminal nerve, often with ipsilateral ocular involvement.

Detection of mutations in SF3B1, EIF1AX and GNAQ in primary orbital melanoma by candidate gene analysis

Background

Ocular melanoma is a rare but often deadly malignancy that arises in the uvea (commonest primary site), conjunctiva or the orbit. Primary orbital melanoma (POM) is exceedingly rare, with approximately 60 cases reported to date. Despite recent advances in our understanding of the genetics of primary uveal and conjunctival melanomas, this information is lacking for POM.

Methods

DNA was extracted from 12 POM tissues, with matched germline DNA (where available). MLPA was conducted to detect chromosomal alterations and Sanger sequencing used to identify point mutations in candidate melanoma driver genes (BRAF, NRAS, KRAS, GNA11, GNAQ), and other genes implicated in melanoma prognosis (EIF1AX, SF3B1). Immunohistochemistry was performed to analyse BAP1 nuclear expression.

Results

MLPA detected copy number alterations in chromosomes 1p, 3, 6 and 8. Sequencing of melanoma driver genes revealed GNAQ (p.Q209L) mutations in two samples; although it is possible that these samples represent extraocular spread of an occult uveal melanoma. A recurrent mutation in SF3B1 (p.R625H) was observed in indolent, but not aggressive, tumours; a mutation in EIF1AX (p.N4S) was detected in one patient with non-aggressive disease.

Conclusions

EIF1AX and SF3B1 mutations appear have a role in determining the clinical course of POM and detection of these changes could have clinical significance. Further in depth analysis of this rare group using differing ‘omic technologies will provide novel insights into tumour pathogenesis.

Primary meningeal melanocytoma of the cerebellopontine angle associated with ipsilateral nevus of Ota: A case report

BACKGROUND

Cerebellopontine angle represents a complex anatomical area of the brain. A cerebellopontine angle lesion could be a vestibular schwannoma, meningioma, epidermoid cyst, or less likely, arachnoid cyst, metastasis, lower cranial nerves schwannoma, lipoma, hemangioma, paraganglioma, or vertebra-basilar dolichoectasia. Primary meningeal melanocytoma is a rare neoplasm, especially when it occurs at the cerebellopontine angle. Nevus of Ota (aka oculodermal melanocytosis) is a hyperpigmentation along the distribution of the ophthalmic and maxillary branches of trigeminal nerve; it occurs due to entrapment of melanocytes at the upper third of the dermis. It may not present at birth and may show up at puberty.

CASE DESCRIPTION

We describe a case of primary meningeal melanocytoma of the cerebellopontine angle associated with nevus of Ota in a 46-year-old male patient presented with 7-day history of left arm weakness and vertigo. Computed tomography and MRI showed right-sided cerebellopontine angle mass, which was resected. Histopathology confirmed the meningeal melanocytic lesion and revealed its nature.

CONCLUSION

Primary meningeal melanocytoma of the brain is a rare but benign tumor; the association between meningeal melanocytoma and nevus of Ota is also rare and possibly explained by their common embryonic origin from neural crest cells. There are six cases reported so far in literature including our case for meningeal melanocytoma associated with nevus of Ota.

Primary Orbital Melanoma: Presentation, Treatment, and Long-term Outcomes for 13 Patients

BACKGROUND

Periocular melanoma is a rare but often deadly malignancy that arises in the uvea (commonest origin), conjunctiva or orbit (rarest primary site). Melanoma accounts for 5-10% of metastatic/secondary orbital malignancies, but only a tiny proportion of primary orbital neoplasia. Primary orbital melanoma (POM) is exceedingly rare, with approximately 50 cases reported to date.

METHODS

All patients seen in the orbital unit at a tertiary referral hospital (1991-2016) with a biopsy-proven diagnosis of POM were identified from a diagnostic database and were studied. The case notes, imaging, surgical approach, and histology were reviewed.

RESULTS

Thirteen patients (five male; 38%) presented with isolated malignant melanoma of the orbit, for which no other primary site was identified at presentation or during an average follow-up of 44 months (median 22; range 0-13 years). The patients presented between the ages of 40 and 84 years (mean 55.5; median 48 years) and typically gave a short history of rapidly increasing proptosis and eyelid swelling. On the basis of history, a malignant lesion was suspected in most patients and all underwent incisional biopsy, with debulking of the mass in 10 (77%) patients, and skin-sparing exenteration in 3/13 (23%). Ten patients underwent orbital radiotherapy and the survival to date ranged from 9 months to 14 years (mean 55 months; median 23 months); two patients received solely palliative care for widespread disease and one patient refused orbital radiotherapy. Five of the 13 (38%) patients died from the disease.

DISCUSSION

POM is a very rare malignancy, but clinical analysis of this cohort gives insight into disease presentation and prognosis. The tumor typically presents with a rapidly progressive, well-defined mass that is, in some cases, amenable to macroscopically intact excision. Unusual for malignant melanoma, some of these patients can show an unusually long period of quiescent disease after surgical debulking and radiotherapy.

Nevus of Ota (oculodermal melanocytosis) in a dog

A 5-year-old, female, spayed Rhodesian Ridgeback presented with ocular melanocytosis and skin hyperpigmentation involving the distribution of the first and second divisions of the trigeminal nerve on the right side of the face. The dermatomal pattern of the hyperpigmentation was similar to nevus of Ota or oculodermal melanocytosis reported in humans. This condition has been associated with increased risk of developing secondary glaucoma and melanoma transformation in skin, ocular, orbital tissues, and the central nervous system. The clinical investigation and description of oculodermal melanocytosis (nevus of Ota) are presented for the first time in the dog.

Treatment of venous lake with multiwavelength 595 and 1064 nm lasers in Asian Fitzpatrick skin type IV patients

BACKGROUND

Multiwavelength lasers are reportedly useful for treating venous lake (VL) in Caucasian patients. However, the same parameters may not be safe for Asian patients with Fitzpatrick skin type (FST) IV.

PURPOSE

Report experience with using multiwavelength laser for VL treatment in Asian patients with FST IV.

METHODS

Seventeen episodes of VL in 15 Chinese patients with FST IV were treated. 595-nm pulsed dye laser (PDL) followed by 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was administered. The treatment was performed with 7-mm spot size at 7-11.5 J/cm² , 2-10 ms with PDL, followed with Nd:YAG at 35-40 J/cm² , 15-40 ms. The laser treatment was performed with a single pass without overlap.

RESULTS

Complete resolution was observed in 14 lesions after 1-2 treatment sessions, with 10 ms duration of PDL. The remaining three patients achieved 80%-90% resolution after 1-3 treatment sessions, with 2 ms duration of PDL. Only one case exhibited recurrence after 1 year.

CONCLUSION

Multiwavelength laser treatment for VL is highly effective and safe in Asians, although a much lower fluence of Nd:YAG is used, as compared to that used in Caucasians in the literature. Moreover, an appropriate PDL pulse duration (10 ms) ensures better outcomes.

Sturge-Weber Syndrome Associated with Monolateral Ocular Melanocytosis, Iris Mammillations, and Diffuse Choroidal Haemangioma

We present the case of a 12-year-old boy with Sturge-Weber syndrome and ocular melanocytosis who presented with bilateral naevus flammeus of the face and hyperpigmentation of the right iris associated with ipsilateral iris mammillations. The patient had glaucoma and a diffuse choroidal haemangioma of the right eye. Optical coherence tomography of the anterior segment confirmed iris hyper-pigmentation and did not show abnormalities of the chamber angle structures. B-scan ultrasonography and enhanced depth imaging optical coherence tomography were performed and showed a marked difference in thickness and reflectance between the right and left choroid. Visual field examinations with perimetry showed early defects in the right eye. Peripapillary optical coherence imaging showed borderline values of retinal nerve fibre layer thickness reduction in the right eye. Sturge-Weber syndrome associated with ocular melanocytosis and iris mammillations is an extremely rare condition. This paper highlights the role of multi-imaging methods in the enhanced evaluation of rare diseases towards choosing the most appropriate management strategies and improving the follow-up of patients over time.

An Update on Oculodermal Melanocytosis and Rare Associated Conditions

Oculodermal melanocytosis (ODM) is a rare disease, which is characterized by hyperpigmentation of facial skin and several parts of the eye, such as the sclera, conjunctiva, cornea, iris, ciliary body, and choroid. The condition usually affects the Asian female population. The most typical presenting ocular sign is iris heterocromia. Iris hyperpigmentation may be associated with iris mammillations, which are dome-shaped protuberations of the iris surface. They are linked to a higher risk of malignant transformation when present in patients with ODM. Glaucoma is a complication of ODM and is caused by angle abnormalities or mechanical occlusion by melanocytes in an open irido-corneal angle. Choroidal and ciliary body melanoma have a higher incidence in this condition characterized by melanocytosis. Patients presenting ODM should undergo routine ophthalmological examination in order to carefully monitor for glaucoma and melanoma.

Rare Diseases Leading to Childhood Glaucoma: Epidemiology, Pathophysiogenesis, and Management

Noteworthy heterogeneity exists in the rare diseases associated with childhood glaucoma. Primary congenital glaucoma is mostly sporadic; however, 10% to 40% of cases are familial. CYP1B1 gene mutations seem to account for 87% of familial cases and 27% of sporadic cases. Childhood glaucoma is classified in primary and secondary congenital glaucoma, further divided as glaucoma arising in dysgenesis associated with neural crest anomalies, phakomatoses, metabolic disorders, mitotic diseases, congenital disorders, and acquired conditions. Neural crest alterations lead to the wide spectrum of iridocorneal trabeculodysgenesis. Systemic diseases associated with childhood glaucoma include the heterogenous group of phakomatoses where glaucoma is frequently encountered in the Sturge-Weber syndrome and its variants, in phakomatosis pigmentovascularis associated with oculodermal melanocytosis, and more rarely in neurofibromatosis type 1. Childhood glaucoma is also described in systemic disorders of mitotic and metabolic activity. Acquired secondary glaucoma has been associated with uveitis, trauma, drugs, and neoplastic diseases. A database research revealed reports of childhood glaucoma in rare diseases, which do not include glaucoma in their manifestation. These are otopalatodigital syndrome, complete androgen insensitivity, pseudotrisomy 13, Brachmann-de Lange syndrome, acrofrontofacionasal dysostosis, caudal regression syndrome, and Wolf-Hirschhorn syndrome.

Primary Meningeal Melanocytoma in the Left Temporal Lobe Associated with Nevus Ota: a Case Report and Review of the Literature

BACKGROUND

Primary melanocytic neoplasms of the central nervous system are rare lesions arising from melanocytes of the leptomeninge that are found at highest density underneath the brain stem and along the upper cervical spinal cord. Thus most reported cases of meningeal melanocytomas are located in the posterior fossa and the spinal cord, and presentation of a supratentorial tumor is rare.

METHODS

A 19-year-old man presented with a headache and seizure at our department. Neurological examinations were otherwise normal. On physical examination he had asymptomatic, bluish, speckled, and well-demarcated hyperpigmented macules on the left midface extraorally. A left temporal space-occupying lesion was seen on magnetic resonance imaging. The mass was hyperintense on T1-weighted images and isointense on T2-weighted images. Enhancement was shown on contrast-enhanced magnetic resonance imaging (MRI). The preoperative diagnosis was meningioma.

RESULT

Gross complete resection was performed. Pathological studies led to the diagnosis of meningeal melanocytoma World Health Organization (WHO) grade I. The patient received oncologic consultation. Because total resection of the tumor was achieved and its histopathologic grade was benign (WHO grade I), radiotherapy was not advised for the patient and he followed up every 6 months. No tumor was seen on follow-up MRI one year after surgery.

CONCLUSION

Presentation of meningeal melanocytoma in the supratentorial compartment is rare, and its combination with nevus Ota has been reported in very few cases. Although this lesion is benign, it might behave aggressively. Complete surgical resection of the lesion is the preferred therapeutic option.

Nevus of ota"- a rare pigmentation disorder with intraoral findings

Nevus of Ota is a dermal melanocytosis seen along the distribution of ophthalmic and maxillary divisions of the trigeminal nerve. Only 12 cases so far have been reported in English literature and it is rare in Indian subcontinent. Most of the cases reported are in females and oral cavity is infrequently involved. Here, we report a rare case of unilateral Nevus of Ota in a 56-year-old male with oral manifestations.

A retrospective analysis of the clinical efficacies of Q-switched Alexandrite and Q-switched Nd:YAG lasers in the treatment of nevus of Ota in Korean patients

BACKGROUND

While the Q-switched Alexandrite laser (QSAL) and the Q-switched neodymium: yttrium-aluminum-garnet (QSNY) laser have been widely used in treating nevus of Ota, few studies compared them.

OBJECTIVE

To compare the efficacies of the QSAL and the QSNY laser in the treatment of nevus of Ota in Korean patients.

METHODS AND MATERIALS

A retrospective multicenter study was conducted in 76 patients with nevus of Ota. Thirty-one patients were treated with a QSAL (5.5-8.0 J/cm(2), 4-mm spot size) and 45 patients were treated with QSNY laser (6.0-12.0 J/cm(2), 2-mm spot size). Treatment outcomes were categorized into five grades and the results were compared with the relevant variables taken into account using multivariate logistic regression analysis.

RESULTS

QSAL treatment was more likely to achieve a better response compared with that with QSNY laser treatment. The odds ratio of achieving an excellent response, compared with the odds ratio of having a poor response, was 12.213-times more likely when a QSAL was used than when a QSNY laser was used (p = 0.026).

CONCLUSION

The QSAL tends to be more efficient than the QSNY laser in the treatment of nevus of Ota in Korean patients. Further controlled, prospective comparison studies are needed.

Orbital malignant melanoma associated with nevus of Ota

Nevus of Ota (oculodermal melanosis) is a dermal melanocytic hamartoma with bluish hyperpigmentation along the first and second branches of the trigeminal nerve. Extracutaneous involvement, especially ocular, has been reported. A 45-year-old male presented with malignant melanoma of the left orbit in association with nevus of Ota. Being locally invasive, a modified exenteration with frontal flap repair was done on left eye. Adjuvant chemotherapy was given after wound healing. All pigmented lesions of the eye require close monitoring to help in the early diagnosis. Since malignant transformation has been reported in oculodermal melanosis, close follow-up and patient education will facilitate early diagnosis and prompt management. This case is reported for its rarity and unusual presentation.

Unilateral open-angle glaucoma associated with the ipsilateral nevus of ota

The nevus of Ota also known as “congenital melanosis bulbi” and “oculodermal melanocytosis” is a blue-gray hyperpigmentation that occurs on the face and eyes. The sclera is involved in two-thirds of cases (causing an increased risk of glaucoma). Women are nearly five times more likely to be affected than men. It is rare among Caucasian people. The nevus of Ota is congenital or acquired. Most cases of the nevus of Ota are unilateral (90%), although pigmentation is present bilaterally in 5%–10%. Ocular abnormalities included pigmentation of the sclera, cornea, retina, and optic disc and cavernous hemangiomas of the optic disc, elevated intraocular pressure, glaucoma, and ocular melanoma. We reported an appearance of unilateral glaucoma in a Caucasian female patient with the acquired, ipsilateral nevus of Ota.

Surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis

PURPOSE

To show the outcomes of surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis.

METHODS

Surgical reduction of ocular pigmentation was performed in 49 patients with oculodermal melanocytosis at the Asan Medical Center, Seoul, Republic of Korea, between January 2005 and January 2009.

RESULTS

In all patients, ocular pigmentation was cosmetically reduced, and most patients were satisfied with the results of surgery. Preoperative and postoperative visual acuities, intraocular pressure (IOP), keratometry, and refractive outcomes did not differ significantly. During the follow-ups, 14 patients showed transient IOP elevation and 4 patients showed conjunctival neovascularization.

CONCLUSIONS

Surgical reduction of oculodermal melanocytosis seemed to be cosmetically satisfactory and did not cause significant changes in visual acuity, refraction, or keratometry, although 28.6% (14 of 49) of patients showed transient IOP elevation.

Eponyms in dermatology literature linked to Japan

There are many different eponyms in common use in dermatology today, originating from a variety of countries worldwide. This review discusses a selection of dermatological eponyms that are linked to Japan.

Cosmetic improvement of nevus of Ota by scleral allograft overlay

OBJECTIVE

To report surgical outcome of a new therapeutic technique for nevus of Ota by scleral allograft overlay.

DESIGN

Noncomparative clinical interventional study.

PARTICIPANTS

Eight eyes of 7 patients with scleral nevus of Ota.

METHODS

Patients underwent subconjunctival scleral allograft overlay between September 2005 and June 2007 at Seoul National University Hospital. Preoperative neval extent, postoperative cosmesis, complications, and visual acuity change were evaluated.

RESULTS

Most of the patients showed satisfying cosmetic improvement. There were no significant complications in a follow-up period of more than 3 years.

CONCLUSIONS

Scleral allograft overlay is a safe and effective procedure for cosmetic improvement of nevus of Ota.

QYAG5 Q-switched Nd:YAG Laser Treatment of Nevus of Ota: An Indian Study of 50 Patients

Background:

Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy.

Aims and Objectives:

To evaluate long-term safety and efficacy of pigmented lesion laser Palomar QYAG5 Q-switched Nd:YAG in 50 Indian patients.

Materials and Methods:

Fifty patients of nevus of Ota underwent multiple treatments (average 6 sessions) carried out over a period of 1year with a Q-switched Nd:YAG laser (QYAG5, Palomar, USA). Of the 50 patients, 2 were males; and the rest, females. Five patients had a bilateral involvement. Skin types treated included phototypes 4 and 5. The response after subsequent treatments was documented through serial photographs that were taken before and after the completion of treatments. Patients were followed up for a period of 1 year after the last session. Response to treatment was graded based on physician’s global assessment.

Results:

Excellent improvement was noted in a majority of the patients at the end of the treatments. Greater-than-60% improvement was seen in 66% of the patients. The remaining patients had moderate clearing of pigmentation (30%-60% improvement). No significant adverse effects were seen immediately after the treatments and on long-term follow-up. Transient post-inflammatory hyperpigmentation was observed in 5 (10%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was seen. Hypopigmentation (guttate type) was observed in 1 (2%) patient, which resolved within 3 months. No recurrence was observed after 1 year of follow-up.

Conclusion:

This study validates the superior efficacy of Q-switched Nd:YAG laser when compared to conventional methods for treatment of nevus of Ota.

Nevus of ota with rare palatal involvement: a case report with emphasis on differential diagnosis

Nevus of Ota, a dermal melanocytic nevus, is rare in the Indian subcontinent. It presents as a brown, blue, or gray patch on the face and is within the distribution of the ophthalmic and maxillary branches of the trigeminal nerve. The oral cavity is infrequently involved in nevus of Ota. Only 11 cases have been documented in the English literature. We report a rare case of intraoral nevus of Ota in a 22-year-old male patient. This paper focuses on the differential diagnosis of oral manifestations of nevus of Ota to assist in proper followup to avert malignant transformation.

Diagnosis and Treatment of Pigmentary Disorders in Asian Skin

Individuals of Asian heritage are predisposed to congenital and acquired pigmentary disorders. Cosmetic enhancement is frequently the primary treatment goal for these benign lesions. Accurate diagnosis of the nature of the pigmentary disorder is fundamental for administering safe and effective therapy. Before the advent of modern laser technology, such reported treatments as cryotherapy, dermabrasion, chemical peeling, and surgical excision resulted in unpredictable results. This article focuses on the diagnosis of disorders of pigmentation in Asian patients and reviews laser and light treatment modalities.

Laser removal of pigmented and vascular lesions

Twenty years of laser dermatology has resulted in current technology which allows variable spot sizes, different wavelengths, and a variety of effective cooling devices. These developments have made the treatment of cutaneous pigmented and vascular lesions safe and efficacious by targeting selected chromophores while minimizing damage to the surrounding tissue. Vascular lesions are targeted by a variety of wavelength lasers including the KTP (532 nm), pulsed dye (585-595 nm), and the Nd:YAG (1064 nm) laser systems. Pigmented lesions may be treated with a wide variety of lasers due to the broad absorption spectrum of melanin. Intense pulsed light (IPL), with its widely adjustable parameters, has established itself as a useful adjunctive for the treatment of a variety of pigmented and vascular lesions. The purpose of this review article is to present the current treatment options for the common aesthetic complaints of pigmented and vascular lesions.

Ojo y piel

Las relaciones entre la patología del ojo y de su revestimiento cutáneo son muy numerosas. Debido a las analogías embriológicas e histológicas, sus principales consecuencias oftalmológicas afectan a la superficie ocular en el sentido más amplio: tegumentos de los párpados, conjuntivas y córnea. La exploración clínica dermatológica sospechará estas alteraciones, que confirmará el oftalmólogo. No obstante, algunos trastornos pueden afectar a todos los demás tejidos oculares. Ya se trate de una localización ocular de algunas enfermedades dermatológicas, como las dermatosis infecciosas, o de auténticos síndromes oculocutáneos, la exploración clínica especializada, y a veces repetida, suele orientar el tratamiento. Las consecuencias sobre la función visual de algunas de estas alteraciones pueden ser graves. La epidermólisis tóxica de Lyell constituye el ejemplo extremo que puede provocar una ceguera corneal bilateral de tratamiento temible. La dermatitis atópica es otro ejemplo de enfermedad más frecuente, pero cuyas complicaciones oculares también pueden amenazar la visión si el tratamiento oftalmodermatológico no es correcto. El ojo y la piel se asocian de nuevo en numerosas enfermedades generales, congénitas, hereditarias o no, o bien adquiridas, cuyos síntomas específicos relacionados con ambas especialidades ayudan a establecer el diagnóstico positivo. Los ejemplos más frecuentes son el lupus, la enfermedad de Behçet, la sarcoidosis y las facomatosis. La superficie ocular conjuntivocorneal comparte con la piel una cierta similitud en cuanto al desarrollo de tumores, pigmentados o no. Por último, merecen describirse las consecuencias oculares de algunos tratamientos dermatológicos. También se hará mención a las situaciones inversas, que son más excepcionales.