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There is a wide range of equivocal melanocytic lesions that can be clinically and dermoscopically indistinguishable from early melanoma. In the present work, we assessed the possibilities of combined using of multiphoton microscopy (MPM) and optical coherence angiography (OCA) for differential diagnosis of the equivocal melanocytic lesions. Clinical and dermoscopic examinations of 60 melanocytic lesions revealed 10 benign lesions and 32 melanomas, while 18 lesions remained difficult to diagnose. Histopathological analysis of these lesions revealed 4 intradermal, 3 compound and 3 junctional nevi in the “benign” group, 7 superficial spreading, 14 lentigo maligna and 11 nodular melanomas in the “melanoma” group and 2 lentigo simplex, 4 dysplastic nevi, 6 melanomas in situ, 4 invasive lentigo melanomas and 2 invasive superficial spreading melanomas in the “equivocal” group. On the basis of MPM, a multiphoton microscopy score (MPMS) has been developed for quantitative assessment of melanoma features at the cellular level, that showed lower score for benign lesions compare with malignant ones. OCA revealed that the invasive melanoma has a higher vessel density and thicker blood vessels than melanoma in situ and benign lesions. Discriminant functions analysis of MPM and OCA data allowed to differentiate correctly between all equivocal melanocytic lesions. Therefore, we demonstrate, for the first time, that a combined use of MPM and OCA has the potential to improve early diagnosis of melanoma.

The concern about malignant skin neoplasms leads to the excision of smaller lesions. This study on small melano-cytic lesions aims to evaluate the range of possible histopathological diagnoses, describe histopathological aspects, and assess the usefulness of serial histological sections. We performed a cross-sectional descriptive histopathological study examining 76 pigmented skin lesions up to 6 mm in diameter. Histopathological diagnoses included atypical melanocytic nevi (n=38), common melanocytic nevi (n=18), atypical lentiginous melanocytic hyperplasia with architectural features of atypical mela-nocytic nevi (n=7), lentigo simplex (n=2), and malignant melanoma (n=1). Ten cases were non-diagnostic. Cytological atypia was not an exclusive findingof atypical lesions. Examination of serial sections did not change histopathological impression. Early detection of malignant melanoma is important, but clinical and dermoscopy exams may be leading to the resection of a great number of benign lesions. Strict attention to histopathological criteria results in a large number of non-diagnostic cases.

症例は30代女性。右足関節の悪性軟部組織腫瘍にて当院整形外科で化学療法中であった。右足底の色素斑が拡大してきたという主訴で当科を紹介受診した。経過観察したところ1カ月間で色素斑は5.5×5.5mm大から7.0×5.5mmと拡大し, 色調も初診時に比べ濃淡差を認めるようになった。ダーモスコピーでは皮丘パターンを示しており悪性黒色腫を疑った。足底の色素斑を全摘生検したところ病理組織は単純黒子であった。色素斑は化学療法により生じたものであると推測された。

Background Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions. Aim To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings. Materials and methods A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated. Results A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry. Conclusion All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.

Neurofibromatosis type 1 (NF-1) or von Recklinghausen disease is the most common neurocutaneous syndrome. It is characterized by the appearance of various cutaneous stigmata, neurological manifestations, and an increased susceptibility to develop tumors.1 Although it is frequently associated with a wide variety of central nervous system (CNS) dysplasias, the association with Arnold-Chiari malformation type I is unusual. A 60-year-old woman with a past history of systemic hypertension, hiatus hernia, and iron-deficiency anemia, was seen in our outpatient clinic for lesions on her neck that had been present the years and that caused discomfort due to friction. On physical examination of the skin, multiple soft fibromas were observed in the cervical region; however, a large number of hyperpigmented macules with a homogeneous, light brown color and welldefined borders were also observed, mainly on the trunk, though also at the root of the limbs, and 9 of them were over 15 mm in diameter, and there were also groups of hyperchromic macules between 2 and 10 mm in diameter in both axillas, clinically consistent with lentigo simplex (Crowe sign). The patient stated that those lesions had been present since birth, and that her father had similar spots. Based on these findings, the patient was diagnosed with NF-1 and was referred to the neurology and ophthalmology departments to exclude CNS and optic nerve involvement. Ophthalmologic examination was normal, with no evidence of Lisch nodules. The patient had no neurological symptoms and neurological examination revealed generalized, symmetrical muscle hyperreflexia but no other alterations. Cerebral magnetic resonance imaging (MRI) showed herniation of the cerebellar tonsils into the upper cervical canal, below the level of the Figure 1. Sagittal cerebral magnetic resonance image: the T 1-weighted image shows herniation of the cerebellar tonsils into the upper cervical canal, below the level of the occipital foramen, consistent with Arnold-Chiari malformation type I. neurofibromatosis type 1 and arnold-Chiari Malformation

A 44-year-old male had been suffered from psoriasis for 12 years. He had been treated with tar and topical steroid. In addition, he received PUVA and UVB therapy for 12 years since 1979. The total irradiated amount of UVA and UVB was 831 joules/cm2 and 102 joules/cm2, respectively. He had also taken etretinate in 1984 and methotrexate in 1987. When he was admitted to our hospital for the exacerbation of psoriasis, a lot of pigmented frecles were found. Forty-eight pigmented lesions could be classified into 5 different types; type A to E. Type A is lentigo simplex which shows an increased production of melanin. Type B is a lentigo simplex with atypical melanocytic hyperplasia. Type C shows a lentigo simplex with atypical melanocytic hyperplasia and remarkable pigment blockade. Type D is a junction nevus with nests of atypical melanocytes. Type E is a lentigo maligna with the nests of atypical spindle- shaped melanocytes that extents along epidermal-dermal junction. Type E pigmented lesions are distributed in intermittently sun-exposed skin. In this case, there were 2 nevus cell nevus, 12 type A, 20 type B, 5 type C, 5 type D, and 4 type E in 48 pigmented lesions. There was no correlation between the size and the type of pigmented lesions.

A 64-year-old woman with a clinically diagnosed 'lentigo simplex' on her right cheek was dermatologically treated several times with a CO2 laser. Three years later she showed a metastasis of a malignant melanoma in her right parotid gland. Considering this case, as well as other published cases reporting malignant melanomas occurring after laser treatment, we again underscore that naevomelanocytic lesions are not a routine indication for laser treatment.