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A variety of black-pigmented lesions of the oral cavity can be found, ranging from harmless benign lesions such as melanotic macule, smoker’s melanosis, amalgam/graphite tattoos, and pigmented nevus to a life-threatening oral malignant melanoma. Oral melanoma is a rare and aggressive malignant tumor that originates from melanocytes’ proliferation and accounts for only 0.5% of all oral malignancies. The etiology is unknown. Most oral melanomas are present at the palate and the upper alveolar ridge, whereas occurrences at the buccal mucosa, the lower alveolar ridge, and the lip are rare, with only a few reports in the literature. The diagnosis is confirmed by a biopsy. The prognosis is poor, with a 5-year survival rate of ~20%. In this report, we present a case of large oral melanoma at the right buccal mucosa involving the right lower alveolar ridge and lip commissure, which are relatively unusual locations for oral melanoma. In addition, immunohistochemical markers used for diagnostic, therapeutic, and prognostic decision-making of oral melanoma are also discussed.

Usually the lower part of melanocyte nevi is at a depth of not more than 1–2 mm or more, which is typical for congenital nevi, as well as for large pigmented tumors that protrude significantly above the skin surface and have a pronounced intradermal part. Incomplete removal of pigmented nevi occurs during their superficial removal with insufficient capture of healthy tissues. When excision of pigmented nevi by acute method means in the vast majority of cases of incomplete removal can be avoided, and primarily because the suturing of the edges of the postoperative wound requires much deeper excision of tissues. Рurpose – to increase the effectiveness of surgical treatment of pigmented skin tumors in children by using a mathematical model. Materials and methods. The study was conducted on the basis of the oncohematology department of Vinnytsia Regional Children’s Clinical Hospital, a mathematical model for calculating the parameters of operational access was conducted on the Microsoft Excel platform. Results. Using the proposed mathematical model, the following parameters of the operating material were calculated: the area of the resection edges of the operating material; the area of the base of the operating material; the total area of morphological examination of the surface of the surgical material; determining the difference in the volume of surgical material to be histologically examined by different methods of its collection. In all cases, the tumor for three-dimensional histological examination was excised in the form of an ellipse with a safety zone (healthy tissue around the tumor). The surgical direction of the incision was formed with an inclination to the surface of the skin towards the tumor with the formation of an acute angle with it, while the upper part of the dermis was cut less than its lower part. This approach to the formation of the profile of the surgical wound improves the conditions for further reconstructive wound defect closure. Conclusions. Comparative mathematical calculation according to the proposed spatial geometric model of the biopsy in the form of a truncated elliptical cone convincingly shows an increase in the useful volume of surgical material in the planned histological examination compared with the cylindrical elliptical configuration of the biopsy due to involvement in the field of microscopic structures «residual structures» (processes) corresponding to melanocyte nevi, under the guise of which the development of the initial stages of melanoma may occur. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, melanocyte nevi, operative accesses.

Introduccion: el nevo melanocitico (NM) congenito gigante es una lesion pigmentada de gran tamano, usualmente presente desde el nacimiento, aunque algunas lesiones pueden aparecer a los pocos meses de vida. Es una proliferacion atipica benigna de melanocitos en la piel que puede tener morfologias curiosas. Se asocia en algunas ocasiones, a manifestaciones extracutaneas y al desarrollo de melanoma. Se caracteriza por una lesion hiperpigmentada en diferentes tonos del marron y puede afectar desde el encefalo hasta los miembros inferiores. La localizacion mas frecuente es el tronco posterior, la cara, el cuero cabelludo y las extremidades. Caso clinico: se presenta caso clinico de una paciente adolescente con NM gigante en calzon con multiples lesiones satelites, con el objetivo de realizar una revision del tema y senalar la importancia del control periodico y seguimiento. Conclusion: el NM gigante congenito es una alteracion cutanea benigna, que implica serio compromiso estetico en la medida que aumente de tamano. Se deben enfatizar la dificultad del tratamiento y las implicaciones medico sociales. Rev.cienc.biomed. 2015;6(1):155-159 PALABRAS CLAVE Nevo; Nevo pigmentado; Melanoma; Melanocitos. SUMMARY Introduction: the Giant Congenital Melanocytic Nevus (GCMN) is a pigmented lesion of great size, usually presented since the birth, although some lesions could appear in the first months of life. It is an atypical benign proliferation of melanocytes in the skin that could have curious morphologies. It is associated in some cases to extracutaneous manifestations and melanoma development. It is characterized by a hyperpigmented lesion in different tones of brown and could affect since the brain until the lower limbs. The most frequent location is the posterior trunk, the face, scalp and extremities. Case report: the case of a young female patient with GCMN «in garment» with several satellite lesions is presented in order to carry out a thematic review and to indicate the importance of the control period and following. Conclusion: the GCMN is a benign cutaneous alteration that implies serious esthetic disorders when it increases its size. The treatment difficulties and the medico-social implications must be kept in mind. Rev.cienc.biomed. 2015;6(1):155-159 KEYWORDS Nevus, Pigmented nevus; Melanoma; Melanocytes.

Introduction: Ticks are ectoparasites which can lead to various blood borne diseases. Tick bite may resemble pigmented nevi, mole or nodule resulting a diagnostic dilemma. Tick bite in eye lid is rare and this case report describes tick bite in lower eye lid mimicking a traumatized pigmented nodule where the tick was identified only on magnification and was successfully removed mechanically. Case: A 61-year-old man presented to the eye out patient department with a sudden and painful black pigmented lesion on the right lower lid for four days. The tick was manually removed with forceps. Conclusion: This case report explains the need for a high index of suspicion as tick bite in sudden or recent onset pigmented lesions especially in endemic areas.

Neurofibromatosis type 1 (NF1) is a genodermatosis caused by heterozygous germ line variations in the NF1 gene. A second-hit NF1 aberration results in the formation of café-au-lait macules, cutaneous neurofibroma and plexiform neurofibroma (PNF). Mosaic NF1 (mNF1), caused by a postzygotic NF1 mutation, is characterized by localized or generalized NF1-related manifestations. Although NF1 and mNF1 are associated with pigmentary skin lesions, clinically recognizable melanocytic nevi that developed over PNF have not been reported. Here, we report the first case of multiple melanocytic nevi that developed on a giant café-au-lait macule and PNF. The PNF had biallelic NF1 deletions, a whole deletion of NF1 and a novel intragenic deletion involving exons 25-30. The deletions were not detected in the blood, which resulted in the diagnosis of mNF1. Furthermore, the nevus cells had not only biallelic NF1 deletions but also NRAS Q61R, a common mutation found in congenital melanocytic nevi. These analyses revealed the coexistence of the two different mosaic diseases, mNF1 and congenital melanocytic nevi. For a diagnosis of cases with atypical NF1-like symptoms, genetic analyses using blood and lesional tissues are useful and aid in genetic counseling.

In der taglichen Praxis konnen Nagelpigmentierungen eine diagnostische Herausforderung darstellen, insbesondere wenn sie dermatoskopisch unspezifische Veranderungen zeigen. Wir stellen exemplarische Falle vor, bei denen die optische Koharenztomographie als schnelle, nichtinvasive bildgebende Methode typische Veranderungen zeigte, die hinweisend fur die Diagnose waren.

The high incidence of melanoma and unsatisfactory results of its treatment in some cases make the issue of timely diagnostics of pre-melanoma skin pathology, in particular the identification of pre-melanoma pigmented nevi, of great importance and can be used for choice an adequate tactics of treatment. The purpose of the study was to evaluate the informativeness of dermatoscopy in cases of patients with pigmented nevi of skin as a part of melanoma prevention. 168 patients with pigmented nevi were screened. All nevi were photographed with a digital camera SONY Cyber-Shot DSC-H3, first in normal mode with the capture of the localization zone of the tumor and its surrounding tissues, and then in macro mode (“Zoom 10”). To confirm the clinical diagnosis, additional characteristics of the pigment formation on the skin, the manual immersion dermatoscopy, was used using the contact non-polarized HEINE mini 3000 LED dermatoscope. Evaluation of images was carried out using the diagnostic algorithm ABCD and ABCD-E. Our findings suggest that the clinical diagnostic algorithm used by us for detecting signs of the activation of a pigmented nevi is highly informative — the sensitivity is 97.6 %. Performing immersion dermatoscopy allows to increase the informativeness of the clinical and instrumental examination at the preoperative stage up to 98.2 %, which is comparable with the data obtained at the stage of urgent cytological examination: the method sensitivityis 98.2 %.

Phakomatosis pigmentovascularis is a rare syndrome characterized by widespread capillary malformation and pigmented nevus. The objective of this study was to evaluate its characteristics and treatment. Fifty-two patients presenting between 2003 and 2017 were retrospectively reviewed. Type IIa (port-wine stain and dermal melanocytosis with oculocutaneous involvement) was most common. Systemic involvement was observed in 17.3% and it was not significantly correlated to extent of capillary malformation or pigmented nevus. However, systemic involvement was significantly frequent in patients with nevus of Ota and in patients with pigmented nevus located on the head and neck (P = 0.004 and 0.035, respectively). Capillary malformation was almost cleared in 28.6% of patients using pulsed dye laser, whereas pigmented nevus was almost cleared in 23.7% and completely cleared in 42.1% of patients using Q-switched neodymium:yttrium-aluminum-garnet laser. Treatment outcome score showed significant inverse correlation with the extent of port-wine stain or pigmented nevus (P = 0.047, ρ = -0.308 and P = 0.011, ρ = -0.410, respectively). Pigmented nevus demonstrated better treatment response to lasers than did capillary malformation. Smaller lesions tended to show better treatment outcomes for both capillary malformation and pigmented nevus.

INTRODUCTION Phacomatosis pigmentovascularis is a term encompassing a group of disorders characterized by the coexistence of a segmental pigmented nevus of melanocytic origin and segmental capillary nevus. Over the past decades, confusion over the names and definitions of phacomatosis spilorosea, phacomatosis melanorosea, and their defining nevi, as well as of unclassifiable phacomatosis pigmentovascularis cases, has led to several misplaced diagnoses in published cases. METHODS A systematic and critical review of the worldwide literature on phacomatosis spilorosea and phacomatosis melanorosea was carried out. RESULTS This study yielded 18 definite instances of phacomatosis spilorosea and 14 of phacomatosis melanorosea, with one and six previously unrecognized cases, respectively. CONCLUSIONS Phacomatosis spilorosea predominantly involves the musculoskeletal system and can be complicated by neurological manifestations. Phacomatosis melanorosea is sometimes associated with ancillary cutaneous lesions, displays a relevant association with vascular malformations of the brain, and in general appears to be a less severe syndrome. Established phacomatosis pigmentovascularis variants now include phacomatosis cesioflammea, phacomatosis cesiomarmorata, phacomatosis spilorosea, phacomatosis melanorosea, phacomatosis cesioflammeomarmorata, and phacomatosis melanocesioflammea.

Oral mucosal melanoma (OMM) is a rare and aggresive melanocytic malignant neoplasm, with incidence lower that 0.01 cases per 100.000 person-year and a worse prognosis than cutaneous melanoma. Oral melanocytic nevus (OMN) is a rare benign oral neoplasm, whose malignant transformation to OMM is debatable. The genetic basis of both lesions has been poorly explored and OMM is studied together with other mucosal melanomas as a group, despite being a separate entity....

Skin cancer is one of the most common cancers. Most skin cancers are not life threatening, but malignant melanoma is fatal. Currently, it still remains a challenge to discriminate malignant melanoma from benign melanoma by using conventional diagnostic techniques, such as ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography. As a new type of bio-optical imaging technology, hyperspectral imaging (HSI) has become the focus of research. It can provide information about hemoglobin and melanin content for the differentiation of various skin diseases. In this study, we propose a hyperspectral imaging system based on push-broom imaging spectrometer to image skin-pigmented nevus, and then segment the nevus out from surrounding normal skin through pixel-wised spectrum classification with deep learning techniques. The HIS system can produce hyperspectral image over the spectral range of 465-630nm and with a spectral resolution of 2.1 nm. Meanwhile, we evaluated the performance of K-means, Gaussian Mixture Model (GMM) and Hierarchical Clustering (HAC) in detecting the nevus with manual segmentation as the gold standard. The results show that these three techniques all have a good accuracy in differentiating the nevus from normal skin, which proves that the hyperspectral system combined with classification techniques has a good potential to detect the pigmented nevus on the skin.

Basal cell carcinoma is a common skin carcinogenesis that occurs in the epidermis and the basal layer of the skin.in general, basal cell carcinoma grows slowly, rarely metastasizes, but is locally invasive and destructive. The diagnosis is based on clinical manifestations, but the clinicopathological manifestations are different, and sometimes it is difficult to differentiate from pigmented nevus, malignant melanoma, etc. Therefore, skin biopsy is essential for the diagnosis and assessment of the risk of recurrence.There are many ways to treat basal cell carcinoma. This article reviews the diagnosis and treatment.

Pigmented vulvar lesions are uncommon; they occur in about 10%-12% of women and include benign and malignant processes, as well as post-inflammatory changes and hyperchromatic lesions due to melanin increase. Among the benign processes, there are vulvar nevi, present in 2% of adult women. There is a small subgroup classified as atypical melanocytic nevi that account for 5% of vulvar nevi and is associated with younger women. Despite the importance of early diagnosis, the clinical history and time of evolution of the lesion are not well explored, as patients rarely examine the region, as do dermatologists. We report a case of an melanocytic nevus in the small lip in a 43-year-old woman.

A 41-year-old lady was presented for a regular mole check. Clinical and dermoscopic examination revealed numerous pigmented nevi with cobblestone and reticular pattern. However, a clinically looking nevus located on the left pectoral region was dermoscopically suspicious. The dermoscopic evaluation showed peripherally distributed dots, also known as pseudopods, which are a pathognomonic sign for melanoma in adults. The lesion was excised, and pathohistological examination of the suspected lesion revealed melanoma in situ.

A 38-year old patient presented for newly developed highly pigmented nevus located on the right knee. Clinical examination revealed a small, 0.8 cm in diameter, roundish, sharply demarcated, highly pigmented lesion, located on the patient’s right knee. Dermoscopic examination revealed an atypical prominent pigment network associated with whitish lines throughout almost the entire lesion indicating the diagnosis of early melanoma. The lesion was excised, and the pathohistological examination confirmed the diagnosis of melanoma in situ.

A 51-year old patient suffering from long-standing type 2 diabetes mellitus presented with a dark lesion on his forehead that had been growing for several weeks (Fig. 8.1). He had had a similar lesion several years before that had been diagnosed and treated topically as a seborrheic keratosis. Clinical examination showed a brown-grey lesion with clear but irregular margins and a smooth surface covered by a few pits. The clinical diagnosis of seborrheic keratosis was confirmed by dermoscopy.

Objective It has been attempted to find out that Homine Placents and Soyeom mixed Pharmacopuncture (HSP) procedure is effective for the removal of melanocytic nevus of considerable size which cannot be applied to general acupuncture. Methods Hominis placenta (0.5ml) and Soyeom (0.5ml) mixed pharmacopuncture (1.0ml) was subcutaneously injected in several places of melanocytic nevus. The treatment was performed about 20 times, once a week. Layer analysis of pigmentation was carried out using ECOSKIN. Results One year after the HSP procedure, the pigmentation of the melanocytic nevus was slightly reduced and completely removed after 2 years of procedure. Conclusion The HSP could be effective for removing hyperpigmentation in the melanocytic nevus.

Although giant congenital melanocytic nevus is a rare lesion, it causes significant deformity and carries a risk of malignant degeneration. Different surgical techniques for the lesion removal are described, including serial resection, resection with skin grafting, and resection and coverage with expanded skin flap (skin expanders). The aim of this study is to report the author's 40 years of experience with cases requiring at least 4 serial excisions to complete the treatment. Serial resection is an effective, safe, and simple technique that requires a lot of patience. Treatment often results in a single linear scar, requires no donor sites, nor large flaps. It is not subject to potencial complications of expanders and avoid aesthetic deformities depending on the location.

Perinevoid alopecia has been described as an associated alopecia surrounding a pigmented nevus due to an inflammatory response against nevus structures. It is described as a part of other nevocentric phenomena in which a cellular inflammatory response against nevus antigens develops. A 35-year-old male presented with a unique area of non-scarring alopecia surrounding an asymptomatic, pigmented nevus with a 1-month evolution. Trichoscopic and histologic findings were compatible with alopecia areata (AA). One month after excision, hair regrowth was reported by the patient. We concluded that perinevoid alopecia is an extremely rare clinical presentation of AA associated with a central, pigmented nevus where a cellular inflammatory response is triggered against hair follicles, nevoid cells, and melanocytic structures.

Pigmented nevi, still called melanocytic nevi or more improperly "naevus naevocellulaires" are benign melanocytic tumors characterized by a proliferation of melanocytes near the dermoepidermal junction. They are grouped in clusters or in theca cells that differentiate them from normal melanocytes. They occur at birth in approximately 1% of newborns with no sex predominance. Their occurrence is mostly sporadic, although rare family forms have also been reported. They can be separated in an arbitrary manner according to their diameter on the day of the birth: small congenital nevi1.5cm, medium-sized 1.5 to 20cm and large-sized20cm. Umbilical nevi are rare. We here report an interesting case of atypical and rare congenital nevus. The study involved a young girl presenting with pigmented umbilical nodule occurred at birth which had recently become problematic. We suspected a nevus, a melanoma or an endometriosis on the basis of the clinical appearance of this nodule. Resection was performed. The diagnosis of benign melanocytic tumor was confirmed.

Recently, skin disease patients have been rising rapidly, and more than 5.4 million cases of skin cancer were treated in over 3.3 million people in the U.S. in 2012, and more people are diagnosed with skin cancer each year than all other cancers combined in the U.S. [1]. Because a malignant lesion is difficult to distinguish from pigmented nevus, elaborate detection devices are needed for accurate diagnosis [2]. Optical Coherence Tomography and Laminar Optical Tomography are mainly used for skin disease diagnosis, however, equipment for those tomography are too bulky to be used in house. The Electrical Impedance Spectroscopy is also applied to analyze skin disorders [3], but its equipment requires assistance from experts.

A newborn presented with a massive cerebriform exophytic scalp swelling, asymmetric overgrowth, pigmented nevi, and radiological signs of brain atrophy. The clinical and radiographic features suggested a rare sporadic disorder.

BACKGROUND: The main goal of excision of a pigmented nevus is to achieve an esthetically pleasing result. A single nevus can be removed by simple excision, whereas S-shaped suture can be used for the excision of 2 adjacent nevi. However, the choice of suturing method is based on the experience of the dermatologic surgeon, as there is no uniform standard for suture following the excision of 2 adjacent nevi. The aim of the present study was to determine whether S-shaped wound closure is appropriate for the excision of 2 adjacent nevi. METHODS: The outcomes of 21 patients who underwent simultaneous resection of 2 adjacent nevi were retrospectively reviewed. Of these patients, 17 chose S-shaped suture and 4 chose direct suture. Patients were followed-up for more than 6 months to review their postoperative scars. Differences between the 2 methods were compared based on the patient and observer scar assessment scale. Diameters and the proportional relationship between the 2 nevi were analyzed. RESULTS: Patients who underwent S-shaped wound closure surgery were more satisfied compared to those who had direct suturing (P

Background Malignant melanoma (MM) arising in a giant pigmented nevus (GPN) is a rare disease in adults with no large series published to our knowledge. Objective We sought to describe the characteristics, treatment, and survival of MM in GPN for adults. Methods Adults with invasive MM in GPN (n = 976) reported to the National Cancer Data Base from 1998 to 2012 were evaluated for patient and tumor characteristics, treatment, and survival. For comparison, data from adults with invasive superficial spreading melanoma (SSM) (n = 111,870) and nodular melanoma (n = 35,962) were used. Results Compared with patients with SSM, patients with MM in GPN had a thicker Breslow depth, more positive lymph nodes, and distant metastasis more frequently. Multivariate analysis identified age older than 65 years, Breslow thickness greater than 2 mm, presence of ulceration, presence of distant metastasis, and positive margins as independent predictors of survival in patients with MM in GPN. At all stages, having MM in GPN has similar overall survival compared with SSM. Limitations The study is retrospective and registry-based. Conclusions Invasive MM in GPN occurs in adults, with overall survival similar to SSM. Clinicians should be aware of the continued risk of MM in adults with GPN with low threshold for biopsy.

A clinical trial on the autofluorescence imaging of skin lesions comprising 16 dermatologically confirmed pigmented nevi, 15 seborrheic keratosis, 2 dysplastic nevi, histologically confirmed 17 basal cell carcinomas and 1 melanoma was performed. The autofluorescence spatial properties of the skin lesions were acquired by smartphone RGB camera under 405 nm LED excitation. The diagnostic criterion is based on the calculation of the mean autofluorescence intensity of the examined lesion in the spectral range of 515 nm–700 nm. The proposed methodology is able to differentiate seborrheic keratosis from basal cell carcinoma, pigmented nevi and melanoma. The sensitivity and specificity of the proposed method was estimated as being close to 100%. The proposed methodology and potential clinical applications are discussed in this article.

Small pigmented lesions in children can represent a significant diagnostic challenge. If the diagnostic features and therapeutic approach are relatively well established in large and giant nevi, there is still much controversy regarding small and intermediate-sized congenital pigmented lesions that can lead to significant diagnostic challenges, both clinically and dermoscopically, and consequently to difficulty in defining the optimal approach in such cases. Although dermoscopy can be useful in the diagnosis of pigmented lesions, the diversity of clinical and dermoscopic features of pigmented nevi in children usually hinder the differentiation between them and melanoma. Histological findings after resection often show surprising results that do not correspond either to the clinical nor the dermoscopic features. With the present case, we want to emphasise the variable natural behaviour of melanocytic lesions in children, which sometimes leads to unnecessary surgical excisions, which should be avoided in pediatric patients.

The aim of the present study was to investigate the clinical diagnosis and treatment of intracranial malignant melanoma. For this purpose, the clinical manifestation, signs, cerebrospinal fluid (CSF) contents, imageology, pathological features, treatment and prognosis of 7 cases of intracranial malignant melanoma were analyzed in The Chinese PLA General Hospital (Beijing, China) from 1996 to 2013. All the melanoma cases were confirmed by histopathology, and CSF cytopathology demonstrated that there were 5 cases of primary malignant melanoma and 2 cases of secondary malignant melanoma. Among the patients, 4 presented with >1 pigmented nevus in the skin, and 1 presented with skin melanoma. Intracranial malignant melanoma mostly affects middle-aged males. CSF cytopathology and imageology (particularly enhanced magnetic resonance), are important tools in the diagnosis of the disease. Particularly, when a patient presents with a pigmented nevus in the skin and an abnormal lesion in the brain, a diagnosis of intracranial malignant melanoma should be considered.

Melanoma of the conjunctiva (MC) is a tumor that can affect the next bulbar conjunctiva to the limbus, conjunctiva, eyelid, forniceal in plica or caruncles region, which may originate from melanosis areas acquired primary with atypia, conjunctival nevus areas, and no local lesions. Clinically it presents itself as a mass or a high pigmented conjunctival lesion. This Study aimed at describing a case of conjunctival melanoma multifocal from preexisting pigmented nevus. Histopathological diagnosis and staging of early conjunctival lesion is extremely important to designate the management of patients.

Background Melanoma is an immunogenic tumor and the presence of T-cell infiltrates within melanoma lesions may correlated with longer patient survival. Psoriasis is a chronic immune-mediated inflammatory disease, in which the role of T-cells is well established. The aim of our prospective pilot study was to investigate the relationship between melanoma and psoriasis examining 3 groups of patients: the melanoma-group (MG), the psoriasis-group (PG) and the control-group (CG). Methods Every patient underwent detailed anamnestic and clinical examination. Moreover, gene expression of interleukin-6 (IL-6), interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) was analyzed in all groups and in subjects affected by both melanoma and psoriasis (MP). Results Melanoma patients showed a lower frequency of psoriasis and positive family history (FH) of psoriasis respect to CG. Moreover, psoriatic patients presented fewer MN, and lower frequency of positive FH of melanoma than CG. IL-6 and IFN-γ were significantly increased in PG and reduced in MG. Conclusions We propose a provocative hypothesis of a possible protective role of psoriasis for melanoma development.

A 46-year-old man presented with a 4-year history of headache and visual field defect. Physical examination revealed a large patch of pigmented skin with alopecia areata measuring 10 × 12 cm in the right occipitotemporal region (figure 1A). Imaging showed a large intracranial space-occupying mass (figure 1, B–D). Pitch-black, chocolate-like substance was found during the surgery (figure 2A). The wound was repaired using split-skin graft (figure 2B). Pathologic examination confirmed the diagnosis of pigmented nevus. Giant pigmented nevus is a congenital melanocytic lesion originating from the neural crest.1 Intracranial spread is extremely rare2 and may represent a malignant transformation.

BACKGROUND To evaluate the methylation levels of human telomerase reverse transcriptase (hTERT) promoter three CpG island (CGIs) regions and its prognostic impact in Chinese patients with acral and mucosal melanoma. METHODS Bioinformatics software was used to analyze hTERT gene promoter. Fresh frozen tissues were taken from 14 patients with melanoma (6 acral melanoma and 8 mucosal melanoma) and 14 pigmented nevus as control subjects (14 acral pigmented nevus). Bisulfite sequencing PCR (BSP) combined TA clone sequencing was used to assess the methylation levels of hTERT promoter CGIs regions. The relative expression level of hTERT mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS CGIs-1 (-1392--1098 bp), CGIs-2 (-945--669 bp), and CGIs-3 (-445--48 bp) were selected for our study. Our results indicated that the methylation levels of hTERT promotor CGIs regions in melanoma were greater than pigmented nevus (CGIs-1: 69.3 ± 18.7% vs 46.8 ± 20.4%, t = 3.048 P = .005; CGIs-2: 73.8 ± 14.7% vs 55.6 ± 16.0%, t = 3.120 P = .004; CGIs-3: 5.8 ± 2.2% vs 2.2 ± 1.3%, t = 5.164 P

The topical administration of rebamipide (Mucosta®), an antiulcer agent, clinically increases the mucin level of tear film. The aim of this study was to report the histological changes of goblet cells following the topical administration of rebamipide to a patient with nevus of the lacrimal caruncle. A 62-year-old male exhibited a pigmented nodule located in the lacrimal caruncle in the left eye. An excisional biopsy and subsequent surgical resection were conducted at the caruncle, prior to and three months after topical rebamipide administration. Histologically, a biopsy specimen revealed a pigmented nevus beneath the caruncle epithelium containing a few goblet cells [4 cells/high power field (HPF)]. A few nevus cells were present at the surgical margin. By contrast, the secondary resected specimen obtained three months after the initiation of topical rebamipide treatment revealed the epithelium and nevus, where numerous goblet cells were present (28 cells/HPF), and mucin-like substances were markedly secreted from the goblet cells. Topical rebamipide markedly increased the number of goblet cells and stimulated the secretion of mucin-like substances in the caruncular tissue of a human patient. These results suggest that topical rebamipide is useful in patients following surgery and/or biopsy to support tissue repair of the ocular surface.

Osteonevus of Nanta is a melanocytic nevus displaying secondary ossification and carrying a potential for malignancy. A solitary occurrence is reported herein, presenting as a flesh-colored papule following laser ablation.A 56-year-old woman sought treatment for a minor papular growth of the cheek. This lesion had developed at the site of prior CO2 laser ablation done elsewhere to eradicate a pigmented nevus. The patient's medical records and histopathology report were obtained after surgical excision.Histologically, a completely excised osteonevus of Nanta was evident, marked by an intradermal nevus with subjacent osseous metaplasia. Clinical presentations of these lesions may vary, but the potential for malignancy remains.

This learning exercise challenges clinicians and dermatopathologists to consider the differential diagnosis of an unevenly colored solitary papule over the upper back of an adolescent female.

Purpose To describe the characteristics of choroidal nevus using the enhanced depth imaging (EDI) feature of spectral-domain optical coherence tomography (OCT). Design Retrospective, observational case series. Participants One hundred four eyes with choroidal nevus. Methods Spectral-domain EDI OCT was performed with a Heidelberg Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) using a custom scan acquisition protocol of up to 13 raster lines of 9-mm scan length with automatic real-time image averaging set at 100 images. The thickness of choroidal nevus was measured by combining Heidelberg's autosegmentation with manual segmentation. Main Outcome Measures Imaging features and thickness correlation of choroidal nevus by EDI OCT versus standard ultrasonography. Results Of 104 eyes with choroidal nevus imaged with EDI OCT, 51 (49%) displayed image detail suitable for study. The remaining 53 cases were suboptimal because of statistically identified factors of age older than 60 years ( P = 0.027), female gender ( P = 0.008), extramacular location of nevus ( P P = 0.002), mean distance from optic disc more than 4 mm ( P P = 0.006). Of the 51 suitable cases, mean nevus thickness was 685 μm (median, 628 μm; range, 184–1643 μm) by EDI OCT compared with 1500 μm (median, 1500 μm; range, 1000–2700 μm) by ultrasonography. The most common EDI OCT imaging features included partial (59%) or complete (35%) choroidal shadowing deep to the nevus, choriocapillaris thinning overlying the nevus (94%), retinal pigment epithelial (RPE) atrophy (43%), RPE loss (14%), RPE nodularity (8%), photoreceptor loss (43%), inner segment–outer segment junction (IS–OS) irregularity (37%), IS–OS loss (6%), external limiting membrane irregularity (18%), outer nuclear and outer plexiform layer irregularity (8%), and inner nuclear layer irregularity (6%). Overlying subretinal fluid was identified by EDI OCT (16%), ophthalmoscopic examination (8%), and ultrasonographic evaluation (0%). A comparison of pigmented versus nonpigmented nevus showed only 1 significant difference of more intense choroidal shadowing with pigmented nevus ( P = 0.046). Conclusions Imaging of choroidal nevus with EDI OCT enables precise measurement of tumor thickness with comparatively reduced thickness relative to ultrasonography. Using EDI OCT, 94% of choroidal nevi were found to have overlying choriocapillaris thinning. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Background: Nevi are proposed to reflect the mosaicism and thus generally follow the different archetypal patterns of mosaicism. Blaschko's lines are the most common pattern of mosaicism. There have been many attempts to elucidate the Blaschko's lines on face from the distributional patterns of different nevi, but studies that evaluated exclusively pigmentary nevi are sparse. Aims: This study attempted to evaluate the patterns followed by different pigmentary nevi on face and utilized this to elucidate the pattern of embryological pigmentation on face. Materials and Methods: Spatial parameters like shape, orientation, and distribution patterns of different flat pigmentary nevi on face were analyzed and graphically drawn on human facial diagram. This was compared with existing facial Blaschko's lines. All cases of palpable pigmented nevi like congenital and giant melanocytic nevi and nevus spilus were excluded. Results: A total of 68 cases of pigmentary nevi on face (male-39, female-29) were examined. The shape and distribution lines were found to have a close similarity with Blaschko's lines on face with distinct differences. Conclusions: The concept of facial embryonic pigmentary ‘segment’, ‘unit’ and existence of separate Blaschko's lines for facial pigmentary nevi is conceived. Some insight into the pathogenesis of Blaschko's lines is also proposed in this study.

Eyebrows play an important role in face expression and facial mimics by virtue of muscle contraction. Defects or deformity of the eyebrows result in abnormal facial expressions, and may lead to aesthetic issues for patients. The objective of this study is to report the case of a patient, with a congenital skin pigmented nevus at the right side of the eyebrow treated with direct surgical resection and followed by immediate reconstruction of the eyebrow with a V-Y advancement pedicle flap based on the orbicularis oculi muscle.

We describe a case of plantar interdigital cutaneous melanoma in a 22-year-old woman who reported changes in a pigmented lesion during pregnancy. Diagnosis was late and evolution unfavourable. The purpose of this report is to draw the attention of dermatologists to the need for careful regular examination of melanocytic lesions in pregnant women, not ignoring possible changes as always physiological. Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Dermatology Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departments of Dermatology and Pathology UNIFESP, EPM, Department of Dermatology UNIFESP, EPM, Departments of Dermatology and Pathology SciELO

Becker's nevus is a hyperpigmented macula that is predominantly located on the anterior trunk or on the scapular region, frequently associated with hypertrichosis. The association of Becker's nevus with other cutaneous, musculoskeletal or maxillofacial anomalies has been called Becker's nevus syndrome. We report a case of a 16-year-old girl with a hyperpigmented macula which spread from her right anterolateral trunk to the inner part of her right thigh accompanied by ipsilateral mammary hypoplasia. The skin lesion started when the patient was seven years old when it was also noticed ipsilateral mammary hypoplasia. The histological exam confirmed the clinical hypothesis of Becker's nevus.

Skin lesions can often be the only sign of an underlying systemic abnormality which will require further investigation. Several syndromic conditions are diagnosed after their cutaneous marker, which is in most cases a nevus. We report a neurocutaneous condition which we named “syndromic nevoid hypermelanosis” (SNH). We studied seven patients who presented with hyperpigmented disseminated macules (melanotic or pigmented nevi) as a cardinal sign. Neurological abnormalities were detected in all cases and skeletal dysmorphism in four. In spite of the genetic alteration that may be the cause of this disease, dermatologists should be able to diagnose it based on its semiological features and distinguish it from other neurocuataneous conditions. We consider SNH to be a distinct clinical entity that has not been clearly defined until now.

Cutaneous melanoma is the most aggressive type of skin cancer and Ft-Raman spectroscopy has been studied as a potential method that could be a real alternative for early diagnosis of neoplasms. PURPOSE: To qualify the spectral FT-Raman data, in order to differentiate cutaneous melanoma and pigmented nevus. METHODS: For this study, 10 samples of cutaneous melanoma, 9 samples of pigmented nevi, and 10 samples of normal skin were obtained by incisional biopsies performed during plastic surgeries ex vivo, immediately after removing the surgical sample. RESULTS: The FT-Raman spectra of each group presented a high correlation between the elements of the same group, thus favoring the elaboration of spectral averages. When analyzing the spectral standard of each group, the normal skin standard did not show a significant variation between the spectra; the standard of the pigmented nevi group showed significant variation, and the cutaneous melanoma group also showed variation. Through univariate analysis, specific bands were detected for each vibrational mode identified. The discriminatory analysis of the data showed a 75.3% efficiency of the differentiation between the three groups studied. CONCLUSION: The vibrational modes Polysaccharides, Tyrosine and Amide-I differentiated the melanoma from the pigmented nevus. O melanoma cutâneo é o câncer de pele mais agressivo, e a espectroscopia FT-Raman tem sido estudada como um método em potencial que pode ser uma verdadeira alternativa no diagnóstico precoce de neoplasias. OBJETIVO: Qualificar os dados espectrais FT-Raman de modo a diferenciar melanoma cutâneo de nevo pigmentado. MÉTODOS: Foram utilizadas 10 amostras de melanoma cutâneo, obtidas por meio de biopsias incisionais realizadas "ex-vivo"; nove amostras de nevo pigmentado e 10 amostras de pele normal foram coletadas durante cirurgias plásticas. RESULTADOS: Os espectros FT-Raman de cada grupo diagnóstico apresentaram alta correlação entre os elementos do mesmo grupo, o que favoreceu a realização das médias espectrais. Analisando o padrão espectral de cada grupo, o de pele normal não mostrou grande variação entre os espectros; o de nevo pigmentado apresentou variação notável e, o grupo melanoma primário também indicou variação. Por meio de análise univariada foram identificadas bandas específicas para cada modo vibracional identificado. A análise discriminante aos dados mostrou 75,3% de eficiência na diferenciação entre os três grupos estudados. CONCLUSÃO: Os modos vibracionais Polissacarídeos (Banda I), Tirosina (Banda 6) e Amida I (Banda 10) diferenciaram o melanoma do nevo pigmentado.