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Background: Although choosing the appropriate treatment method is relatively easy for papular or protuberant lesions, for small macular lesions it may not be so, because they are generally percepted as mild lesions by the patient and she/he usually has the anxiety of final disfigurement which may result esthetically worse than the original one. It is reasonable to choose the method which will reveal the least scar formation and lowest recurrence rate with cost-effectiveness, in removal of superficial small macular lesions for cosmetic purposes. Methods: Fifty-six male and female patients with small hyperpigmented flat or macular lesions, less than or equal to 5 mm diameter on their face, who referred to hospital dermatology clinic for removal and received an interventional therapy with a radio-wave surgery unit in the years 2018-2019 were retrospectively recruited. Besides the observation of scar formation and residual erythema, 3-month recurrence rates were also analyzed. Results: At the end of 3 months, there was no scar on any lesion site. Mild erythema was detected on 15 lesion sites out of a total of 218 (6.9%).The total recurrence rate was 7.7%. The mean age of the patients with at least one recurrence was significantly greater than the patients with no recurrence, and the lesions greater than 3 mm were more prone to recur than the lesions less than or equal to 3 mm. Conclusion: Although no method of lesion removal can warrant a scarless result without recurrence, for benign macular hyperpigmented lesions of the face up to 5 mm in diameter, radio-wave surgery may be preferred due to both its minimal scar formation and recurrence rate, in addition to its cost-effectiveness.

A 20 years old female presented with multiple small brown pigmented macules over cheek, nose and upper eyelids without any systemic complaints. There was no history of spontaneous resolution of lesions. Based on these clinical information diagnosis of lentigo was made. Lentigines are small hyperpigmented well demarcated macules resulting due to increased number of melanocytes. Based on cause of lentigo formation they can be classified as lentigo simplex, solar lentigo, PUVA lentigo, radiation lentigo and sometimes they are associated with genetic factors. Lentigo simplex is the most common lentigo and chronic sun exposure is most important causing factor but they don’t disappear on avoidance of sun exposure. Common differential diagnoses are freckles, nevus spilus and flat seborrhoeic keratosis. Usually, diagnosis is made on clinical grounds. Histopathology of lentigo shows increased pigmentation of basal layer with slight increase in number of non-atypical melanocytes. Dermoscopy shows scalloped borders, pseudonetwork and structureless areas. Lentigo simplex usually doesn’t require any active treatment. Avoidance of causative factor may reduce development of new lesions. For cosmetic concern depigmenting agents, chemical peels, Q-switch Nd:Yag laser can be used with variable success.

Background Though the combination/collision of nevi or lentigo simplex and hemangiomas is frequent, the malignant collision tumor melanoma-hemangioma is exceptional and can sometime clinically simulate a benign collision. To date, a series of collision tumors of hemangiomas associated with either benign or malignant melanocytic skin lesions (MSL) has yet to be studied by non-invasive imaging and clinico-pathologic correlates. Methods We present 10 cases of patients with collision tumors of hemangioma with different MSL including: 2 in situ lentigo-maligna melanoma, 1 invasive melanoma, 5 melanocytic nevi, and 2 lentigo simplex. The clinical aspect along with the dermoscopic and reflectance confocal microscopy (RCM) features is described and compared with histopathologic findings. Results Dermoscopic examination allows to recognize a dark ring in malignant collision melanoma-hemangioma and a jelly ring sign in benign collision of nevi/lentigo simplex-hemangioma. These peculiar features were confirmed by RCM and histopathologic findings. Conclusion Two simple dermoscopic clues confirmed by RCM features can be proposed to help distinguish between benign and malignant collisions tumors.

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.

60歳台, 男性。20年前から右踵部に拇指頭大の黒色の色素斑を認めていた。3年前に徐々に拡大してきたため, 近医にて部分生検を施行, 病理組織からlentigo simplexと診断されていた。経過をみていたところ, 皮疹の拡大と色の濃淡を認めてきた。初診時, 右踵部に70×40 mmの不整形の色素斑を認めた。境界は不明瞭で, 色調の濃淡がみられた。ダーモスコピーではparallel ridge patternとdepigmentationを認めた。悪性黒色腫が疑われ全切除生検を行った。臨床所見と病理所見よりacral lentiginous melanoma in situと診断した。前医の生検の時点で悪性黒色腫を生じていたのか, あるいは生検後に生じたのかは不明であった。しかし, 部分生検の所見がその病変全体の状態を反映しているとは限らないことから, 悪性黒色腫が疑われる症例では可能な限り全切除生検が望ましいと考えられた。

Lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome (multiple lentigines syndrome) is most often characterized by multiple lentigines and cardiac conduction defects. Café noir spot is a term proposed, by analogy to café au lait spots, for the larger and darkly pigmented patches that are frequently observed in patients with this syndrome. Although presumed by some authors to represent lentigines, the histologic features of café noir spots have not been well documented in the literature. Only two previous cases have been reported in which a biopsy of the café noir spots than melanocytic nevi. We describe the histologic characteristics of seven café noir spots in six patients with lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome. Three lesions represented melanocytic nevi (one with dysplastic features), and four were compatible with lentigo simplex. These findings help our understanding of the histologic spectrum of pigmented lesions in lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome.

Background/purpose: Polarized light has been used as an aid in visualizing various skin conditions, including acne vulgaris, rosacea, photoageing, lentigo simplex, and basal cell carcinoma. The use of parallel-polarized and cross-polarized light was evaluated in mild irritant reactions to determine, if this increases the ability to detect very early stages or low levels of irritation. Methods: Low concentrations of sodium lauryl sulfate (0.01% and 0.1%) were patched on human volunteers for 2, 6, and 24 hr, daily for 2–3 days in a modification of the standard patch test. Feminine protection products were evaluated in the behind-the-knee (BTK) test. Erythema reactions were scored by unaided visual assessment and using a polarized light visualization system. Results: In the 24-hr patch test, mean erythema assessed with polarized light was consistent with results of unaided visual scoring. Under milder conditions (2- and 6-hr patches), and in the BTK, significant differences from pretreatment levels of erythema were apparent earlier in the series of treatments compared with unaided scoring. In addition, subsurface scoring demonstrated that changes were still present under the skin surface even after unaided visual scoring indicated recovery. Conclusion: Low (subclinical) levels of irritation can be detected using enhanced visual scoring, indicating this non-invasive method has the potential to increase the sensitivity of our clinical studies.

Cryosurgery is a useful office therapeutic method for treating diverse benign unaesthetic skin diseases. Treatment of acne, acne scars, idiopathic gutatte hypomelanosis, infantile hemangiomas, flat warts, freckles, lentigo simplex, photoaging, pyogenic granuloma, rhinophyma, sebaceous hyperplasia, seborrheic keratosis, skin tags, solar lentigo, spider nevi, trichoepithelioma, and venous lakes is addressed. Most conditions require a single, less than 30 s long, 1 mm margin treatment cycle. Avoidance of overtreatment and careful patient selection can minimize potential adverse effects such as hypopigmentation or scarring. Combination with other treatment modalities can improve aesthetic outcome. Cryolipolysis is a non-invasive subcutaneous fat-reduction technique indicated for the flanks and abdomen that needs further evaluation. When properly applied, cryosurgery is a fast, safe, effective and economical tool for the treatment of most unaesthetic dermatoses.

Lentigo simplex and solar lentigines, although a minor cosmetic problem, have become an important concern among aging people, since the life span has increased substantially in the last 50 or more years, people keep active socially for much longer. These skin lesions can be easily removed by a number of dermatological procedures, among them cryosurgery. Traditionally, cryosurgery has been carried out by the use of LN. The problem is that extreme cold (−196 °C) may be too aggressive for the treatment of superficial dark spots, like lentigo and lentigines. For that reason we employ nitrous oxide, a cryogen with a much less freezing potential (boiling point −89.5 °C) for their treatment. Nitrous oxide is a relatively cheap gas since there is no insensible loss like with LN. It has less potential for blistering and causes less pain. It can be adjusted for treating small lesions, either in the form of a spray or with probes. We have found that cryosurgery with nitrous oxide to be the best treatment option for lentigos and lentigines.

Multiple blue nevi have rarely been reported, and the majority of the lesions are located on the trunk and lower extremities. The blue nevus is a rare lesion on genital mucosa and may cause confusion in differential diagnosis with other pigmented lesions such as genital melanocytic macules, lentigo simplex, and malignant melanoma. Here, we describe an unusual patient who presented with a sudden onset in adulthood of multiple blue nevi on the glans penis. The epiluminescence examination revealed a substantially homogenous bluish pigmentation, which led us to favor a diagnosis of blue nevus, whereas not entirely excluding the possibility of a regressing melanoma or a metastatic melanoma. Because of the well-known diagnostic value of the blue hue in the diagnosis of malignancy by dermoscopy, a careful examination of these lesions should be made in order to minimize any risk of misclassification with melanoma.

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.

Benign lesions are the most commonly treated lesions by those who perform cryosurgery; most of treated lesions include seborrheic keratosis, lentigo simplex molluscum, and warts. The versatility of this technique has extended its use to other conditions that range from keloids and leishmaniasis to anecdotal uses as in alopecia areata and granuloma annular.

Background and objectives Freckles (ephelides) are small, light brown macules of sun-exposed areas in fair-skinned subjects. On the other hand, freckle-like pigmentation of the axilla is a highly characteristic feature of neurofibromatosis. To what extent (clinically and pathologically) are the two pigmentary defects similar? And to what extent are cafe-au-lait patches and freckle-like lesions similar pathologically? Subjects and methods Ten cases of neurofibromatosis and 10 cases of freckles were examined clinically. Two biopsies were taken from the former; one obtained from an axillary freckle-like lesion, and the other from a cafe-au-lait patch. One biopsy only was taken from freckles. The biopsies were processed for haematoxylin and eosin, silver stain and transmission electron microscopy. Results Obvious differences were detected between freckles (ephelides) and freckle-like lesions in cases of neurofibromatosis. Cafe-au-lait patches and freckle-like lesions showed the same pathological changes of lentigo simplex, with increased melanin pigment from the basal layer up to the stratum corneum, moderate elongation of the rete ridges and mild inflammatory infiltrate intermingled with melanophages. Electron microscopy revealed an increase in melanocyte number and the presence of giant melanin granules in freckle-like pigmentation as well as cafe-au-lait patches. These ultrastructural freckles (ephelides) showed an increase in activity but not the number of melanocytes. Conclusions The term freckle-like should be changed to lentiginous macules of neurofibromatosis. On the other hand, the cafe-au-lait patches should be considered as lentiginous patches. Freckles should be restricted to sun-exposed areas in fair-skinned persons only.

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

We investigated 115 individuals in Tokyo from two groups of persons with conspicuous nevi on the head, neck, and arms, etc. (nevus-positive group) and persons who do not exhibit such nevi (nevi-negative group) interviewing them to determine whether they suffered from allergic rhinitis/conjunctivitis (pollinosis) and examining them for the presence and extent of nevi. There was a distinct correlation: only 5 persons among 85 individuals of the nevus-positive group suffered from pollinosis, and all 30 people in the nevus-negative group had pollinosis. Thus, individuals exhibiting conspicuous nevi are resistant to pollinosis, but those who do not show increased susceptibility to pollinosis.

Lentigo is a term that describes a clinically distinct lesion that may be sub-classified as solar lentigo and lentigo simplex. Lentiginous is a descriptive term of a pattern of melanocytic growth as individual cells along the dermal epidermal junction. Lentiginous melanocytic proliferation may be observed in lentigo, however it is also observed in other processes including dysplastic nevus, lentigo maligna, acral lentiginous melanoma and mucosal melanoma.

ejd.2012.1866 Auteur(s) : Maddalena Siragusa1, Maria Lentini2, Carmelo Schepis1 cschepis@oasi.en.it 1 Unit of Dermatology, Oasi Institute for Research (IRCCS), Troina, Italy 2 Department of Human Pathology, University of Messina, Messina, Italy Lentigo simplex can present as an isolated form, diffuse, involving the whole skin and/or mucosae. A unilateral distribution is rare, limited to one or more quadrants and termed agminated lentiginosis (AL) by Rhodes [1]. More rarely, AL is bilateral or with [...]

A 38-year-old Korean woman visited the Dermatology Department of Korea University Medical Center with her son and daughter in January 2001. The patient was a healthy individual with numerous brownish to black-colored macular lesions particularly abundant on her face, but also present in large numbers on her trunk, extremities, buttocks, and lips (Fig. 1). The soles of the feet and the palms showed fewer numbers of macular lesions, and the oral mucosa, genital mucosa, and conjunctiva of each eye were not involved. She recalled the beginning of lentiginosis as being around the age of 3 years. A few lentigines were present initially, and their number and darkness increased with increasing age. On physical examination, she showed a normal heart beat without a murmur, normal sexual development, and normal growth pattern. Strabismus was observed, and the ratio of the distance between the inner canthi to the biorbital distance was 2.75, i.e. hypertelorism by definition (ratio of less than 2.85). Figure Figure 1 . Numerous brownish to black-colored macules, most prominent on the face Download figure to PowerPoint The results of laboratory evaluations, including complete blood cell count, serum chemical profile, urine analysis, chest X-ray examination, electrocardiography, and audiography, were all negative or within normal limits. Biopsy of pigmented lesions from both the sun-exposed area (face) and the non-sun-exposed area (trunk) was performed. Both revealed elongation of the rete ridges, increased numbers of melanocytes at the rete ridges, and occasional melanophages in the papillary dermis. No nevus cells or nests of melanocytes were present (Fig. 2). These findings were thought to be characteristic of lentigo simplex. Figure 2. Biopsy from the patient's trunk (hematoxylin and eosin stain, × 400) reveals the elongation of rete ridges, increased numbers of melanocytes at the rete ridges, and occasional melanophages in the papillary dermis. No nevus cells or nests of melanocytes are present Download figure to PowerPoint Her 9-year-old son showed the same skin lesions as his mother (Fig. 3). The numbers of lentigines were fewer and the distribution was sparser. On physical examination, he did not show any abnormalities. His interocular–biorbital index was 2.87, which was in the normal range. Results of laboratory evaluations, including complete blood cell count, serum chemical profile, urinanalysis, chest X-ray examination, and electrocardiography, were negative or within normal limits. His audiography did not show any evidence of sensorineural defects. Biopsy of pigmented lesions from the sun-exposed face and non-sun-exposed trunk showed the findings of lentigo simplex. Figure 3. Son of the patient showing similar findings to his mother Download figure to PowerPoint The pedigree (Fig. 4) showed that her father, her three brothers and three sisters, and her son had the same cutaneous findings. Her father had strabismus, but did not have any other abnormalities before he died from an accident. Her younger brother died of measles when he was 7 years old. Part of the facial lesions in the patient and her son were removed by laser for cosmetic purposes. Figure 4. Family pedigree Download figure to PowerPoint

This study reviews a total of 1000 melanocytic lesions - two separate 500 consecutive sample groupings from 1980 and 1989, respectively - diagnosed in a private non-hospital-associated pathology practice. Lesions were classified as lentigo simplex, congenital nevus, “common” nevus, dysplastic nevus, blue nevus, Spitz's nevus or malignant melanoma. A comparison of the two periods reveals an increase in dysplastic nevi from one in 1980 to nine in 1989. The histologic changes in these nevi were compared to those of the other tumors. Pronounced cytologic atypia was seen in the melanocytes of a few “common” nevi, but more often in the dysplastic nevi and in all of the melanomas. Slight nuclear atypia was usual in “common” nevi and lentigines, and also fibroplasia, lymphocytic infiltration, vessel proliferation and pigment incontinence were seen in both “common” nevi and dysplastic nevi. It is concluded that no single histologic variable was specific for dysplastic nevi.

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.

Background An important challenge facing clinicians is recognizing and distinguishing benign pigmented lesions from cutaneous melanoma. Lentigines are a type of benign pigmented lesion that can resemble melanoma. Physician diagnostic accuracy is less than perfect, prompting research into noninvasive technology such as reflectance mode in vivo confocal scanning laser microscopy (CSLM). Objectives Our aims were twofold: to describe the in vivo characteristics of benign lentigines with reflectance CSLM and to compare them with histopathology; and to contrast the in vivo CSLM differences of lentigines, lentigo maligna, and lentigo maligna melanomas. Methods Patients with a suspect pigmented lesion were prospectively recruited to undergo CSLM before biopsy. Lentigo simplex, solar lentigo, or malignant melanoma, lentigo maligna type, were included in the study. Images were qualitatively described and compared with histopathologic findings. Results Ten patients, whose lesions included 6 lentigines and 4 lentigo malignas, were examined with CSLM. Distinct architectural and cytologic features were noted in benign lentigines compared with melanomas. The most striking finding in lentigines was observed at the dermoepidermal junction. In all cases of lentigines there was an increase in the density of dermal papillae surrounded by a bright monomorphic layer of cells. Distinct patterns were noted, as these papillae assumed irregular geometric shapes or formed papillary projections with a rim of bright, highly refractile, monomorphic, and cytologically benign-appearing cells. These findings were absent in all of the melanomas studied. Lentigines had an absence of atypical melanocytes, whereas the melanomas had bright, atypical, polymorphous cells present in a pagetoid pattern with coarse, branching dendrites observed throughout the epidermis. Limitations This is a descriptive pilot study involving a limited number of patients. Conclusion Unique CSLM characteristics of lentigines were found that have not been previously described, facilitating rapid in vivo discrimination from malignant melanoma. This descriptive study supports the further examination of CSLM features of lentigines to aid in the diagnosis of melanoma and discrimination from benign lesions.

We report on a 29-year-old female patient with an unusual pigmented lesion of the face. Clinically the lesion looked like a pigment patch of the naevus spilus type, while histological examination revealed the presence of dermal melanocytosis and multiple common blue naevi with a discrete lentiginous component in addition. The melanocytic nature of the infiltrate was ascertained by immunohistochemistry analysis using S 100 protein and HMB 45 antibodies. We interpret this lesion as agminated blue naevi in association with lentigo simplex, an unusual variant of speckled lentiginous naevus.

A 21-year-old woman with skin type IV, who had developed photophobia and brown, spotty, hyperpigmented lesions on her face from early childhood, presented to our center for treatment of her facial lesions. Examination on admission revealed numerous, freckle-like, hyperpigmented macules and actinic keratoses over the central part of the face, with sparing of the forehead, chin, and peripheral area (Fig. 1). The area involved was approximated to be around 2% of the total body surface. The dorsal parts of the hands showed no lesions (Fig. 2), but guttate hypomelanotic lesions were apparent on both forearms. Figure 1. Limitation of xeroderma pigmentosum lesions to the center of the face Download figure to PowerPoint Figure 2. Hands are devoid of any lesions Download figure to PowerPoint Histologic examination of biopsies from four different facial lesions revealed them to be keratoacanthoma (1.5 × 2.5 cm ulcerative nodule on the right cheek), sclerosing basal cell epithelioma (nasal lesion), lentigo simplex, and hypertrophic actinic keratosis. Corneal clouding, conjunctival injection, loss of lashes, and atrophy of the lids were apparent on ophthalmologic examination. Other parts of the physical examination, including examination of the oral cavity, were nonsignificant. In addition, except for the presence of mild eczema in a sibling, the patient's family history regarding the presence of any similar problem and also any other important dermatologic or general disorder was negative.

We report a case of speckled lentiginous nevus with extensive unilateral distribution in a 53-year-old man. The lesions involved the left back, extending from the midline anteriorly to the thorax, arm, and forearm. The background pigmentary patch covered only the back and upper arm. Histologic examination revealed a lentiginous pattern as well as a congenital nevocytic pattern, even in the areas where the background was nontanned skin. This combined clinical pattern in the same patient fits the descriptions for both the usual and unusual speckled lentiginous nevus. Cases with variants of extensive unilateral distribution are infrequent and pathologists should pay particular attention to them because of the possibility of their malignant transformation.

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.

This is a beautifully presented book that has as its stated goal "to provide a comprehensive description of melanocytic lesions occurring in the skin." The abundance of color illustrations on acid-free paper provides a durable atlas that can serve as a good reference book for pathology and dermatology residents who need to study the microscopic anatomy of pigmented lesions of the skin. The text has an abundance of tables that summarize the features of the most important lesions and their distinction from other lesions in the differential diagnosis. The overall organization of the book gives insight into whether this book is for you. It is divided into 12 chapters with the following headings: (1) "Melanocytes" (11 pages on basic aspects); (2) "Biopsies, Tissue Processing, and Special Studies" (8 pages on basic tissue processing); (3) "Circumscribed Pigmented Lesions Composed of Basilar Melanocytes" (11 pages on freckle, cafe-aulait macule, lentigo simplex, solar

• Cutaneous melanoma developed in contiguity with a congenital nevus spilus on the leg of a 79-year-old white woman. The unique features of the nevus spilus in this case were its relatively large size (diameter, 8 cm), irregular gross appearance, lifelong stability until the recent appearance of a tumor nodule, and the presence of intraepidermal melanocytic dysplasia appearing as multifocal elements within darkly pigmented speckles distributed throughout a lightly pigmented background of lentigo simplex. Based on this observation, we suggest that the presence of intraepidermal melanocytic dysplasia in nevus spilus may be a predisposing factor for the development of melanoma. The malignant potential of "dysplastic" nevus spilus requires further study. (Arch Dermatol.1990;126:500-505)

The nature and significance of macromelanosomes, or giant melanosomes, in various pigmented skin lesions are characterized in this paper in terms of a) their morphological features, b) the specificity for their occurrence, and c) the possible mechanisms responsible for their formation. These granules occur most frequently in the skin and eyes of persons with x-linked ocular albinism of the Nettleship-Fall type, in the café-au-lait macules of neurofibromatosis, and in the pigmented macules of xeroderma pigmentosa. In these genetic disorders, skin biopsy for detection of the macromelanosomes could be valuable for confirming the diagnosis and for establishing who in asymptomatic families are carriers of the disorders. The macromelanosomes seem not to be formed solely by autophagic degradation of melanosomes, as has been proposed recently in studies of melanocytic nevi and lentigo simplex where aggregation of the macromelanosomes and melanosomes often do occur through autophagocytosis. The macromelanosomes in these genetic disorders may be formed by a more complex process in which the melanocytes are coded for aberrant melanogenesis with formation of precursor vacuoles similar to those of pheomelanosomes and with continuous accumulation of vesiculoglobular bodies. We suggest that vesiculoglobular bodies are crucial to the formation of macromelanosomes.

This study compared the fine structure of macromelanosomes with that of giant melanosome complexes formed through melanosomal autophagocytosis in nevocytes and melanocytes of nevocellular nevi, lentigo simplex and malignant melanoma. While macromelanosomes were found only on rare occasions in these pigmentary disorders [2 of 79 nevocellular nevi (2 junctional nevi), 3 of 12 lentigo simplex and 2 of 93 malignant melanoma], the giant autophagic melanosome complexes were always present, indicating the macromelanosomes are not synthesized simply through melanosomal autophagocytosis. Although both macromelanosomes and giant melanosome complexes exhibited acid phosphatase activity similar to melanosomes, they showed many different ultrastructural features. Characteristically, macromelanosomes contained numerous vesiculoglobular bodies, whereas these bodies were absent in giant melanosome complexes. In those tissues where the presence of macromelanosomes had been ruled out by light microscopy, none of the giant melanosome complexes revealed ultrastructural features indicative of macromelanosomes. Various phases of melanosomal degradation were seen, indicating that they were not simply end-products of lysosomal degradation of melanosomes. It was thought that the key process in the development of macromelanosomes was the accumulation of vesiculoglobular bodies.

Widespread lentigines in fourteen patients following long-term therapy with psoralens and ultraviolet A (PUVA) for psoriasis were documented by biopsy of a representative lesion in a non-sun-exposed site. Chronically PUVA-exposed nonlesional skin was examined in ten of the fourteen patients. Melanocytic atypia consisting of large or angular hyperchromatic nuclei was observed in 57% of PUVA lentigines and 70% of the nonlesional PUVA-exposed skin. Comparison with twenty-four specimens of lentigo simplex or solar lentigines revealed melanocytic nuclear atypia in only two cases. Binucleated melanocytes suggesting disturbed cellular kinetics were seen in all types of lesions examined but most commonly in PUVA lentigines. The presence of giant melanosomes was also a frequent nonspecific finding. Our findings of melanocytic atypia in chronically PUVA-exposed skin, as well as in PUVA lentigines, suggest that both sites are at risk for potential complications of repeated melanocytic stimulation. Whether melanocytic atypia will prove to be a precursor of melanocytic dysplasia or malignancy following PUVA therapy requires long-term evaluation.

• Speckled lentiginous nevus is, we feel, a distinctive nevocytic disorder and a clinical variety of nevus-cell nevus. The speckled areas show varying histological patterns that range from nevus incipiens to junctional and compound nevi. The background shows histological features of lentigo simplex. It is our contention that speckled lentiginous nevus should be separated from nevus spilus and nevus spilus tardus (Becker's), which we consider to be variants of epidermal nevus. ( Arch Dermatol 114:895-896, 1978)

• Two hundred fifty-one black patients were examined for the presence of melanocytic nevi. The average number detected was 8.3 per patient. Light-skinned blacks had a greater number of total body nevi, while dark-skinned blacks had more lesions on the palms and soles. The usual histologic pattern seen in plantar-palmar lesions was that of lentigo simplex. The differentiation of lentigines of the palms and soles from early expression of acral lentiginous melanomas may be difficult; however, most acral pigmented lesions do not require excision. ( Arch Dermatol 116:548-551, 1980)