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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.

We studied the effects of cathepsins produced by immunocompetent cells of intact mice, mice with B16 melanoma, mice with removed B16 melanoma, and mice with removed Ehrlich carcinoma on the growth of B16 melanoma. Incubation of B16 melanoma cells with cathepsins from immunocompetent cells of intact mice, mice with B16 melanoma, and mice with removed Ehrlich carcinoma did not affect tumor growth. Incubation of B16 melanoma cells with cathepsin from immunocompetent cells of mice with removed B16 melanoma was followed by complete loss of malignancy by these cells. Melanoma cells formed no tumor node within at least 1 year after transplantation, though exhibited high proliferative activity and formed pigmented nevi. The formation of a nevus by B16 melanoma cells is described for the first time. The existence of a mechanism regulating proliferation of malignant cells in the tumor-bearing host was hypothesized. Studies of this mechanism are expected to promote the development of new methods for the treatment of tumors.

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.

BACKGROUND Long-pulsed (LP) lasers at pulse durations of 1-300 ms have been used to destroy nests of nevi cells by selectively targeting pigment chromophores. OBJECTIVE To evaluate dual-wavelength LP laser-induced tissue reactions. METHODS The patterns of LP 755-nm alexandrite (Alex) and/or 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser-induced tissue reactions were macroscopically evaluated using a tattoo-embedded phantom. Additionally, a pilot in vivo human study was performed for common acquired melanocytic nevus, of which dermoscopic images and high-speed cinematographs were obtained. RESULTS Combinations of Nd:YAG and Alex laser treatments at interpulse intervals of 10 or 20 ms generated round to oval zones of photothermal and photoacoustic injury in two distinctive areas containing disintegrated tattoo particles. Treatment at interpulse intervals of 10 or 20 ms between Alex and Nd:YAG pulses elicited lesser degrees of thermal damage to surrounding tissues, compared to treatment at 100 or 200 ms. Immediately after combined LP laser treatment of human nevus lesions in vivo, Nd:YAG-Alex treatment at a 20-ms interpulse interval exhibited more remarkable crusting and erosive appearances than Alex-Nd:YAG treatment. CONCLUSION For treating pigmented disorders, sequential delivery of LP Nd:YAG and Alex pulses at short interpulse intervals of 10-20 ms can effectively destroy nests of pigment chromophores.

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.

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.

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.

The total number of acquired melanocytic nevi on the skin is strongly correlated with melanoma risk. Here we report a meta-analysis of 11 nevus GWAS from Australia, Netherlands, United Kingdom, and United States, comprising a total of 52,506 phenotyped individuals. We confirm known loci including MTAP, PLA2G6, and IRF4, and detect novel SNPs at a genome-wide level of significance in KITLG, DOCK8, and a broad region of 9q32. In a bivariate analysis combining the nevus results with those from a recent melanoma GWAS meta-analysis (12,874 cases, 23,203 controls), SNPs near GPRC5A, CYP1B1, PPARGC1B, HDAC4, FAM208B and SYNE2 reached global significance, and other loci, including MIR146A and OBFC1, reached a suggestive level of significance. Overall, we conclude that most nevus genes affect melanoma risk (KITLG an exception), while many melanoma risk loci do not alter nevus count. For example, variants in TERC and OBFC1 affect both traits, but other telomere length maintenance genes seem to affect melanoma risk only. Our findings implicate multiple pathways in nevogenesis via genes we can show to be expressed under control of the MITF melanocytic cell lineage regulator.

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

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.

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.

Malignant melanoma (MM) is a type of malignant tumor, which originates from neural crest melanocytes. MM progresses rapidly and results in a high mortality rate. The present study aims to investigate the expression of microphthalmia transcription factor (MITF), the S100 protein, and HMB-45 in MM and pigmented nevi. A total of 32 MM samples (including three skin metastasis, three lymph node metastasis and two spindle cell MM samples), two Spitz nevus samples, four pigmented nevus samples and two blue nevus samples were collected. The expression levels of S100 protein, HMB-45, and MITF were observed via immunostaining. The S100 protein exhibited high positive rates in MM and pigment disorders (96.7 and 100%, respectively), but with low specificity. The S100 protein was also expressed in fibroblasts, myoepithelial cells, histocytes and Langerhans cells in normal skin samples. HMB-45 had high specificity. Its positive expression was only confined to MM cells and junctional nevus cells. Furthermore, HMB-45 was not expressed in melanocytes in the normal tissue samples around the tumor or in the benign intradermal nevus cells. MITF exhibited high specificity and high sensitivity. It was expressed in the nuclei of melanocytes, MM cells and nevus cells. It was observed to be strongly expressed in metastatic MM and spindle cell MMs. Thus, MITF may present as a specific immunomarker for the diagnosis and differential diagnosis of MM.

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.

Aims: To investigate the expression of CB 2 in normal skin, pigmented nevus, and malignant melanoma; analyze its relation with genesis; and development of malignant melanoma. Materials and Methods: In our study, we detected the expression of CB 2 in 20 cases of melanoma, nevus tissue, and normal skin tissues, respectively, by using immunohistochemistry, in situ hybridization, and RT-PCR. Moreover, we investigated the localization and expression of CB 2 in human melanoma cell line A375 and human immortalized keratinocyte cell line HaCaT by using immunofluorescence and western blotting. Results: Our data revealed that CB 2 is unregulated in melanoma. Conclusions: CB 2 plays a role in the development of melanoma.

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.

Fast jedes hellhautige Kind weist einen oder mehrere Pigmentnavi am Integument auf. Diese entwickeln sich uberwiegend in den ersten beiden Lebensjahrzehnten infolge endogener Disposition und exogener Provokationsfaktoren. Die meisten Pigmentmale sind per se harmloser Natur, als Melanomvorstufen und Risikoindikatoren gelten kongenitale und atypische (dysplastische) Navi. Obwohl ein einzelner gewohnlicher Pigmentnavus in der Regel keine Gefahrdung darstellt, besteht bei Kindern und Erwachsenen mit multiplen Pigmentnavi ein stark erhohtes Risiko, im Lauf ihres Lebens ein Melanom zu entwickeln. Die Entstehung der Pigmentmale wird eindeutig durch ultraviolettes Licht getriggert, weshalb einer entsprechenden Prophylaxe grose Bedeutung zukommt. Die Differenzialdiagnose der Navuszellnavi zum Melanom stellt besonders bei den atypischen Navi eine grose Herausforderung dar.

Focal pigmented melanocytic lesions rarely occur in the oral cavity but should not be taken for granted for they may represent markers or risks for oral mucosal melanoma (OMM). The study investigated the clinical and pathological features of focal pigmented lesions of melanocytic origin focusing on oral melanotic macule (oral MM), oral pigmented nevus (OPN) and OMM. Immunohistochemistry was employed with S100, HMB-45, Melan A, c-kit and Ki-67. Oral MM mostly occurred on the gingiva and buccal mucosa while OPN mostly occurred on the buccal mucosa. OMM occurred on the palate and gingiva. A female gender predilection was observed in oral MM. Most of the benign lesions were less than 6 mm in diameter while OMM had greater than 10 mm in diameter. Benign lesions occurred in almost the same location as that of OMM. S100 and c-kit were detected in most benign cases while HMB-45 and Melan A were focally detected in some cases. S100, HMB-45 and Melan A expressions were detected in all cases of OMM. Ki-67 was only detected at the epithelial basal layer in oral MM and was completely negative in nevus cells. In OMM, Ki-67 was more than 80. In conclusion, oral MM and OPN may not be markers of risk for OMM but excisional biopsy is highly recommended for clinically undefined lesions greater than 6 mm in diameter. The combination of S100, c-kit, HMB-45 and Melan A can be utilized to support the diagnosis of OMM. © 2010 The Hard Tissue Biology Network Association Printed in Japan. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Background: Congenital pigmented nevi of the auricle are uncommon. The authors' approach is to excise these nevi and perform reconstruction because of the risk of malignant transformation and the aesthetic and psychological effects these nevi can have on the child. This study presents the authors' experience in treating congenital nevi of the ear and suggests treatment principles and guidelines for the reconstructive surgeon. Methods: Fourteen patients with congenital nevus of the ear were treated from October of 1992 to September of 2008 by the senior surgeon (B.S.B.). Nevi involving the more stable areas such as the concha can be resected and grafted early; the antihelix, scapha, and triangular fossa area can be resected and grafted next; and the helical rim, having the most easily distorted cartilage, should be treated last. Lobule reconstruction requires combined flaps and a dermal fat graft or a postauricular fascial fat flap. Results: Successful reconstruction was achieved in 10 patients. Three patients require final revision procedures (lobule reconstruction). One patient, early in our series, developed a deformed helical rim resulting from skin grafting at age 16 months, before the cartilage was firm enough to withstand the contraction forces of the skin graft. All subsequent patients with helical rim involvement had treatment delayed until the ear was at or near completion of its growth. Conclusions: Congenital nevi of the ear present a challenging reconstruction surgeon. The authors developed a treatment plan that breaks the ear down to aesthetic units and considers the location of the nevus, patient age, and the firmness of the cartilage.

We report herein a 4-year-old girl with Dowling-Meara type epidermolysis bullosa (EB) who presented with peculiar pigmented nevi. Blister formation had repeatedly occurred on the erythematous plaques in a circinate fashion since birth, and marked hyperkeratosis was observed on the palms and soles associated with nail deformity. Her mother and maternal grandmother also had similar symptoms. In addition to the blistering lesions, the patient had three large, asymmetrical, pigmented plaques with color variegation. Light and electron microscopic findings of the blis- tering lesions showed a subepidermal blister with intracytoplasmic granules in keratinocytes as well as degeneration of basal cells and aggregation of tonofilaments. The pigmented lesions revealed histopathological features of compound nevus without malignant changes. Gene analysis revealed an E478K (Glu to Lys) mutation in exon 5 of the keratin 5 (K5) gene. These findings, together with clinical features, were consistent with those of Dowling-Meara type EB associated with so-called EB nevus.

Nevus sebaceus syndrome (SNS) is a constellation of nevus sebaceus with extracutaneous findings, including the ophthalmologic nervous, and musculoskeletal systems. Didymosis aplasticosebacea is a recently described entity consisting of aplasia cutis congenita and nevus sebaceus, implying twin spotting (didymosis). We describe a neonate with a nevus sebaceus on the scalp and a limbal dermoid on her left eye. Contiguous with the nevus sebaceus was a giant congenital melanocytic nevus and numerous areas of membranous aplasia cutis congenita. We propose the acronym SCALP (nevus sebaceus, central nervous system malformations, aplasia cutis congenita, limbal dermoid, pigmented nevus) to summarize the unique features of this case and review the two similar cases in the literature.

Background The surgical treatment of large and giant congenital pigmented nevi of the lower extremity is a challenging endeavor with limited reconstructive options. Methods Fifty large (>10 cm) and giant (>20 cm) congenital pigmented nevi of the lower extremity treated by the senior author (B.S.B.) over a 25-year period were reviewed. All of these nevi were too large for serial excision or direct closure. Results A reconstructive algorithm based on the extent and location (thigh, knee, popliteal fossa, leg, and foot) of the nevus is proposed. The approach to each anatomical region is described in detail, along with nuances of tissue expansion in the extremities. Conclusions Treating large and giant congenital pigmented nevi of the lower extremity requires careful planning and often multiple stages. An evolution of the authors' approach to these lesions has led to improved outcomes. Contour and the limiting of scar contracture around the joints are of paramount importance.

Various biological effects including anti-inflammatory response following low reactive level laser therapy (LLLT) have been described in different studies. The purpose of this study was to evaluate the anti-inflammatory effect of LLLT using 60 mW GaAlAs (830 nm) laser on damaged tissue induced by high reactive level laser treatment (HLLT). Two acquired pigmented nevi of a single person’s face were treated with high reactive level lasers (Ultra Pulse CO2 laser and Q-switched Alexandrite laser). After high reactive level lasers irradiation, one acquired pigmented nevus was exposed to 60 mW GaAlAs laser irradiation, whereas the other nevus was not irradiated and served as control. Both nevi were evaluated with digital photographs, thermography and a questionnaire survey. Compared to the nonirradiated control nevus, LLLT decreased the rubor and calor of the acute inflammation caused by HLLT. LLLT immediately after HLLT (Xenogeneous combined laser treatment) seems to be useful to control acute inflammation caused by HLLT.

Melanocytic nevi are benign hamartomas of the skin composed of nevus cells. They are almost always present in fair-skinned individuals and can arise in any anatomic site. When present at birth or during the first 2 years of life, they are categorized as congenital nevi. Melanocytic nevi that show up later in life are described as acquired nevi. The latter are further classified into common acquired nevus, dysplastic (atypical) nevus, blue nevus, Spitz nevus, and halo nevus. Their association with melanoma seems to depend on the total number and the specific types of melanocytic nevi. Regarding their benign nature, usually they do not require any therapeutic intervention. However nevi at special anatomic sites, atypical nevi, or nevi with an intriguing clinical-dermoscopic presentation should be followed up with dermoscopy in a more regular basis.

O objetivo deste estudo é relatar um caso de lesão verrucosa cujo diagnóstico foi de nevo melanocítico composto associado à hiperplasia siringofibroadenomatóide. O paciente foi submetido a exérese de lesão cutânea abdominal com diagnóstico clínico de nevo melanocítico de Miesher. A microscopia óptica revelou epiderme hiperplásica e derme com ninhos de células névicas intimamente associados com aglomerados de ductos écrinos e arranjados segundo um padrão siringomatóide. A concomitância de hiperplasia epidérmica e proliferação siringomatóide é definida como siringofibroadenomatose écrina e pode ser devida a fatores de crescimento secretadas pelo estroma alterado.

We have developed a modality of treatment of giant pigmented nevus of intradermal type. This method involves application of autologous cultured dermal substitute (CDS), followed by grafting of epidermis separated from the patient's nevus skin. To prepare the wound bed, autologous CDS was applied onto a full-thickness skin defect after complete excision of the nevus. The excised nevus skin was preserved for 1 week, after which the epidermis was separated from the nevus skin by enzymatic treatment with dispase. The epidermis thus obtained was grafted onto the resulting wound bed. This procedure was used to treat a giant pigmented nevus on a 7-year-old patient. The grafted region was soft with good tone 1 year after epidermis grafting. These results indicate that the present method can achieve complete excision of giant nevus, with esthetically acceptable results, although it requires careful monitoring for a long time.

Background Giant congenital melanocytic naevi (CMN) are often disfiguring, potentially malignant pigmented lesions present at birth. Their management is based on two main considerations: attempt to minimize the risk of malignancy and to obtain an acceptable cosmetic result. In the past various approaches have been used to treat these naevi. Objectives To describe clinical and histopathological results after treatment of CMN in neonates with erbium:YAG (Er:YAG) laser resurfacing. Methods Ten children with CMN were treated with Er:YAG laser resurfacing in the first weeks of life. Results Laser ablation was well tolerated by all children and immediate results were good. At a total follow-up ranging from 3 to 36 months we saw good results, with no or minimal repigmentation, in eight of 10 patients. Patients experienced minimal side-effects such as postoperative pain, bleeding and scar formation. Postoperative histopathology showed disappearance of heavily pigmented cells in the upper part of the dermis. Conclusions Er:YAG laser resurfacing is an effective method of ablating CMN, with minimal scarring and postoperative complications.

We report a case of sarcomatoid carcinoma of the skin in a 63-year-old man who was treated with the carbon dioxide snow freezing method for a huge congenital pigmented nevus that extended from the right upper extremity to the right trunk during childhood. He had an exophytic red tumor on the nevus in the right upper extremity that grew slowly for 4 years and rapidly recently. Histological and immunohistochemical studies revealed both epithelial and mesenchymal malignancy in the same tumor. The epithelial component was composed of basaloid cells forming multiple nests with peripheral palisading, positive for keratins and BerEP4, implying basal cell carcinoma. The mesenchymal component was composed of spindle-shaped cells negative for keratins and positive for vimentin, suggesting sarcoma. This is, to our knowledge, the first report of sarcomatoid carcinoma arising in the primary pigmented nevus that had been treated by the carbon dioxide snow freezing method.

Pigmented nevi are a heterogeneous group of lesions that range from uniquely curable with laser treatment, to partially responsive, to unresponsive or dangerous. This article presents laser and IPL treatment strategies from a clinical perspective for nevi organized by their typical responsiveness. A rationale for surgical excision, laser, and/or medical therapy in individual patients is also presented. Despite significant recent progress, it is clear that much understanding are still lacking about optimal laser treatment for pigmented lesions.

Background: The increasing use of lasers for the removal of pigmented skin lesions has led to a growing risk of erroneously treated malignant melanocytic tumours. Patients and methods: In two patients, both of whom developed a melanoma, the lesions were initially misdiagnosed clinically as a benign naevus and treated with laser vaporisation. Results: On recurrence of the tumours, the diagnosis of melanoma was finally established by histological examination of the excised tumours in which differentiation from pseudomelanoma remained difficult. Conclusions: In such cases of initially misdiagnosed melanomas, laser removal not only complicates and delays the correct diagnosis but might also worsen the prognosis after recurrence of an incompletely removed tumour.

This article describes the unusual case of an intraoral pigmented naevus with pseudoepitheliomatous hyperplasia of the gingiva. A 62-year-old man presented with an almost coal-black pigmented and partly white, spotted, dome-shaped swelling on the lingual gingiva of the mandible. Histologically, the lesion consisted of clusters of round-shaped naevus cells containing melanin granules, reactive with both S-100 immunohistochemical stain and Masson-Fontana silver stain, and pseudoinvasive squamous nests, reactive with cytokeratin. The pathogenesis of the present lesion and problems encountered in its differential diagnosis are discussed.

Phacomatosis pigmentovascularis is a rare syndrome characterized by the coexistence of a pigmented nevus and a cutaneous vascular malformation. We report a 5-year-old boy with all the typical findings of phacomatosis pigmentovascularis type Ia. Although its existence according to the traditional classification has been questioned, this case represents a very rare association of a capillary vascular malformation and a common keratinocytic nevus of the soft type.