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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.

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.

Melanonychia, which is characterized by brown or black pigmentation within the nail plate, includes heterogeneous conditions such as pigmented nevus, subungual melanoma and lentigo. We treated two cases of subungual melanoma in situ. One case was a 58-year-old woman who suffered from a malignant melanoma in situ of the left third fingernail, who had also suffered from melanonychia of the fingers for more than 30 years. She had a past history of carcinoma of the uterine cervix. The other patient was a 42-year-old man, who suffered from a malignant melanoma in situ of the right fifth fingernail. He had a past history of carcinoma of the stomach for which he had undergone surgery 2 years earlier. Both cases were accompanied by Hutchinson's sign on the fingertip skin, and the presence of this sign led to the correct diagnosis of subungual melanoma in situ. Judging from previously reported cases, it is unlikely that patients with malignant melanoma have an increased risk of carcinoma of the uterine cervix or of the stomach.

Background Malignant melanoma of the conjunctiva is a rare tumour. Early disease stages may be difficult to distinguish from benign lesions such as pigmented nevi or primary acquired melanosis. We describe the therapeutic procedure and histological findings in two patients and review the epidemiology and pathogenesis of malignant conjunctival melanoma. Two female patients (84 and 85 years old, respectively) presented with a pigmented tumor close to the limbus with surrounding conjunctival pigmentation and involvement of the cornea. Results Following complete excision of the tumour, conjunctival malignant melanoma arising from primary acquired melanosis was diagnosed histologically. Subsequent treatment with mitomycin C eye drops was initiated. There was no recurrence of the tumor within the follow-up period (24 and 6 months). Discussion Patients with primary acquired melanosis need to be reviewed on a regular basis to detect malignant transformation at an early stage.

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.

Nine patients developed multiple areas of eczema surrounding centrally located pigmented nevi. There was no significant history of atopy or evidence of external contact factors to account for the reaction. The eczema did not appear to influence the central melanocytic nevi, which persisted after resolution of the inflammation. The pathogenesis of this striking phenomenon remains unclear but differs from that associated with classical halo nevi.

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.

International audience; Congenital melanocytic nevi of the face are a frequent reason for consultation in paediatric plastic surgery. Usually of small size, they raise a complex problem of reconstruction when they are large and giant. The indication of excision is generally stated on aesthetic criteria whereas the risk of melanoma is especially important in the giant nevi. Simple suture, full thickness skin graft and expanded skin flaps are the techniques of choice. The treatment must be carried out precociously, follow a surgical planning, respect the aesthetic units of the face and the periorificial areas, adapt to the age of the child and bring psychological benefit to the child.

Standard resection of pediatric facial skin lesions consists of lenticular excision and linear closure. This one-stage procedure for circular lesions results in a linear scar 3 times longer than the diameter of the removed specimen. Circular excision and purse-string closure has been described for infantile hemangiomas to reduce the length of scar. The purpose of this study was to analyze the application of this technique for any type of circular facial skin lesion in the pediatric population. Records of consecutive pediatric patients with facial skin lesions treated with circular excision and purse-string closure from 2007-2014 were reviewed. Patient age, sex, type of lesion, location, and size were recorded. Number of stages necessary to remove the area and complications were analyzed. Seventy-seven children (74% female) underwent circular excision and purse-string closure for an infantile hemangioma (46%), pigmented nevus (27%), Spitz nevus (7%), pilomatrixoma (5%), pyogenic granuloma (5%), vascular malformation (4%), or another type of skin lesion (6%). Age at the time of resection was 6.0 years (range 4 months-17 years) and mean lesion area was 3.9 cm (range 0.2-19.6); 30% of patients underwent a second procedure and no infection or wound dehiscence occurred. Circular excision and purse-string closure is an effective technique to manage any type of circular skin lesion in the pediatric population. It is particularly useful for lesions on the face because it limits the length of a scar. A subset of patients may benefit from second procedure to convert the circular scar from a circle into a line.

Congenital melanocytic nevi (CMN) are benign pigmented nevi present at birth. The incidence ranges from 1% for small single nevi to approximately 1 in 20,000 for nevi projected to be greater than 20 cm in diameter in adulthood. CMN can present as an isolated single lesion or can be accompanied by a variable number of other CMN. Neurological abnormalities, in particular intraparenchymal melanosis, are the most common complications of CMN. CMN syndrome is the association of CMN, extracutaneous features such as neurological abnormalities, and/or the typical facies of many affected children. The overall incidence of melanoma in childen with CMN is approximately 1%–2% for all phenotypes, with a further increased risk in patients with abnormal screening MRI of the CNS. Melanoma more commonly arises in the CNS than in skin in children, and an acute neurological presentation should be viewed with concern. CMN are caused by an embryonic mutation, most commonly in the gene NRAS, or rarely in the gene BRAF. Genotyping is an important part of management where melanoma does arise. Surgery with current techniques has not been proven to alter the risk of malignancy and thus should only be routinely considered for esthetic improvement.

Congenital melanocytic nevus – represents a benign proliferation of dermal melanocytes, which clinically is observed at birth or appears during the first weeks of life. Congenital nevi vary in size, macroscopic manifestations and histological characteristics [1], they appearing in about 1% of newborns. Most nevi are characterized by small size, but there are large (LCN) and giant congenital nevi (GCN) as well, which have a large area, and sometimes extend to the entire segment. GCN are relatively infrequent congenital malformation which under macroscopic study typically characterized by intense pigmentation and often can have a differently expressed hair cover [2].

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.

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.

Purpose To evaluate the efficacy of an argon laser in the ablation of benign conjunctival pigmented nevi. Design Interventional case series. Methods We conducted argon laser ablations for conjunctival pigmented nevus in 30 eyes of 28 patients. Laser ablation was applied directly to the conjunctival pigmented nevus in all patients. All patients were followed up over a period of 12 months. Results In all patients, the conjunctival lesions to which the argon laser was applied disappeared almost completely within two days after treatment. No recurrence of lesions was detected in any patient during the follow-up period, nor were any conjunctival scars or conjunctival injections. Conclusions The argon-laser ablation of conjunctival pigmented nevi uniformaly resulted in excellent clinical outcomes. Therefore, this study concludes that argon laser ablation is a safe and effective modality for the treatment of benign conjunctival nevi, and this method could replace the classical surgical procedure.

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.

Analysis of the low frequency region of Raman spectra enables determination of water structure. It has been previously demonstrated by various techniques that water content and possibly also the water structure is altered in some malignant tumours. To further elucidate possible change in water structure in tumours we performed NIR FT Raman spectroscopy on biopsies from selected benign and malignant skin tumours (benign: seborrheic keratosis, pigmented nevi; malignant: malignant melanoma, basal cell carcinoma). We did not observe any differences in water content between malignant and benign skin tumours with an exception of seborrheic keratosis, in which the water content was decreased. Increase in the tetrahedral (free) water was found in malignant skin tumours and sun-damaged skin relative to normal young skin and benign skin tumours. This finding may add to the understanding of molecular alterations in cancer.

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.

e21066 Background: Melanocytes are involved into the synthesis and metabolism of steroid hormones in the skin. Cutaneous melanoma in 75% of cases occurs in congenital or acquired pigmented nevi. There are no studies comparing local hormonogenesis in nevi and melanomas. The purpose of the study was a comparative analysis of hormone levels in tissues of dysplastic nevi and cutaneous melanoma (pТ1-2N0M0). Methods: Levels of prolactin (PRL), progesterone (P4), total and free testosterone (T and fT), estrone (E1) and estriol (E3) and sex steroid-binding globulin (SSBG) were studied by ELISA in 17 samples of рТ1-2N0M0 melanoma and in 23 samples of dysplastic nevi. Intact tissues (n = 15) obtained from non-cancer patients during surgical treatment was used as the control. Results: Levels of T in nevi, compared to intact tissues, were 1.4 times higher, fT – 8.7 times higher, while SSBG content was 1.9 times lower; E3 was 1.6 times higher, PRL – 1.4 times lower, and levels of E1 in nevi were similar to the values in intact tissues. рТ1-2N0M0 melanomas, compared to intact tissues, demonstrated local androgen imbalance: T levels were decreased by 1.8 times, while fT exceeded the norm by 1.8 times, and SSBG – by 6 times. E1 content increased by 1.6 times, E3 decreased by 2.8 times. The E1/E3 ratio in nevi was reduced by 1.6 times, while in melanoma it was increased by 4.4 times. The T/E1 ratio in nevi was increased by 1.4 times, and in melanoma it was decreased by 2.8 times. Levels of PRL and P4 in melanomas, nevi and in intact tissues did not differ significantly. Conclusions: Melanoma was characterized by hyperestrogenia due to increased levels of E1 and low E3 concentrations which caused malignant transformation of melanocytes. Most likely, in melanoma spent SVT estrone synthesis, as evidenced by increase in the E1 / E3 and decrease T / E1.Apparently, fT in melanoma is used for estrogen synthesis, as indicated by the E1/E3 increase and decrease in the T/E1 ratio. Increased E1 synthesis can contribute to the realization of estrogen genotoxic effects. These mechanisms are absent in tissues of nevi. Hyperandrogenism in nevi probably prevents malignant transformation due to low aromatase activity.

doi: 10.1007/s12519-015-0050-2 Online First November 2015 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2015. All rights reserved. A four-day-old female infant with jaundice was admitted to our hospital. On her examination, a capillary hemangioma with a pigmented nevus and a Mongolian spot was noticed (Fig. 1). Ultrasound examination revealed spinal dysraphism at L2, L3 and L4 vertebrae (Fig. 2). Spina bifida results from incomplete fusion of vertebral arches and manifests in various degrees of severity. Occult spinal dysraphism, however, can be suspected in the asymptomatic neonate when cutaneous stigmata, such as hemangiomas, lipomas, hairy patches, pigmented nevi or subcutaneous masses are seen over the lumbosacral spine. Two or more congenital midline skin lesions are considered as the strongest markers of occult spinal dysraphism. The present case shows that such simple lesions should be taken seriously if they occur simultaneously. On the other hand, Mongolian spots, sacral pits and dimples do not indicate a high risk of occult spinal dysraphism. Clinical examination should focus on neurological

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.

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.

O melanoma conjuntival multifocal recidivado originado de nevus preexistente e extremamente raro, ocorrendo em uma pessoa para cinco milhoes de habitantes. Seu estudo e de extrema relevância, devido sua potencial letalidade. Este estudo objetiva descrever um caso de melanoma conjuntival multifocal recidivado proveniente de nevus pigmentado preexistente ocorrido em Patos de Minas, MG. Este e um estudo de caso com revisao de literatura. O diagnostico histopatologico e o estadiamento precoce da lesao conjuntival e de fundamental importância para designar a conduta frente ao paciente. O procedimento terapeutico mais utilizado nos dias atuais e a excisao cirurgica com crioterapia adjuvante associada a mitomicina C. O prognostico do melanoma conjuntival multifocal recidivado originado de nevus preexistente e o pior dentre todos os melanomas oculares, apresentando alta taxa de mortalidade, 12% a 20% em 5 anos e 30% em 10 anos de desenvolvimento patologico.

The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the primary modality of treatment. The median age at presentation was approximately 1 year; mean postoperative follow-up was 4 years. Nevi were classified according to the predominant anatomic areas they occupied (temporal, hemiforehead, and midforehead/central); some of the lesions involved more than one aesthetic subunit. The authors propose the following guidelines: (1) Midforehead nevi are best treated using an expansion of bilateral normal forehead segments and advancement of the flaps medially, with scars placed along the brow and at or posterior to the hairline. (2) Hemiforehead nevi often require serial expansion of the uninvolved half of the forehead to minimize the need for a back-cut to release the advancing flap. (3) Nevi of the supraorbital and temporal forehead are preferentially treated with a transposition of a portion of the expanded normal skin medial to the nevus. (4) When the temporal scalp is minimally involved with nevus, the parietal scalp can be expanded and advanced to create the new hairline. When the temporoparietal scalp is also involved with nevus, a transposition flap (actually a combined advancement and transposition flap because the base of the pedicle moves forward as well) provides the optimal hair direction for the temporal hairline and allows significantly greater movement of the expanded flap, thereby minimizing the need for serial expansion. (5) Once the brow is significantly elevated on either the ipsilateral or contralateral side from the reconstruction, it can only be returned to the preoperative position with the interposition of additional, non-hair-bearing forehead skin. Expansion of the deficient area alone will not reliably lower the brow once a skin deficiency exists. (6) In general, one should always use the largest expander possible beneath the uninvolved forehead skin, occasionally even carrying the expander under the lesion. Expanders are often overexpanded.

We report four patients presenting with rare synchronous upper- and lower-eyelid naevi. The distributions and appearances of these naevi resemble the distinctive periorbital pigmentation of the panda. The possible embryological origin of this naevus and an approach to management are discussed.

To determine if there is a significant difference in the relative frequency and degree of atypia of sporadic dysplastic nevi from the scalp, face, and neck area in children as compared with nevi from the rest of the body, we reviewed 99 consecutive biopsy specimens of melanocytic nevi from the scalp, face, and neck areas in children less than 18 years of age and compared them with 95 consecutive cases of nevi from other areas of the body in children of the same age. Large numbers of the nevi biopsied from the scalp (13 of 31; 41.93%) and forehead (2 of 10; 20%) were dysplastic. The number of dysplastic nevi from the neck (1 of 58; 1.72%) was not assessed as very different from the incidence found in other regions of the body, where 7 dysplastic nevi (7.36%) from a total of 95 nevi were found. Of the 13 dysplastic nevi from the scalp, 9 showed minimal atypia and 4 showed moderate atypia. No nevi with severe atypia were found. Many pigmented nevi from the scalp and forehead in children in this study were dysplastic. This finding points out the importance of examining the scalp of children for the presence of dysplastic nevi. The majority of nevi from the neck were common nevi.

Proteus syndrome is a rare hamartomatous condition comprising overgrowth of some part of the body in association with various cutaneous, neurovascular, musculoskeletal, and other organ systems. In some cases, there is a family history. The case presented is that of a 6-year-old boy with left hemihypertrophy, widespread capillary hemangiomatosis in the extremities, a pigmented nevus on the right forearm, macrosyndactyly of the second and third fingers, together with a history of urolithiasis. The literature on this rare syndrome is reviewed.

Neurocutaneous melanosis (NCM) is a rare nonfamilial syndrome, characterised by large or numerous congenital pigmented nevi and excessive proliferation of melanin-containing cells in the leptomeninges. We report the MR findings in the brain and spine of a child with NCM who underwent neurosurgical treatment and was followed up for 8 years. The findings in this child (small hyperintense collections of melanocytes in both temporal lobes, mild meningeal enhancement along the spine and the development of an extensive subarachnoid CSF accumulation with cord compression and syringomyelia) are believed to be exceptionally rare.

A 43-year-old woman presented with a pigmented flat tumor situated at the posterior surface of the cornea nasally in her left eye. Anterior-segment optical coherence tomography revealed that the lesion was similar to the iris leaf, was limited to the cornea, and did not communicate with the iridocorneal angle. In vivo scanning slit confocal microscopy imaged dense hyperreflective tissue behind the endothelium and bright spots dispersed on the adjacent endothelial surface. Multiple hyporeflective formations resembling cell nuclei were visualized within the hyperreflective mass and the cell borders were distinguished. The diagnosis of pigmented nevus or retrocorneal membrane was suspected. The authors conclude that anterior-segment optical coherence tomography and in vivo scanning slit confocal microscopy are useful in assessing the microstructure and penetration of pigmented corneal lesions. [Ophthalmic Surg Lasers Imaging 2009;40:586-588.] AUTHORS From the Department of Ophthalmology (JPS, MU, PT, JS) and the Department of Histology and Embryology (MO), Center of Biostructure Research, Medical University of Warsaw, Warsaw, Poland. Accepted for publication July 23, 2008. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Jacek P. Szaflik, MD, PhD, Department of Ophthalmology, Medical University of Warsaw, SPKSO, ul. Sierakowskiego 13, 03-709 Warsaw, Poland. doi: 10.3928/15428877-20091030-09

Giant congenital pigmented nevi pose a substantial reconstructive challenge for the treating physician. Due to the increased risk of malignant transformation in such lesions, complete excision with tissue expansion or skin grafting is the generally accepted treatment. These modalities can, however, leave the patient with secondary deformities that also require complex reconstructive procedures. The following case details a patient requiring secondary reconstruction with large-volume tissue expansion 12 years after excision of a giant nevus, and split-thickness skin grafting. This patient illustrates a severe secondary deformity and the usefulness of large-volume serial expansion in such patients.

Melanocytes are pigment-producing cells derived from the neural crest. These specialized exocrine cells produce melanin, which is packaged and dispersed to neighboring keratinocytes in organelles called melanosomes. Within the melanocyte, tyrosine is converted to dopa, and then dopaquinone via the bifunctional enzyme tyrosinase. Dopaquinone is oxidized further to form the pigment melanin. Each epidermal melanocyte secretes melanosomes to approximately 36 adjacent keratinocytes, forming an epidermal melanin unit. Genetically programmed constitutive skin color is determined by the amount of cutaneous melanin pigmentation. The common mole or acquired melanocytic nevus (AMN) is a collection of nevomelanocytes grouped into nests located in the epidermis (junctional nevus), dermis (dermal nevus), or both (compound nevus). It is hypothesized that nevomelanocytes are derived from either epidermal melanoblasts or dermal Schwann cells. AMN first appear at ∼1 year of age, peaking in number during the second or third decades of life, and disappearing by the seventh to ninth decades. AMN may appear suddenly or become more prominent in response to sun exposure, cortisone and corticotropin, blistering diseases, chemotherapy, immunosuppression, and other factors that are not well-defined. Reports of AMN increasing in size and darkening in color during puberty and pregnancy have been reported but not quantitated systematically.melanocytes, keratinocytes, acquired melanocytic nevi.

Summary Congenital pigmented new are found in approximately 1 % of newbom infants. Two main factors determine their management: 1) thenskofmalignancy (melanoma); 2) the aesthetic consequences, these factors being themse Ives dependent upon the size and the localization of the nevi. Thus, if the systematic resection of small new is not required, early treatment of giant nevi which cany a high risk of malignancy before the age of ten years, is highly recommended. Main methods of treatmentare surgicalresection (with the help of skin grafts, orcutaneous expansion or mobilization, in giant nevi), dermabrasion and curettage. n˦vus pigmentaire congenital naevus, pigmented / abnormalities

A 20-year-old woman presented with a 2-day history of headache. She had a congenital grayish-blue pigmented nevus on her left side face, which involved ipsilateral sclera and oral mucosal membrane, diagnosed as nevus of Ota (figure 1, A and B). Neuroradiologic manifestation revealed a lesion in the left cerebellar hemisphere, the etiology of the presenting tumor apoplexy (figure 1, C–F). A left cerebellar hemisphere craniotomy was performed. A well-defined black lesion involved dura mater to the pia mater and was firmly attached to the cerebellar tentorium (figure 2, A and B). Histopathologic examination confirmed a meningeal melanocytoma. Postoperative CT demonstrated total tumor resection.1

Two cases of pigmented nevus of the palate are presented. The first case was an intradermal pigmented nevus in a 32-year-old male and the other a junctional pigmented nevus in a 49-year-old female. We also reviewed 31 cases reported in Japanese literatures, and the resultswere as follows: 1) Histologically, the intradermal type is the most common (68%), followed by compound (23%) and junctional types (9%). 2) Pigmented nevus develop mostly on the palate (39%), with gingiva of the mandible (32%), buccal mucosa (13%), and lip (10%), gingiva of the maxilla (6%). 3) More females than males have pigmented nevi. 4) The highest incidence is in the third and fourth decades, and almost half of the patients (55%) are in those age groups. 5) Size, given as the largest dimension of the lesion, ranged from 2mm to 40mm. More than four fifths (89%) are described as slightly raised or as raised, and the remaining lesions are flat. 6) The lesions were surgically excised, and except for our one case there are no reports of recurrence.

Giant hairy nevus of the face is a unique form of congenital nevus, fortunately rare and typically hair-bearing. In its usual form, it is large and disfiguring, thus the name garment or bathing trunk nevus. These lesions have a relatively high risk of becoming malignant. These lesions, when large, make a formidable undertaking in view of lack of suitable donor sites and multiple procedures involved in its treatment. Giant hairy nevus of the face is a particular challenge to a plastic surgeon not only because of a very high standard of skill required but also for the patient and parental concern for cosmetic results. This paper presents as to how the different modalities of treatment were applied to achieve good cosmetic results.

Non-invasive and fast primary diagnostics of pigmented skin lesions is required due to frequent incidence of skin cancer – melanoma. Diagnostic potential of principal component analysis (PCA) for distant skin melanoma recognition is discussed. Processing of the measured clinical multi-spectral images (31 melanomas and 94 nonmalignant pigmented lesions) in the wavelength range of 450-950 nm by means of PCA resulted in 87 % sensitivity and 78 % specificity for separation between malignant melanomas and pigmented nevi.

Phacomatosis pigmentovascularis is a rare disorder which occurs sporadically, with just about 200 cases reported worldwide.1 The syndrome is characterized by a capillary nevus occurring in conjunction with a pigmented nevus of various types.2 The condition may occur with systemic/syndromic involvement.3 The first reported case dates back to 1920, but it was only in 1947 that the condition was described in detail by Ota et al. Happle simplified and reclassified the disorder in 2005.4 We report a case of phacomatosis pigmentovascularis with Raynaud's phenomena in a young adult male.