Frequency, clinical and dermoscopic features of benign papillomatous melanocytic naevi (Unna type)

Background  Most previous studies on melanocytic naevi have not distinguished between the different types of naevi, except for some studies trying to define atypical naevi. No large, population-based studies on papillomatous or Unna-type melanocytic naevi have been performed.
Objectives  To investigate the dermoscopic and clinical features of papillomatous naevi and to study some of the factors which could potentially influence their development.
Methods  Seven hundred and seven caucasians aged 1–82 years participated in a screening campaign at open-air recreation facilities in Austria. The volunteers underwent a total body examination by experienced dermatologists and answered a questionnaire. Clinical and dermoscopic images of one representative papillomatous naevus per person were taken.
Results  Twenty-nine per cent of the volunteers exhibited papillomatous naevi, the highest frequency being found in young adults. No correlation between the frequency of papillomatous naevi and gender, skin type, sunburns, sunbed use or hormonal factors was found. Most lesions were brown papules (median diameter 5·0 mm), located on the trunk. Dermoscopy showed a predominance of homogeneous and globular pattern, multifocal hypo/hyperpigmentation and comma vessels. Of the papillomatous naevi, 9·8% showed suspicious scores with dermoscopic algorithms.
Conclusions  The lack of exogenous influencing factors and the predominance of globular dermoscopic pattern strengthen the hypothesis that papillomatous naevi belong to the same spectrum as small congenital melanocytic naevi. As the role of papillomatous naevi as precursors of melanoma remains unclear and they are frequently not recognized by the patients, one should perform dermoscopy of papillomatous naevi during skin cancer screening.     

Pigmented spindle cell naevus of Reed: a controversial diagnostic entity in Australia

Background/Objectives: The Reed naevus or pigmented spindle cell naevus of Reed (PSCN) was previously considered a pigmented variant of the spindle cell‐type of Spitz naevus. It is now considered a distinct entity and may overlap with cutaneous melanoma in both clinical and dermatoscopic features. We hypothesised that PSCN is an under‐recognised entity in Australia and present a typical case. To test our hypothesis, we performed a clinically based survey of Australian dermatology trainees (Registrars). A further aim of our study was to determine the approach of dermatology trainees in this country to the management of this type of lesion. Methods: A web‐based survey questionnaire based on the presented case was circulated to trainees of the Australasian College of Dermatologists. Responses, including level of training and initial approach to management, were collated and form the basis of the results presented herein. Results: Of 39 respondents, 13 (33%) diagnosed the lesion as PSCN. The majority (33/39; 84.6%) indicated they would biopsy the lesion, with most of these (91%) preferring excisional biopsy. Conclusions: The results support our hypothesis that PSCN is under‐recognised in Australia. The results also show that despite difficulty distinguishing this lesion, management of these lesions by dermatology trainees in Australia is consistent and parallels current recommendations.     

Meyerson's naevus: a clinical and histopathological study of 11 cases

We undertook a clinical and histopathological analysis of patients presenting with Meyerson's naevi. Eleven patients with the characteristic histological features of a Meyerson's naevus were identified over a 5-year period. Diagnostic criteria included epidermal spongiosis and a dermal inflammatory infiltrate associated with a banal junctional or compound naevus. Cases were excluded if naevus cells showed moderate to severe atypia or regression. Patients were contacted by phone and interviewed regarding their lesions. The most common clinical appearance was a solitary, pruritic, erythematous eruption encircling a pre-existing pigmented naevus. The trunk and proximal upper extremities were preferentially affected. Only one clinician listed Meyerson's naevus in the clinical differential diagnosis. All cases demonstrated a pigmented junctional or compound naevus with epidermal spongiosis, parakeratosis and a perivascular lymphohistiocytic inflammatory infiltrate with scattered eosinophils. The inflammatory infiltrate consisted almost exclusively of CD3+ lymphocytes, the majority of which were CD4+. However, a substantial number were CD8+. In all patients, the lesions cleared with excision or spontaneously, without recurrence or progression to melanoma. The aetiology of this entity remains unclear and most clinicians are unlikely to be familiar with it.     

Meyerson痣一例

患者男,13岁.因颈后色素痣周围相继出现湿疹样改变2月余,于2007年7月14日来我院就诊.2个月前,无明显诱因,患者颈后色素痣周围开始出现红斑、干燥、脱屑,无脓疱,以瘙痒症状为主,未经任何治疗,上述皮损逐渐消退,中央的色素痣颜色变淡.     

太田痣合并鲜红斑痣3例

报告3例太田痣合并鲜红斑痣，3例患者均为先天发病，第1例为面部双侧太田痣合并躯干部大片鲜红斑痣，组织病理和电镜显示真皮中可见色素细胞；第2例为面部双侧同时太田痣合并鲜红斑痣；第3例为右侧面部太田痣合并颈部、下颌部鲜红斑痣。     

Eruptive disseminated Spitz naevus (EDSN) in a young girl of Indian origin

Eruptive disseminated Spitz naevus (EDSN) is a rare entity and has never been documented in a South‐east Asian individual (of Indian origin) previously. We report an adolescent with this condition which, to our knowledge, has only been previously reported a few times.     

Spitz naevus: histological features and distinction from malignant melanoma

Spitz naevus is a benign lesion that can be confused histologically with malignant melanoma. Some malignant melanomas also have an appearance similar to a Spitz naevus. Spitz naevus commonly occurs in children but also occurs in adults. The typical Spitz naevus has a classical histological appearance. This paper reviews several studies which have attempted to develop criteria to separate malignant melanoma and Spitz naevi. Histological features that suggest a diagnosis of malignant melanoma rather than atypical Spitz naevus include deep and marginal mitoses, atypical mitoses, asymmetry, pleomorphism and prominent epidermal involvement.     

多发性皮脂腺痣1例

患儿女,3天。出生时头、面、颈部即见多发性黄红色斑块伴疣状或脑回状增生。诊断:泛发型皮脂腺痣。     

Sebaceus naevi: a clinicopathologic study

OBJECTIVE: To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study. METHODS: We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN. RESULT: A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association. CONCLUSION: The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.     

Dermal melanocytosis: A clinical spectrum

While most dermal melanocytoses are congenital or have an onset in early childhood, there is a group which is clearly acquired, with an onset in adult life. While the Mongolian spot typically disappears in childhood, other dermal melanocytoses persist for life. A brief review of the clinical spectrum of the dermal melanocytoses is undertaken and three illustrative cases are described: a case of congenital naevus of Ota, a case of acquired bilateral naevus of Ota-like macules, and an unusual case of a congenital dermal melaaocytotic lesion on the left hand which began to spread in adulthood. The possibilities regarding the pathogenesis of this intriguing group of disorders are considered.     

RECURRENT MELANOCYTIC NAEVI FOLLOWING PARTIAL REMOVAL (PSEUDOMELANOMA)

Regrowth of a benign melanocytic naevus at the dermo-epidermal junction following inadequate excision has been shown to produce cellular atypia resembling a dysplastic naevus or a superficial spreading melanoma. The term “pseudomelanoma” has been used to identify this process, as the lesion behaves in a benign fashion. In this case naevi of this type recurred in a split skin donor site. The graft was required to repair the defect following excision of a true melanoma which subsequently developed metastases.     

Copper vapour laser treatment of port-wine stains in brown skin

Forty-seven Korean patients with port-wine stains were treated with a copper vapour laser and clinical responses were assessed at three months after the last treatment by comparing photographs taken before each treatment The immediate histologic changes within 15min after laser treatment were also observed by routine H & E and nitroblue tetrazolium chloride staining. When we treated port-wine stains with minimal whitening doses of 6-8 J/cm², no or slight colour changes were obtained. Thus, all port-wine stain lesions in this study were treated with non-specific energy densities ranging from 10-20 J/cm². Good to excellent results were obtained in 18 (38.2%) of 47 Korean patients with port-wine stains. Repeated treatment can continue to reduce colour. Darker lesions (purple or red) are more likely to result in a marked colour change. At above threshold dose, there was wedge-shaped diffuse coagulation necrosis and loss of viability of the epidermis and underlying dermis. Even though copper vapour laser treatment of port-wine stains in brown skin is not as selective as in white skin because of epidermal melanin, our clinical data demonstrate the usefulness of the copper vapour laser for the treatment of port-wine stains in brown skin.     

Review of neurological manifestations in 196 patients with sebaceous naevi

The incidence of neurological abnormalities in patients with sebaceous naevi may not be as high as has been previously accepted. One hundred and ninety-six patients with epidermal naevi of the sebaceous type were examined for clinical neurological abnormalities. Ninety-three per cent of these patients were neurologically normal on examination. Extensive naevi were present in 21% (3/14) of patients with neurological abnormalities and in 5% (9/182) of those without. A centrofacial location of the naevus was found in 21% (3/14) of patients with abnormalities and in 2% (4/182) of neurologically normal patients. A surprising finding was the low yield of abnormalities from neuroimaging in the patients with clinical neurological abnormalities. Imaging was performed in eight of the 14 and was normal in six patients. Despite the lower than expected rate of associated abnormalities and the low yield of abnormal findings from imaging, it is strongly recommended that all patients with sebaceous naevi have a detailed neurological assessment and that imaging be performed on all those in whom clinical abnormalities are demonstrated, as well as on those patients with large naevi involving the centrofacial area.     

Naevus lipomatosus cutaneous superficialis

A young male presenting with cutaneous papules and plaques in a segmental distribution in the pelvic girdle area is reported. The clinical features were suggestive of naevus lipomatosus cutaneous superficialis, but diagnostic biopsy is essential to demonstrate the typical histopathological features and exclude important differential diagnoses such as segmental neurofibromatosis.     

Melanomas arising from naevi and de novo melanomas — does origin matter?

BACKGROUND: It is widely accepted that some melanomas arise from pre-existing naevi, while others appear de novo. The proportions involved and the effect of melanoma origin on prognosis is unclear. OBJECTIVES: To determine whether melanomas reported by the patient to have developed from a pre-existing naevus are associated with a better or worse prognosis compared with those arising de novo when adjusted for confounding variables. METHODS: All patients attending a dedicated melanoma screening clinic between March 1997 and March 2002 were included. The distinction between melanoma arising without any pre-existing lesion (de novo) and those derived from a pre-existing lesion (naevus melanoma) was based on patient history. We categorized patients into three groups: those who gave a history of their lesion arising within a pre-existing naevus, those in whom the melanoma developed de novo and those in whom no conclusive history could be obtained. We compared prognostic indicators between the naevus and de novo melanoma groups. RESULTS: Of 8593 patients screened, 377 had a positive diagnosis of melanoma (in situ or invasive). Of these 42% had naevus melanomas, 34% new melanomas and 24% were uncertain. Patients presenting with a melanoma arising from a pre-existing naevus had a greater Breslow thickness despite presenting sooner than the de novo group, although no significant difference in thickness was found when other prognostic factors were controlled for. CONCLUSIONS: This prospective study shows that naevi that undergo malignant change may result in melanomas that are thicker and thus potentially have a worse prognosis than de novo melanomas. Although our results were not statistically significant when other risk factors were also taken into account, it is possible that a larger study would identify a significant association.     

棘层松解角化不良性表皮痣并发色素性毛表皮痣

报告1例单侧棘层松解角化不良性表皮痣并发色素性毛表皮痣。患者男,40岁。10岁时左侧胸部出现片状多毛区,其间有许多淡红色小丘疹。10年前同侧肢体出现红色疣状丘疹,部分融合。皮损冬轻夏重,伴有轻度瘙痒。皮损组织病理学检查可见表皮乳头瘤样增生,基底层上方棘层松解和裂隙,类似Darier病样改变。     

Becker's naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings

BACKGROUND: Becker's naevus (BN) may represent a distressing cosmetic handicap and a challenging issue regarding treatment. OBJECTIVES: To compare clinical and histopathological findings of patients with BN treated with two different lasers: an erbium:yttrium-aluminium-garnet (Er:YAG) system vs. a neodymium:YAG (Nd:YAG) laser. PATIENTS AND METHODS: In this prospective and comparative study we present the clinical and histopathological evolution during a 2-year follow-up of 22 patients with BN treated with only one pass of the Er:YAG laser (n = 11) or three treatment sessions with the Q-switched Nd:YAG system (n = 11). RESULTS: Clinical evaluation 2 years after treatment with the Er:YAG laser showed complete clearance (100%) in 54% of the patients (n = 6) and clearance of > 50% in 100% of the subjects. In relation to Nd:YAG laser treatments our results echo those of other authors. Numerous sessions are necessary to get an acceptable clinical clearance rate. Only one patient showed marked clearance (51-99%) after three treatment sessions. Moderate (26-50%) and mild (1-25%) clearance was observed in 45.5% (n = 5) and 27.3% (n = 3) of the patients. CONCLUSIONS: Both Er:YAG and Nd:YAG are safe tools to treat BN. However, in terms of pigment removal, one pass with Er:YAG is a superior technique to three treatment sessions with the Nd:YAG.     

Spitz naevi misdiagnosed histologically as melanoma: Prevalence and clinical profile

A Spitz naevus is a benign melanocytic tumour that may histologically resemble a malignant melanoma. Data was retrospectively gathered from patients who attended the Victorian Melanoma Service to determine the prevalence of Spitz naevi pathologically misdiagnosed as melanoma. Assessment of the clinical characteristics of these patients was also performed and compared to those with correctly diagnosed melanoma. It was found that 6.5% of all melanomas referred were in fact Spitz naevi and that Spitz naevi represented the majority of pathologically misdiagnosed melanomas. The Spitz naevi were more likely to be on the lower extremities and were on average, considerably smaller than the melanomas. Patients with Spitz naevi were more likely to be younger, female, have fewer dysplastic naevi and have brown eyes. One hundred per cent of the Spitz naevi were brought to the attention of the initial doctor by the patient compared to 72% of the melanomas. This study concludes that Spitz naevi that are pathologically misdiagnosed as melanomas retain the clinical characteristics of other Spitz naevi and mat greater clinicopathological communication may reduce the frequency of diagnostic error.     

颧部褐青色痣的激光治疗进展

目前颧部褐青色痣(naevus fuscocaeruleus zygomaticus,NFZ)的治疗主要以Q开关激光为主.该文就NFZ激光治疗最新进展进行综述,包括纳秒激光,皮秒激光及激光治疗的影响因素等.