黑素瘤并发晕痣样色素减退斑

报告1例黑素瘤并发晕痣样色素减退斑.患者女,55岁.因左臀部黑色丘疹30余年,出现结节并逐渐增大和色素减退斑2年,破溃、结痂10个月就诊.皮肤科检查:左臀部-2 cm× 3 cm ×0.6 cm暗红色结节,表面破溃、结痂;结节周围绕以1-2 cm宽、边界清楚的色素脱失晕.皮损组织病理检查示真皮中上部境界清楚的肿瘤团块,由多数梭形细胞和部分上皮样细胞组成,免疫组化染色示S-100(+),HMB45(+).诊断为黑素瘤并发晕痣样色素减退斑.     

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。     

Unusual inflammatory and hyperkeratotic halo naevus in children

Although the classic halo naevus (HN) is a melanocytic naevus with a surrounding rim of depigmentation, these naevi can present unusual features. We describe an unusual and previously unreported variety of HN in children. Between March 1999 and September 2002, 14 children (11 boys and three girls, age range 6-14 years) were referred to us for evaluation of one or more 'inflamed' naevi. All the affected naevi showed the same clinical development: (i) after an initial inflammatory stage their surfaces gradually became thickened and rough, then (ii) verrucous and raised, and finally (iii) scaly crusted. A marked halo of depigmentation subsequently developed in all lesions, with simultaneous disappearance of the hyperkeratotic surface appearance. Lesions were multiple in five cases and single in nine, and were mainly located on the back (nine cases). Excisional biopsy was performed in eight cases. The biopsies were all taken in the 'prehalo phase'. In each case, histopathology revealed a compound melanocytic naevus, with additional features that varied depending on the clinical stage of the lesion. Immunohistochemical staining of the dense inflammatory infiltrate showed a predominance of CD3(+)/CD8(+) T lymphocytes, as usually occurs in HN. On the basis of these observations, we believe that the described naevi represent an unusual variety of HN in children. Knowledge of this possible clinical evolution of HN is important to avoid unnecessary surgical excision in these young patients.     

伊藤痣上继发色素减退斑1例

报告1例伊藤痣上继发色素减退斑。患者女,43岁。7个月前原左颈肩区先天性蓝色斑片中开始出现色素改变：自后体表正中线向左,呈瓷白色、天蓝色及黄蓝色逐渐改变。天蓝色皮损组织病理检查示：表皮基底层黑素细胞消失．真皮浅层及中层少量梭形黑素细胞及较多形态各异的载色素细胞。表皮轻度海绵形成、角化不全、角质形成细胞局灶性坏死及基底层空泡变性。表、真皮交界处淋巴细胞浸润。诊断为继发于伊藤痣上的晕痣（halonevus）和晕皮炎（halo dermatitis）。     

Blue naevus with satellitosis mimicking malignant melanoma

Blue naevus is an acquired benign melanocytic naevus. It is a firm, sharply defined dark blue to grey-black papule or nodule, which is likely to arise from the arrested dermal melanocytes in the dermis. In the last few years, blue naevus has attracted much attention due to the recognition of new entities and to its confusion with malignant melanoma. We report a 69-year-old man who developed a blue-black nodular lesion with satellitosis on his scalp. Although clinically it was thought to be a malignant melanoma, histopathological investigation and conservative methods such as dermatoscopy and power Doppler ultrasonography did not confirm this diagnosis. Histopathological examination excluded malignant melanoma, as there were no cellular atypia and mitotic activity in either the nodular lesion or the satellitosis. Doppler ultrasonography confirmed the benign nature of the lesion. Dermatoscopic examination showed homogeneous steel-blue pigmentation with individual blue globules, dots and some brown veils, and confirmed the histopathological diagnosis. To the best of our knowledge, our case is the third reported case of a blue naevus with satellitosis mimicking malignant melanoma.     

Early melanoma with halo eczema (Meyerson's phenomenon)

We present a case of a 49-year-old man who presented with a solitary atypical pigmented lesion with a surrounding halo of dermatitis. Dermoscopy showed a pigment network at the periphery with areas of scar-like depigmentation, negative pigment network and erythema. The lesion was treated preoperatively with a potent topical corticosteroid resulting in a reduction of inflammation. Histology showed an early Clark level 1 melanoma arising within a severely dysplastic compound melanocytic naevus. There was an adjacent perivascular chronic inflammatory cell infiltrate with occasional eosinophils. Minimal, though definite spongiosis with parakeratosis was also present. The scar was subsequently re-excised achieving appropriate excision margins for melanoma in situ. Six months later, there was recurrence of dermatitis at the scar with no evidence of recurrent melanoma. To our knowledge, melanoma with Meyerson phenomenon has not been reported in the literature. This case highlights that all lesions should be evaluated on clinical and dermoscopic grounds regardless of the presence or absence of eczema. Our case adds yet another entity that may display Meyerson phenomenon and consequently a halo of eczema cannot be considered a reassuring sign when evaluating melanocytic lesions.     

Epithelioid blue naevus of the genital mucosa: report of four cases

Epithelioid blue naevi are an unusual cytological variant of blue naevus that have been recently described mostly in patients with the Carney complex, although they may also occur in isolation. This variant of blue naevus is composed of melanin-laden polygonal epithelioid melanocytes situated within the dermis. The neoplastic cells show no maturation with progressive depth of dermal infiltration and, in contrast with the usual stromal changes in blue naevi, epithelioid blue naevi exhibit no dermal fibrosis. We describe four cases of epithelioid blue naevus located on the genital mucosa in four patients with no evidence of the Carney complex. Three male patients showed an epithelioid blue naevus on the mucosa of the glans penis and a female patient had a lesion of the right labium minoris. Histopathologically, the lesions consisted of entirely intradermal melanocytic naevi composed mostly of heavily pigmented epithelioid melanocytes involving the dermis of the genital mucosa. Immunohistochemically, in all cases, epithelioid melanocytes expressed immunoreactivity for S-100 protein, HMB-45, Melan-A and MiTF antibodies.     

Dermatofibroma and halo dermatitis

The occurrence of a halo of dermatitis surrounding acquired naevi was initially reported by Meyerson in 1971 with histological features of focal spongiosis, parakeratosis, irregular acanthosis and a lymphocytic infiltrate in the upper dermis. When the same inflammatory reaction occurs around other lesions it is referred to as the Meyerson phenomenon or halo dermatitis. We report a rare case of the Meyerson phenomenon occurring around a dermatofibroma in a 69-year-old woman. This case highlights that the phenomenon may occur in a broad range of clinical scenarios and is not limited to acquired naevi in young adults.     

先天性小痣82例临床与病理分析

为了解先天性小痣的临床与病理特点,对８２例进行了分析。在临床上,ＳＣＮ损害常为梭形或椭圆形褐黑色斑块,８４％的损害大小超过１ｃｍ,表面粗糙不平,常覆盖有黑色粗毛;部位最常见于躯干和四肢。由于先天性小闱比后天性闱易于恶变,故支持尽量在青春期前作预防性切除的意见。     

Benign melanocytic proliferative nodule within a congenital naevus

A neonate presented with a deeply pigmented papule within a medium-sized congenital naevus. Histologically, this proved to be a benign proliferative nodule in a congenital naevus. This case is presented to highlight the occurrence of this lesion, the main differential of which is the rare entity of true congenital melanoma.     

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.     

Molecular evidence that halo in Sutton’s naevus is not vitiligo

Both halo naevus and vitiligo are acquired leucodermas of unknown aetiology. To date a significant contribution of oxidative stress through accumulation of hydrogen peroxide (H₂O₂) has been documented in the pathomechanism of vitiligo but not in halo naevus. Both epidermal pterin-4a-carbinolamine dehydratase (PCD) and catalase are sensitive markers to follow H₂O₂ concentration-dependent deactivation of these proteins. In situ protein expression of PCD and catalase was examined in full-skin biopsies from skin phototype-matched controls (n=5), untreated and treated vitiligo patients (n=5) and patients with untreated halo naevus in association with vitiligo (n=3). Vitiligo was treated with pseudocatalase (PC-KUS) only. Catalase levels were determined in epidermal suction blister extracts using fast protein liquid chromatography (FPLC). In addition, epidermal H₂O₂ levels were followed in vivo by Fourier-transform Raman spectroscopy. The results of this study ruled out a contribution of H₂O₂ in the millimolar range in the depigmentation process of halo naevus as previously documented in vitiligo. Therefore, it can be concluded that both leucodermas exercise distinct concentration-dependent H₂O₂ signalling in their pathomechanisms.     

Congenital malignant melanoma: a case report

Congenital malignant melanoma (MM) is an uncommon condition that is defined as MM recognized at birth. Its incidence is difficult to determine because of the small number of reported cases and because of problems associated with diagnosis. Generally, Spitz naevus and melanoma have many clinical and histopathological similarities, so it is difficult to differentiate between the two. We describe a rare case of congenital MM in which differential diagnosis from Spitz naevus was problematic. In addition, we review the literature and comment on the prognostic differences among the three types of congenital and infantile MM.     

REVERSE HALO NAEVUS

An occult naevus associated with a halo of depigmentation is described in a ten year old boy. The development of three lesions in this boy supports the concept that the development progressed from leucoderma to halo naevus to normal pigmented naevus instead of the progression from pigmented naevus to halo naevus to leucoderma as is normally found.     

Bilateral naevus of Ota: a rare manifestation in a Caucasian

The naevus of Ota (naevus fusculocoeruleus ophthalmomaxillaris) was first described by the Japanese dermatologist M. T. Ota in 1939. It has a reported incidence of 0.2% to 1% in the Japanese population. It usually occurs in the skin innervated by the first or second branch of the trigeminal nerve. The naevus comprises dermal melanocytes and is congenital or acquired during adolescence. Commonly associated lesions include scleral melanocytosis and other ocular manifestations as well as lesions of the tympanic membrane, oral and intranasal mucosa and leptomeninges. Diseases associated with Ota's naevus in rare cases are open-angle glaucomas and melanoma. The naevus of Ota in Europeans is a rare manifestation. We report the very rare case of a bilateral naevus of Ota associated with enoral melanocytosis in a white European person.     

Congenital melanocytic naevi

Congenital melanocytic naevi, consisting of clusters of naevo-melanocytes, develop in utero . Although many congenital naevi are visible at birth, some may not become evident until later in life. The timing of naevo-melanocyte proliferation, senescence and melanogenesis may all contribute towards determining when a naevus will become clinically manifest on the skin. Besides the fact that congenital melanocytic naevi may be aesthetically displeasing, resulting in a multitude of psychosocial issues, they also increase the risk for developing cutaneous melanoma, leptomeningeal melanoma, neurocutaneous melanocytosis, malformations of the brain and, rarely, other tumours such as rhabdomyosarcoma and liposarcoma. Whereas the risk of developing malignancy in association with congenital naevi is dependent, to some extent, on the size of the naevus, the risk of developing neurocutaneous melanocytosis correlates best with the number of satellite naevi. Management of patients with congenital melanocytic naevi requires individualization, taking into account the naevus size and location, and the risk of developing cutaneous melanoma or neurocutaneous melanocytosis. When contemplating treatment options, it is important to set realistic expectations and to address the possible aesthetic and functional outcomes, while at the same time addressing the risk for developing cutaneous and/or extracutaneous melanoma.     

Lack of clinical-pathological correlation in the diagnosis of congenital naevi

Congenital naevocellular naevi (CNN) have classical histological criteria that are thought to allow distinction from acquired naevi. These criteria are mainly the horizontal distribution of melanocytes, forming 'Indian files', and a prominent adnexotropism. In order to check whether the previously described criteria were reliable, we analysed 1349 unselected consecutive cases of naevocellular naevi excised in children under 16 years, during a 54-month period. The slides were analysed in order to determine by histological analysis only if they could be classified as CNN. These results were then compared with the clinical files, in which only the most reliable data from parental and/or medical observations were included. Of the 1349 naevi, 659 had the typical histological criteria of CNN, 32 of them being deep CNN, characterized by massive involvement of the lower dermis and hypodermis. The comparison with clinical data showed that 32 naevi with the histological criteria of congenital naevi were actually acquired, and that 179 naevi present at birth did not fulfil these criteria. This study shows that the classic histological criteria are not absolutely specific and are poorly sensitive as 36% of naevi present at birth lacked the classic criteria. The most specific criteria of true CNN were the involvement of eccrine glands and presence of melanocytes in the septae. In the case of deep CNN which corresponded to large or very large naevi, the clinicopathological correlation was 100%. Deep CNN could easily be distinguished from superficial CNN and often exhibited many histological changes consistent with a complex hamartoma, such as presence of brown fat tissue, abnormal vessels and numerous large terminal follicles. In conclusion, our study suggests that it is not possible to predict, by histological analysis alone, that a naevus was present at birth, except in deep CNN which are likely to be a separate entity among all congenital naevi. Studies dealing with congenital naevus-associated melanoma should take into account the lack of sensitivity of these criteria.     

Halo eczema and nevus cell nevi (Meyerson nevi)

In the same way as a halo of depigmentation surrounds a sutton naevus, a halo of eczema can appear around a naevocellular naevus. This phenomenon was first described in 1971 by Meyerson, but publications on the topic are relatively sparse. We report a patient who consulted us because of such lesions. A review of literature is appended.     

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.     

(17) Histopathology of giant congenital melanocytic naevi: implications for treatment

Giant hairy naevi pose not only cosmetic problems, but also therapeutic difficulties because of the increased risk of malignant melanoma. Prophylactic full thickness excision and grafting have previously been recommended for such lesions, but because of the large size this is not always practical. Following observations that in the neonatal period, naevus cells are superficial (predominantly in the papillary dermis) and only later migrate into reticular dermis, some authors have suggested that dermabrasion or shaving of the naevi must be performed soon after birth, as an alternative therapy. We studied 26 children with giant congenital melanocytic naevi to assess: (i) the histological progression with age; (ii) correlation of clinical and histological appearance; and (iii) results of shaving in the treatment of these naevi.
Initial biopsies revealed that naevus cells often occupy the entire dermis, even in the neonatal period, and not infrequently involve the subcutis. Melanocytes showed little organization into nests.
Follow-up biopsies of all naevi showed no change in histological pattern or progression in depth with age, despite changes in clinical appearance.
Post-shaving biopsies revealed that although the epidermis and sometimes the papillary dermis were removed, all the deeper dermal, subcutaneous and fascial components of the naevi remained.
In conclusion our data suggest that: (i) many congenital melanocytic naevi already show deep dermal involvement in the neonatal period; this does not support the hypothesis that naevus cells migrate into the dermis during infancy; (ii) there is no change in naevus depth with age; (iii) shaving does not remove all the naevus cells, and should only be considered as a cosmetic procedure, Three cases showed regeneration of melanocytes following shaving, similar to what is described as the 'pseudomelanoma' phenomenon.