HTERT Expression in Melanocytic Lesions: An Immunohistochemical Study on Paraffin‐Embedded Tissues

Progressive mucinous histiocytosis is a rare, benign, non‐Langerhans cell histiocytosis limited to the skin. A total of ten cases, all women, in four families, and one sporadic case have been described in the English literature. The disorder usually begins in childhood and progresses slowly. We report two sporadic cases of adult‐onset progressive mucinous histiocytosis in unrelated African American women, age 48 and 55 years old respectively, who developed red‐brown and flesh‐colored, asymptomatic papules on the face, arms and legs without truncal, mucosal or visceral involvement. The lesions show no spontaneous regression. Both patients lack associated systemic symptoms including polyuria, polydipsia or seizures. There is no underlying hyperlipidemia, paraproteinemia or lymphoproliferative disease. No family history of similar lesions can be identified. Light microscopy reveals dermal proliferation of spindle‐shaped histiocytes with abundant mucin deposition. Electron microscopy demonstrates a high number of myelin‐figures or zebra bodies in the cytoplasm of histiocytes. On immunohistochemistry, positive staining with macrophage markers CD68, HAM56 and lysozyme, and Factor XIIIa, a transglutaminase present in dermal dendrocytes, and negative staining with Langerhans cell markers CD1a and S100, and CD34, a marker present in dermal dendritic cells derived from uncommitted mesenchymal cells, are observed.     

Meyerson Phenomenon in Children: Observation in Five Cases of Congenital Melanocytic Nevi

Abstract:   To describe the characteristics of five pediatric patients with the Meyerson phenomenon associated with congenital melanocytic nevi, five cases were reviewed to retrieve information relating to clinical presentation, treatment and evolution of the eczematous phenomenon and of the nevi. Three of five patients were male. Mean age at presentation of the Meyerson phenomenon was 23 months (range: 4 mos–4 yrs). Three patients presented with only one halo eczematous lesion, while two patients presented with more then one halo eczematous lesions. The halo eczematous lesions were located on the leg, arm, and trunk in four, two, and two patients, respectively. All were associated with congenital melanocytic nevi with overlying hypertrichosis. Four were treated with topical corticosteroids, and five developed some degree of hypopigmentation within the nevic lesion. In children with Meyerson phenomenon associated with congenital hairy melanocytic nevi, neither trigger to the eczematous eruption nor preferential gender or anatomical site location was identified. The Meyerson phenomenon evolved towards hypopigmentation of the congenital melanocytic nevic lesions in all patients but no other cutaneous changes were observed on follow-up.     

Acute Urticaria: History and Natural Course of 50 Cases

Fifty patients with acute urticaria who visited within a week after the onset were interviewed and the history around the onset of urticaria was carefully taken. It was known that the majority of the patients had experienced some symptoms suggestive of infection. The patients were followed up for a year to determine the last efflorescence. It was disclosed that 43 cases were cured within two weeks and 5 other cases were cured between 2 weeks and 3 months. The remaining 2 cases persisted over a year. These results seem to suggest that urticaria is an immunologically erroneous reaction to foreign body innoculation, a large majority of which is acute infection.     

Sunscreen Use and Melanocytic Nevi in Children: A Systematic Review

Abstract: We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross‐sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta‐analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair‐skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children.     

Onychomycosis in Children: An Experience of 59 Cases

Background

Although tinea unguium in children has been studied in the past, no specific etiological agents of onychomycosis in children has been reported in Korea.

Objective

The purpose of this study was to investigate onychomycosis in Korean children.

Methods

We reviewed fifty nine patients with onychomycosis in children (0~18 years of age) who presented during the ten-year period between 1999 and 2009. Etiological agents were identified by cultures on Sabouraud''s dextrose agar with and without cycloheximide. An isolated colony of yeasts was considered as pathogens if the same fungal element was identified at initial direct microscopy and in specimen-yielding cultures at a follow-up visit.

Results

Onychomycosis in children represented 2.3% of all onychomycosis. Of the 59 pediatric patients with onychomycosis, 66.1% had toenail onychomycosis with the rest (33.9%) having fingernail onychomycosis. The male-to-female ratio was 1.95:1. Fourteen (23.7%) children had concomitant tinea pedis infection, and tinea pedis or onychomycosis was also found in eight of the parents (13.6%). Distal and lateral subungual onychomycosis was the most common (62.7%) clinical type. In toenails, Trichophyton rubrum was the most common etiological agent (51.3%), followed by Candida albicans (10.2%), C. parapsilosis (5.1%), C. tropicalis (2.6%), and C. guilliermondii (2.6%). In fingernails, C. albicans was the most common isolated pathogen (50.0%), followed by T. rubrum (10.0%), C. parapsilosis (10.0%), and C. glabrata (5.0%).

Conclusion

Because of the increase in pediatric onychomycosis, we suggest the need for a careful mycological examination of children who are diagnosed with onychomycosis.     

Dermoscopy for the Pediatric Dermatologist Part III: Dermoscopy of Melanocytic Lesions

Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision‐making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma‐specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma‐specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue‐white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma‐specific structure, the most common being atypical vascular structures and crystalline structures.     

Laminin‐5 Expression in Melanocytic Lesions of the Skin

Background: Laminin‐5 is a basement membrane constituent that functions as an anchoring filament to integrin‐derived hemidesmosomes, and has been detected at the invasive front (tumor‐stromal interface) in many types of carcinomas. Our goal was to analyze laminin‐5 expression in melanocytic lesions and evaluate its role in tumor progression. Design: Immunohistochemical staining for laminin‐5 was performed on 101 cutaneous melanocytic lesions including 41 nevi, 31 primary melanomas, and 29 metastatic melanomas. A standard immunoperoxidase technique (ABC) was used with DAB chromagen and a primary monoclonal antibody to the laminin‐5 gamma2 chain (clone D4B5, 1:50, Chemicon International, Temecula, CA). Any degree of staining in melanoma cells or at the tumor‐stromal interface was considered positive. Results: Positive staining for laminin‐5 was observed in three of the primary melanomas (10.7%), three of the metastatic melanomas (10.3%), and none of the nevi. In primary melanomas, staining was observed predominately at the tumor‐stromal interface. In metastatic lesions, staining was observed around individual melanoma cells and melanoma cell nests.Conclusion: Expression of laminin‐5 was detected in a small percentage of primary and metastatic melanomas and in none of the nevi studied. Laminin‐5 expression does not appear to be essential for the development of melanomas or their metastases.     

Knowledge and Perception of Melanocytic Nevi and Sunburn in Young Children

Abstract: Background/Objectives: Understanding the public’s perception of nevi and sunburn is crucial to melanoma prevention efforts. Methods: We investigated the knowledge and perception of melanocytic nevi and sunburns in 77 children 6 to 10 years old (mean 8.2) in two elementary schools in Styria, Austria. The children were interviewed by specially trained psychologists about the number of their moles and how they felt having them. Additionally questions about sunburn history and sunburn perception were asked. The spontaneous answers of the children were recorded, there were no pregiven answers. Afterwards the children were examined by dermatologists clinically and with dermatoscopes. Results: The 96% of the children could describe a nevus (the term “mole” was translated to “nevus”) and 91% did not feel bothered about theirs. Only 26% had noted the appearance of new nevi within the last year. The 67% of all children had at least one sunburn and remembered the clinical features. The 20% of the children knew that sunburns could provoke skin cancer. All children felt comfortable during the clinical and dermatoscopic examination. Conclusion: Children aged from 6 to 10 years know exactly why they had suffered from sunburn, can describe the sunburn and how to avoid it. They do not feel bothered by their nevi and are alert to the appearance of new nevi.     

Fluorescence In Situ Hybridization Analysis of Atypical Melanocytic Proliferations and Melanoma in Young Patients

Morphologic heterogeneity among melanocytic proliferations is a common challenge in the diagnosis of melanoma. In particular, atypical melanocytic lesions in children, adolescents, and young adults may be difficult to classify because of significant morphologic overlap with melanoma. Recently a four‐probe fluorescence in situ hybridization (FISH) protocol to detect chromosomal abnormalities in chromosomes 6 and 11 has shown promise for improving the classification of melanocytic lesions. We sought to determine the correlation between FISH results, morphology, and clinical outcomes in a series of challenging melanocytic proliferations in young patients. We retrospectively performed the standard four‐probe FISH analysis on 21 melanocytic neoplasms from 21 patients younger than 25 years of age (range 5–25 years, mean 14.6 years) from Stanford University Medical Center who were prospectively followed for a median of 51 months (range 1–136 months). The study cohort included patients with 5 confirmed melanomas, 2 melanocytic tumors of uncertain malignant potential (MelTUMPs), 10 morphologically challenging atypical Spitz tumors (ASTs), and 4 typical Spitz nevi. FISH detected chromosomal aberrations in all five melanomas and in one MelTUMP, in which the patient developed subsequent lymph node and distant metastasis. All 10 ASTs, 4 Spitz nevi, and 1 of 2 MelTUMPs were negative for significant gains or losses in chromosomes 6 and 11q. Our findings demonstrated a strong correlation between positive FISH results and the histomorphologic impression of melanoma. This finding was also true for the MelTUMP with poor clinical outcome. Therefore FISH may serve as a helpful adjunct in the classification of controversial melanocytic tumors in young patients.     

Expression of Activated Mapk, AKT and C‐Kit in Melanocytic Lesions

Neurofibromatosis is associated with cutaneous melanin pigmentation, but an association with ordinary melanocytic nevi has not been described. This retrospective case‐control study was designed to see if neurofibromas in patients with Neurofibromatosis, Type I (NF‐1) differ from sporadic neurofibromas (SN) in their incidence of associated melanocytic nevi and other histologic features. Slides from 114 NF‐1 were compared with 112 SN. Lentiginous melanocytic nevi were identified over 13 NF‐1 (11%) but no SN (p = 0.00019, Fisher's test). Compared with other NF‐1, NF‐1 with nevi were more frequently associated with melanocytic hyperplasia, honeycomb infiltration of the subcutis (p < 0.03, Fisher's test), and a greater number of biopsies (p = 0.04, t‐test). Compared with SN, NF‐1 were more frequently associated with melanocytic hyperplasia, lentigo simplex‐like changes, honeycomb infiltration of the subcutis (p < 0.001, Chi squared test), plexiform neurofibroma and epidermolytic hyperkeratosis (p < 0.03, Fisher's test). SN more frequently presented as a polyp or papule (p < 0.009). Sebaceous hyperplasia (present in 14% of cases), dermal elastosis (9%), lipomatous neurofibroma (8%), epithelial cysts (4%), and keratin granulomas or folliculitis (3%) were equally common in NF‐1 and SN. This study suggests that there may be a fundamental difference in the potential for melanocytic proliferation in NF‐1 compared with SN.     

Melanocytic Nevi in Children of Southern Italy: Dermoscopic,Constitutional, and Environmental Factors

The objective was to estimate the prevalence of melanocytic nevi (MN) in children and to determine their dermoscopic characteristics and relationship with anatomic location and environmental and constitutional factors. The population was a randomly selected sample of 144 children who attended primary schools in Naples, Italy. Before physical examination of the children, standardized interviews were conducted with their parents. Follow‐up interviews of both the children and parents were conducted 1 year later. Photographic and dermoscopic images were obtained. Boys had more MN than girls; 465 MN (55.6%) were observed in boys and 371 (44.4%) in girls (p < 0.05). The trunk and neck were the most common locations of MN (p < 0.001). The main dermoscopic feature of all MN observed was a globular pattern (p < 0.001). A significant correlation between duration of sunbathing and MN counts was revealed (p < 0.05). At 1‐year follow‐up, 118 new MN were identified in 66 children. The trunk and neck areas were the most common regions involved in the appearance of new MN (n = 68, 57.6% of all new MN, p < 0.001). The new MN count was significantly higher in children who reported more sunbathing (p < 0.001). Changes in the dermoscopic pattern were observed in 45 persistent MN, demonstrating more MN with a reticular‐globular pattern, especially on the trunk, neck, and upper extremities (p < 0.001). MN development in early life is the result of complicated relationships between nevus evolution, anatomic location, and environmental and constitutional factors.     

Four Cases of Lobulated Intradermal Nevus: A Sign of Aging Melanocytic Nevus

Melanocytic nevi are subject to change with age in both clinical and histopathologic findings. In 1991, Cho et al. first reported three cases of lobulated intradermal nevi and suggested their cases represented an unusual form of regressing melanocytic nevus. Herein we report four cases of lobulated intradermal nevus and review previous literature.     

145例儿童过敏性紫癜回顾性研究

目的分析儿童过敏性紫癜(Henoch-Schonlein purpura,HSP)的临床特点,提高临床诊治水平。方法对2008年7月—2011年7月在我科治疗的145例过敏性紫癜患儿的发病特点、临床表现、相关实验室检查等方面进行回顾性分析。结果①HSP主要发生于学龄前儿童和学龄儿童共120例,占92.8%。②诱因:感染73例(61.9%),进食海鲜11例(9.3%)。③出现肾脏损害者15例,发生率10.3%。④145例患儿中,118例(81.4%)痊愈出院,20例(13.8%)好转出院。结论①HSP发病诱因仍以感染为第一位。②以腹痛症状为首发症状的HSP易误诊为急腹症,临床接诊时需认真查体。③早期、足量使用糖皮质激素有利于减轻临床症状、降低严重肾脏损害的发生。     

Counts of Common and Atypical Melanocytic Nevi in Korean Young Men: Assessment of Their Risks and Correlations with Associated Factors

Two hundred and thirty-five Korean young men were examined for the count of melanocytic nevi (MN). The mean count of common MN of at least 2 mm diameter was 16.1. Three subjects had more than 50 common MN and another four had clinically atypical MN. We determined skin phototype by interview with questionnaires in the same persons as proposed by Fitzpatrick. All subjects were classified with respect to skin phototype and the number of previous sunburns. The correlations between common MN and the skin phototype or the number of previous sunburns were statistically analyzed. The skin phototype showed the correlation with the number of common MN, which means if skin phototype of any subject belongs to type I, he could to be predicted to have many more common MN than subjects with darker phototypes, like type VI. The correlation between number of previous sunburns and number of common MN was not statistically significant. This study shows persons at moderate risk of cutaneous melanoma (CM) do exist and skin phototype is associated with the prevalence of common MN in Koreans.