Melanoma on dysplastic nevus spilus

Background Nevus spilus is found with relative frequency. It is observed as a tan to brown macule serving as base to a speckle of smaller and darker maculo-papular elements. On rare occasions it turns into a malignant melanoma. Purposes To describe one case with some characteristics different from routine observations and to revise the cases published reporting nevus spilus that turned into malignant melanoma, in order to point out the most frequent aspects. Results The 17 patients with nevus spilus and melanomas, including ours, were white, with ages between 35 and 56 years. Most of the cases were localized in the dorsal region. Five patients were men. Almost all nevus were congenital and their size ranged between 2 and 10 cm in diameter. Histologically, the speckled spots were junctional nevus, and few of them had dysplastic characterics. Melanomas corresponded to the extensive superficial type MES; one of them was nodular. Some had systemic ganglial metastases and three of the patients are known to have died. Our patient had an intradermal cellular nevus on the main spot, and terminal hairs could be observed on it. The speckled elements were junctional nevus with dysplastic cells. Conclusions Nevus spilus must be closely monitored, because it may turn into a malignant melanoma.     

Malignant melanoma arising in a nevus spilus

Malignant melanoma arising within a nevus spilus is rare. Nevus spilus is characterized by darkly pigmented macules and papules with background hyperpigmention. We report a 65-year-old woman who presented with a melanoma arising in a nevus spilus that had been present since birth.     

Nevus spilus

Nevus spilus (NS), also known as speckled lentiginous nevus (SLN), is a relatively common cutaneous lesion that is characterized by multiple pigmented macules or papules within a pigmented patch. It may be congenital or acquired; however, its etiology remains unknown. NS deserves its own place in the spectrum of classification of important melanocytic nevi; as a lentigo and melanocytic nevus, it has the slight potential to develop into melanoma. Accordingly, we recommend consideration of punch excisions of the speckles alone if excision of the entire NS is declined.     

Hairy Nevus Spilus: A Case Series

Abstract: Nevus spilus, also known as speckled lentiginous nevus, is a nevoid disorder characterized by hyperpigmented macules or papules scattered over a background of tan pigmentation. Although nevus spilus is mainly of cosmetic concern, malignant melanoma may rarely develop in the lesions. Although classically not mentioned as a hairy nevus, a few reports in literature mention overlying hypertrichosis in lesions of nevus spilus. We hereby report four cases of nevus spilus without malignant change with overlying terminal hairs that arose mainly from the background pigmented area.     

The relationship between melanocytic nevi and malignant melanoma

In conclusion, although there are data, some quite convincingly implicating dysplastic nevi and congenital nevi (particularly "giant") as "precursors" of malignant melanomas, our ability to predict the magnitude of these associations is lacking. Thus, until additional basic and clinical research data are forthcoming, any recommendation to prophylactically remove all congenital nevi or all dysplastic nevi in order to decrease the incidence of malignant melanoma is premature. In regard to congenital nevi, evidence exists that giant (larger than 20 cm in diameter) congenital nevi may have a significant risk factor so as to warrant, when feasible, prophylactic excision of such lesions. In our opinion, no uniform recommendation can be made at this time for the management of small and medium-sized congenital nevi. Patients with familial dysplastic nevus syndrome should be followed carefully and educated concerning the early detection of malignant melanoma. Patients with sporadic dysplastic nevus syndrome deserve further study to enable us to accurately determine their risk of developing malignant melanoma.     

Occurrence of melanoma in "dysplastic" nevus spilus: report of case and analysis by flow cytometry

We report a case of melanoma arising in a large nevus spilus. On histologic examination, the nevus spilus had diagnostic features of melanocytic dysplasia. Further characterization by flow cytometry showed DNA-aneuploidy within the melanoma as well as in one of the darker pigmented papules within the nevus spilus. The significance of this finding and a review of melanomas originating in nevi spili are presented.     

Malignant melanoma and acquired dermal melanocytosis on congenital nevus spilus

We reported a case of malignant melanoma and acquired dermal melanocytosis that appeared on congenital nevus spilus; this is the first report from Japan. An 85-year-old woman had had a nevus spilus on the right lower leg since birth. A black-brown nodule developed on the nevus three years before treatment. Blue-gray patches were found within the nevus on inspection. Histopathological analysis of these lesions revealed superficial spreading melanoma and acquired dermal melanocytosis, respectively. There have been 19 previous case reports of malignant melanoma on nevus spilus, and there have only been 4 cases of dermal melanocytosis (plaque-type blue nevus) on nevus spilus. We reviewed the reported cases in the literature and discussed the risk factors of nevus spilus.     

Management of Nevus Spilus

Abstract: Nevus spilus Is clinically defined as a pigmented skin lesion composed of a light brown macule on which darker, circumscribed macular or papular lesions appear at a later stage. Histologically, nevus cells have been found both in pigmented spots and in the background stain. Cases of transformation into melanoma have been reported in the literature and the excision of these lesions is therefore justified. We discuss surgical techniques used in seven patients with nevus spilus and define their indications with respect to the characteristics of the lesion.     

Malignant melanoma in a Hispanic male with nevus of Ota.

Nevus of Ota is uncommon in the non-Oriental population. We report a case of malignant melanoma with metastasis to the genitourinary tract in a Hispanic male with nevus of Ota. Thirty-six prior cases of nevus of Ota with malignant melanoma reported in the English language are reviewed. Sixty-eight percent were women; 76% were Caucasians. Metastatic disease was reported in 16%. Three patients had liver metastases. Our case was the first involving the genitourinary tract. All but one patient with metastatic disease died within 1 month of presentation. Despite the increased frequency of nevus of Ota in the Japanese, only 4 cases of malignant melanoma have been reported. Nevus of Ota would appear to be a risk factor for developing malignant melanoma in the Caucasian population.     

Unusual clinical presentation of melanocytic nevi

Two patients with congenital pigmented lesions with a speckled clinical appearance are described. The lesions were nevus spilus (synonym: speckled lentiginous nevus) and agminate congenital nevi. The clinical aspects of nevus spilus and agminate nevi are reviewed.     

Rare melanocytes and nevus-cell nevi]

This review considers the following melanocytic and nevocytic nevi: nevus spilus, cellular blue nevus, benign juvenile melanoma, mongolian spot and nevus of Ota. Clinical aspects, histopathology and prognosis are outlined, based on data from the recent literature.     

Origin of cutaneous melanoma in a congenital dysplastic nevus spilus

Cutaneous melanoma developed in contiguity with a congenital nevus spilus on the leg of a 79-year-old white woman. The unique features of the nevus spilus in this case were its relatively large size (diameter, 8 cm), irregular gross appearance, lifelong stability until the recent appearance of a tumor nodule, and the presence of intraepidermal melanocytic dysplasia appearing as multifocal elements within darkly pigmented speckles distributed throughout a lightly pigmented background of lentigo simplex. Based on this observation, we suggest that the presence of intraepidermal melanocytic dysplasia in nevus spilus may be a predisposing factor for the development of melanoma. The malignant potential of "dysplastic" nevus spilus requires further study.     

Benign melanocytic lesions: Risk markers or precursors of cutaneous melanoma?

Background: The role of benign melanocytic lesions as precursors and not only as risk markers for the development of cutaneous melanoma is controversial.Objective: The purpose of the study was to assess the frequency of the histologic association of benign melanocytic lesions with cutaneous melanoma of a maximum thickness of 1.00 mm. The possibility that the spatial association of benign lesions with melanoma may be co-incidental was also investigated.Methods: The study subjects representing 289 cases of cutaneous melanoma of maximum thickness 1.00 mm (or less) were examined histologically for the presence of an associated benign melanocytic lesion(s), including lentiginous melanocytic proliferation; junctional, compound, or intradermal nevus; dysplastic nevus; and congenital nevus contiguous with or adjacent to the melanoma. The effects of age, tumor thickness, level of invasion, histologic type, and anatomic site on the association of benign melanocytic lesions with melanoma were assessed. In the control subjects 40 basal cell carcinomas and 38 compound nevi (not dysplastic) randomly chosen and matched for age (±1 year) and site (head/neck, trunk, upper and lower limbs) with a melanoma case were examined to assess the proportion of these cases associated with benign lesions compared with the matched melanoma cases.Results: A nevus was associated with melanoma in 51% of cases (n = 147). Of these, 82 (56%) were dysplastic nevi, 61 (41%) were common acquired nevi, and 4 (3%) were congenital nevi. Lentiginous melanocytic proliferation was present in the epidermis adjacent to 219 melanomas (75%) and in 44% of these cases (n = 97) a coexisting nevus was also present.Conclusion: The results of this study lend further support to the concept of common acquired nevi and dysplastic nevi as precursors of cutaneous melanoma. In addition, lesions diagnosed clinically as simple lentigo and solar lentigo may be important as potential precursors of melanoma, particularly in the elderly.     

Transepidermal elimination of nevus cells. A possible mechanism of nevus involution

Nevus cell nests were seen histologically within the upper levels of the epidermis in biopsy specimens obtained from three patients with clinically banal-appearing nevi. Although the presence of melanocytes arranged as solitary units or grouped in nests in the upper layers of the epidermis is one histopathologic feature of malignant melanoma, we believe this finding represents transepidermal elimination of nevus cells and may be one mechanism of nevus involution.     

Developmental aspects of nevus spilus: review of the literature apropos of 7 cases

The nevus on nevus is a dischromic lesion with a double component made of a pigmented, pale-brown coloured spot, most often congenital punctuated by macular or discretely papular darker elements, with a usually later setting-up and conventionally characterized by an absence of evolutivity. A series of seven cases is reported of whom three present a very peculiar evolution: A 37 years old man is taking a medical advice for a nevus on a congenital nevus on the right buttock on which appeared later on a blue-coloured, lightly sensitive nodule which clinically calls to mind the diagnosis of a blue nevus: the surgical exeresis is refused by the patient. A little girl, born in 1972, has since her birth a nevus on nevus of her right fore-arm; in 1975 and 1976 appeared successively on this lesion three nodules evocative of Spitz melanoma (fig. 4), which are surgically removed; histologic examination confirms the clinical diagnosis (fig. 5). A woman, aged 38, presents a big nevus on congenital zosteriform nevus of the right lower limb; since 1982, one of the dark elements situated on the lower third of the leg is progressively spreading and becoming polychromic (fig. 6); the clinical suspicious of superficial spreading malignant melanoma is confirmed by the histologic examination. In the literature, the terminology aiming to call this kind of nevic pale brown spot recovered by darker macules is not quite clear, as it was already emphasized by Stewart in 1978 (27). Indeed, numerous different denomination are found in it: "nevus spilus", nevus on nevus", "spotty nevus" "speckled lentiginous nevus", "speckled nevus "spilus".(ABSTRACT TRUNCATED AT 250 WORDS)     

Prepubertal Melanoma Arising within a Medium‐Sized Congenital Melanocytic Nevus

We report the case of an 8‐year‐old child who developed a 9.4‐mm‐deep melanoma within a medium‐sized congenital melanocytic nevus on the scalp. Genetic analysis revealed an activating NRAS Q61R mutation within the melanoma, which is more commonly associated with large or giant congenital melanocytic nevi. This case demonstrates that even a “low‐risk” congenital melanocytic nevus at a “low‐risk” age must be monitored regularly for the development of malignancy.     

Fatal malignant melanoma in a child with neurofibromatosis type 1

Neurofibromatosis type 1 is an autosomal dominant disease and is considered one of the most commonly inherited diseases in humans. Malignant melanoma has been reported in up to 5% of patients with neurofibromatosis type 1. We report a young Saudi boy with neurofibromatosis type 1 who developed fatal metastatic malignant melanoma arising from giant melanocytic nevi within speckled lentiginous nevus (SLN).     

The ultrastructure of congenital nevocytic nevi

Summary As only few previous investigations considered size-dependent differences in the histology of congenital nevocytic nevi (CNN) or focused on their ultrastructure, a light- and electron-microscopic study of six giant and six medium-sized CNN was performed. Histologically, giant CNN showed minimal junctional nevus elements and a pandermal, diffuse nevus cell extension including the subcutaneous tissue, while medium-sized CNN exhibited more abundant junctional nests and a rather focal pattern of nevus cell extension into the reticular dermis. Ultrastructurally, giant CNN often showed nevus cells with irregular and indented nuclei and also nevus cells with highly complicated dendrites. Nuclear inclusions, multiple cilia and centrioles, and collagen phagocytosis in nevus cells were found in both groups of CNN. Direct contacts between nevus cells and nerve fibers were observed in mediumsized CNN only. The findings provided no clear morphological indication why giant CNN have a higher risk for malignant degeneration than medium-sized CNN or acquired nevocytic nevi (ANN). On the other hand, the histological differences speak in favor of a different ontogenesis of the various size classes of CNN and ANN.     

Agminated Spitz Nevi Arising on a Nevus Spilus after Chemotherapy

Abstract: Agminated Spitz nevus arising on a background of nevus spilus (NS) is a rare condition. We report here a further case in a child that is original because it is induced by chemotherapy. A 3‐year‐old boy presented 3 months after the onset of a chemotherapy for a vesico‐prostatic rhabdomyosarcoma, multiple pigmented papulo‐nodules located on the face, neck, chest wall, and the higher back. These lesions have arose on a pre‐existent large congenital histologically confirmed nevus spilus extending along the face, neck, the left shoulder and the left chest wall. Histological examination of three excised nodules led to the diagnosis of Spitz nevus. Our patient may have a high risk for melanoma since he has many criteria predisposing to this risk. Some of these criteria are related to NS but we should also take into account the chemotherapy induction and the high number of Spitz nevi.     

Giant congenital melanocytic nevus

Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated in <1:20,000 newborns. Despite its rarity, this lesion is important because it may associate with severe complications such as malignant melanoma, affect the central nervous system (neurocutaneous melanosis), and have major psychosocial impact on the patient and his family due to its unsightly appearance. Giant congenital melanocytic nevus generally presents as a brown lesion, with flat or mammilated surface, well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily a clinical diagnosis. However, congenital nevi are histologically distinguished from acquired nevi mainly by their larger size, the spread of the nevus cells to the deep layers of the skin and by their more varied architecture and morphology. Although giant congenital melanocytic nevus is recognized as a risk factor for the development of melanoma, the precise magnitude of this risk is still controversial. The estimated lifetime risk of developing melanoma varies from 5 to 10%. On account of these uncertainties and the size of the lesions, the management of giant congenital melanocytic nevus needs individualization. Treatment may include surgical and non-surgical procedures, psychological intervention and/or clinical follow-up, with special attention to changes in color, texture or on the surface of the lesion. The only absolute indication for surgery in giant congenital melanocytic nevus is the development of a malignant neoplasm on the lesion.