Melanoma in invisible naevus spilus

BACKGROUND: Diagnosis of naevus lesions may be complex where they contain little or no pigmentation. Naevus spilus (or naevus on naevus) is, generally, readily identified by the difference in pigmentation between overlying and underlying naevi and healthy skin. Malignant transformation of naevus spilus is rare. We report two cases of melanoma in which surgical procedures revealed underlying melanocyte lesions, diagnosed at histology but undetectable on clinical examination. PATIENTS AND METHODS: Two patients were operated for melanoma in which surgery, at a site remote from the melanoma, suggested incomplete relapse despite the fact that previous clinical examination had indicated healthy skin. A diagnosis was made of melanoma in invisible naevus spilus. DISCUSSION: Diagnosis of melanoma in invisible naevus spilus may be suspected where several naevi are found together in a specific area. The main problem is the therapeutic stance to be adopted since complete excision of the underlying naevi is difficult in practice. Wood's light examination may be helpful.     

Persistent congenital milia with naevus spilus

We are reporting a case of solitary persistent left-sided endoareolar congenital milia in association with no serious malformation or abnormality of any structure except the presence of naevus spilus, on the back of the ipsilateral forearm.     

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.     

Atypical naevus spilus: detection by in vivo confocal microscopy

Naevus spilus (NS) is a naevoid disorder characterized by hyperpigmented macules or papules scattered over a café‐au‐lait macule. Such café‐au‐lait macules are often present at birth, and the darker pigmented speckles of NS slowly increase in number and size over a period of several years. NS can therefore be difficult to evaluate clinically for the development of melanoma. In vivo confocal microscopy (IVCM) is a novel method that allows examination at cellular resolution of cutaneous lesions in vivo. IVCM has been shown to have twice the specificity of dermoscopy for the diagnosis of melanoma, with comparable sensitivity. It has been shown to be useful in the detection and grading of dysplastic naevi, which are recognized precursors of melanoma in some cases. In this report, we highlight that IVCM can also be used as a tool complementary to dermoscopy to identify areas of dynamic change in clinically and dermoscopically equivocal lesions. IVCM may thereby assist in the early detection of melanocytic atypia and melanoma arising in NS, in turn leading to excision of melanoma at an early stage, which is associated with a favourable outcome. We also outline some of the difficulties encountered in confocal microscopy and histology when differentiating melanoma from dysplastic naevi.     

Melanoma arising in a hairy nevus spilus

Cutaneous melanoma may develop de novo on normal skin or in contiguity with a potential melanocytic precursor. We report a 45-year-old man who presented with a recently developed nodule in a previously stable congenital nevus. Physical examination revealed a 10x18-cm lesion with speckled lentiginous pigmentation and terminal hairs on the lower back. A 2x2-cm suspicious nodule in the lesion was noted by the patient 2 months earlier. Histopathological evaluation of the nevus and the suspicious nodule revealed the characteristics of a melanocytic nevus and melanoma, respectively. It was interesting for the authors to observe terminal hairs in a lesion that was clinically 'speckled lentiginous' in appearance. This case report is a reminder that there may be great variation in the clinical appearance of nevus spilus, and thus dermatologists must be aware of these lesions as potential precursors of malignant melanoma.     

斑痣 2例

斑痣(nevus spilus)为一临床上相对少见的色素性皮肤病,临床上常误诊为咖啡斑、Becker痣等。现将我们最近见到的2例报道如下。例1,女,28岁。病史、体检及治疗等情况详见本期“彩色图谱”。例2,女,6岁。右腋下淡褐色斑6年,出生时即有,后随身体长大而增大,无自觉症状。曾在当地儿童医院就诊,诊断为“咖啡斑”,行颅脑CT检查,未见明显异常。家族中无类似疾病患者。各系统检查无异常。皮肤科情况：右腋下可见一4cm×7cm淡褐色斑,边界清楚,淡褐色斑上有多个大小不一的深褐色斑丘疹,最大的有10mm×10mm,略隆起于皮面(照片1)。根据…     

发生在斑痣上的Spitz痣5例

报告5例发生在斑痣上的Spitz痣,其中1例位于下肢,4例位于面部.5例患者临床均表现为在斑痣上出现的红色或褐色丘疹,组织病理检查均为Spitz痣.     

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。     

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.     

Melanoma specific protein: occurrence in the urine of patients with halo naevus and vitiligo

Melanoma specific protein is immunologically related to altered naevus cell cytoplasm. It is excreted by patients with malignant melanoma but in no other malignancy. The protein has been detected in patients with actively developing halo naevi but not when repigmentation is taking place. It also occurs in patients with very active vitiligo but in no other pigment condition we have studied. It is suggested that the protein is a marker of active destruction of naevus cells by immune mechanisms and that the release of toxic materials during this immune reaction may be responsible for the production of the halo phenomenon and for the areas of vitiligo that may be seen elsewhere on the skin.     

Two cases of late onset Ota's naevus

Ota's naevus is among the dermal melanocytoses that show a distinct pattern involving skin innervated by the trigeminal nerve. Most cases present at birth or manifest clinically in early childhood. Cases of acquired lesions in adult onset have been reported rarely. We present two cases of late onset Ota's naevus which were confirmed by skin biopsies. Both patients underwent Q-switched alexandrite laser treatment with a dose of 8.0 J/cm2 given four or five times at 6 weekly intervals and showed some improvement.