Asymptomatic Irregular Pigmented Lesions of the Vulva

A 65 year old retired construction worker was urgently referred by his general practitioner to the dermatology clinic. He had noticed that a darkly pigmented painless lesion on his back,...

The patient showed a dark and irregular lesion in an area of chronically sun exposed skin (Fig. 18.1). He had no previous treatment. A biopsy was performed.

Breast desmoid-type fibromatosis (BDF) is a rare, benign, but locally aggressive tumor that mimics breast carcinoma. Management has shifted toward conservative strategies, including active surveillance, especially for asymptomatic or indolent lesions. A 29-year-old woman presented with a 2 cm firm, immobile mass in the left inframammary fold. Ultrasound and magnetic resonance imaging (MRI) revealed an irregular hypoechoic lesion. Core needle biopsy showed spindle cell proliferation. Wide local excision confirmed desmoid-type fibromatosis, with nuclear β-catenin and SMA positivity, CD34 and S-100 negativity, and Ki-67 <5%. The superior margin was positive, while other margins were clear. Considering the low proliferative index and absence of aggressive features, the patient was managed with active surveillance and regular clinical and radiological follow-up. BDF can be safely monitored in selected patients, even with positive margins, avoiding unnecessary surgery while ensuring close follow-up for progression.

Myxomas are rare mesenchymal tumors that can appear in many anatomical locations, although they are mainly seen in heart and skin. To date, only twelve cases of pure renal myxomas have been reported in the literature. We describe a case of a young Cuban woman with an asymptomatic irregular cyst lesion in her left kidney which was eventually diagnosed as renal myxoma. We also provide radiological and pathological studies.

A 62 year old Chinese woman presented with a painless pigmented lesion on the right nipple-areola complex (NAC). The lesion began as a small asymptomatic black spot on the base...

New techniques are being explored for improving diagnostic accuracy of pigmented skin lesions. Confocal scanning laser microscopy (CSLM) may represent such a novel technique. The purpose of this report was to demonstrate the potential application of CSLM as an aid in the diagnosis of a pigmented skin lesion that is clinically suspicious for melanoma. An irregular pigmented lesion was examined clinically and dermoscopically. The lesion was imaged by CSLM and subsequently excised for histologic examination. Findings from CSLM were correlated with features observed on the dermoscopic and histologic examination. Confocal scanning laser microscopy (CSLM) allowed for the non-invasive visualization of the histologic features of superficial pigmented BCC, including buds and "islands" of tumor cells at the dermoepidermal junction and melanin-laden macrophages. Conventional histology confirmed the diagnosis of pigmented BCC. Confocal scanning laser microscopy (CSLM) may serve as an aid in the non-invasive diagnosis of pigmented skin lesions clinically suspicious for melanoma.

Morsicatio buccarum and labiorum are conditions generally caused by chronic habitual cheek and lip biting. Objective findings present thick, shaggy, irregular white lesions on the buccal and labial mucosa. Morsicatio is frequently associated with psychological conditions. This case report aims to assess the depression, anxiety, and stress levels in a patient with morsicatio buccarum and labiorum. A 22-year-old male patient visited the Integrated Polyclinic of Universitas Jenderal Achmad Yani Dental Hospital to check his oral status. Clinical examination revealed incidental findings. Extraoral examination showed clicking on both temporomandibular joint (TMJ) and lip desquamation sides. Intraoral mucosa examination revealed white lesions in the form of unsweepable plaque, irregular, slightly elevated from surrounding tissue, and interspersed with erythematous erosion areas on the buccal and labial mucosa. A pigmented lesion was found on the anterior attached gingiva mucosa on both the upper and lower jaws. The patient admitted to chronic habitual cheek biting since childhood. The Depression, Anxiety, and Stress-21 (DASS-21) assessment showed anxiety reaching a severe level. A psychological approach is needed as part of the treatment planning in morsicatio cases.

A pigmented lesion on a brain-dead organ donor: Should the dermatologist intervene before transplant?

Skin melanoma is very rarely found in the genital region. Additionally, out of all penile skin malignancies, melanoma is one of the rarest, with no cases reported before in the Balkan region. A 68-year-old male presented with atypical and irregular pigmented skin lesions on his left flank and penile shaft. After dermoscopy and radiological work-up, both lesions were completely excised, with pathological examination revealing a high-grade dysplastic nevus with nodular melanoma in the penile location. Wide re-excision was performed one month later, followed by skin reconstruction with a rotation cutaneous flap. No postoperative complications, long-term recurrence signs, nor local or distant metastases were observed. As a very rare case of this kind of condition in the Balkan region and globally, this is the first case of penile skin melanoma described in Serbia, additionally emphasizing the importance of thorough systematic clinical examination and conducting organ-preserving surgery.

RPE hamartomas are rare, presumed congenital proliferations of the RPE (isolated) or both the RPE and neuroretina (combined), without malignant potential. Isolated hamartomas are well delineated, small, pigmented and asymptomatic lesions, most often in the macular region and not requiring any treatment. Combined hamartomas are unilateral malformations consisting of a densification of the RPE and vascularized gliosis of the overlying neuroretina. Its location at the posterior pole is correlated with varying degrees of visual impairment, for which epiretinal membrane peeling remains controversial. Treatment is occasionally required in case of complications such as neovascular membrane, vitreous haemorrhage, retinal detachment or macular hole. Being benign, it is crucial that RPE hamartomas are differentiated from other pigmented lesions, and most importantly choroidal melanoma, to avoid unnecessary radiotherapy or even enucleation in the –usually young‐ patients that present them.

<table border="0" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="456"><p>Introduction: Pigmented lesions of the oral mucosa are numerous and are caused by abnormal collection of melanin or endogenous and exogenous pigments. There are two categories of pigmented lesions: melanocytic and nonmelanocytic lesions. Melanocytic lesions include oral melanotic macules, drug-induced pigmentations (minocycline, antimalarials, some chemotherapeutic agents, oral contraceptives…), smoker's melanosis, oral melanoacanthoma, melanocytic nevi and melanoma. Nonmelanocytic pigmentation includes amalgam tattoos, a common material used for dental restorations. Differential diagnosis requires a careful medical and medication history and a complete head and neck physical examination. In some cases, biopsies can be taken and imaging studies are also helpful.</p><p>Methods: We report a 53-year-old male patient with a smoking history. The patient was referred to our service by his dentist with a history of an asymptomatic lesion on the tongue. Intraoral examination showed a brown, well-circumscribed macule on the right hemi-tongue ventral surface and an indurated 20 x 5 mm lesion. The rest of the physical examination was normal. Magnetic resonance imaging (MRI) showed no significant findings. Anatomopathological study was performed and confirmed the diagnosis of oral melanotic macule.</p><p>Conclusion: Melanocytic lesions of the oral mucosa are numerous and range from benign conditions to malignant ones such as melanoma. Differential diagnosis is particularly important and requires a careful medical history, complete head and neck physical examination and anatomopathological study.</p><p> </p></td></tr><tr><td valign="top" width="456"><p> </p></td></tr><tr><td valign="top" width="456"><p>Keywords: oral melanotic macules, smoker's melanosis, oral melanoacanthoma, melanocytic nevi, melanoma.</p><p> </p></td></tr></tbody></table>

Oral malignant melanoma (OMM) represents an exceptionally rare neoplasm of the oral cavity, ccounting for <1%of all melanomas. It frequently appears as an asymptomatic pigmented lesion, which poses a diagnostic challenge. This report emphasizes a case of OMM in a young male patient; however, the rarity of this condition omplicates recognition and treatment. Although such cases are uncommon, they require careful consideration because early diagnosis can significantly affect outcomes. A 30-year-old male presented with dark pigmentation in the upper left jaw area for 3 months. Clinical examination revealed a nodular, brownish-black pigmented lesion that extended from the medial aspect of 25 to the distal aspect of 26, involving both the buccal and lingual gingiva. The histopathological report confirmed the diagnosis of malignant melanoma. This case underscores the significance of early recognition and histopathological assessment of pigmented oral lesions. Timely diagnosis is crucial for improving outcomes in such aggressive malignancies; however, many may overlook these signs because they can be subtle. Although the prognosis may vary, early intervention can positively impact the treatment trajectory.

A 30-year-old man, forestry worker, with no medical history, presented acutely with pruritic erythematous streaks and bullae (figure 1) in linear configuration on his arms. On the previous day he...

A case of a patient with an irregular pigmented lesion of the lower eyelid margin simulating malignant tumor, which was treated based on the results of impression cytology and diagnosed by histopathological study is presented. The importance of cytological technique is emphasized as an effective and safe method that avoids unnecessary and extensive procedures.

Pagetoid dyskeratosis (PD), which is found in more than 2% of skin biopsy specimens, is accepted as a histopathological finding reflecting the abnormal keratinization process. However, to date, only a limited number of cases have been described to have brown pigmentation on the hands, triggered by friction, and present with pagetoid dyskeratosis as the only sign on histopathology and a parallel ridge pattern on dermoscopy. To present and discuss the typical clinical, histopathological, and dermoscopic features of pagetoid dyskeratosis, and to draw attention to the spontaneous resolution following biopsy. We present a case of pagetoid dyskeratosis with a palmar localization, which rapidly resolved following biopsy, in a patient with no history of friction. PD is the only important histopathological finding in typical irregular pigmented lesions located in the hand. PD should also be considered in the differential diagnosis of lesions that show parallel ridge pattern on the hand. Two weeks after the biopsy, disappearance of the lesion may be due to the effect of inflammatory response revealed by biopsy. Although the cause of this condition is not yet fully understood, most cases being associated with friction or rapid spontaneous resolution following biopsy, as in the current case, may indicate the reactive nature of the lesion. Further researches are required to be clarify etiology of PD.