Lateral Cutaneous Nerve Research Articles

Cutaneous Nerve Transection for the Management of Intractable Upper Extremity Pain Caused By Invasive Squamous Cell Carcinoma

A recurrent clinical dilemma in the management of patients with painful metastatic lesions is achieving a balance between effective analgesic therapies versus intolerable side effects, in particular altered mental status. We present the case of an immunosuppressed patient post-lung transplant who was suffering from intractable pain caused by widely metastatic squamous cell carcinoma. The patient's progressive, excruciating neuropathic pain was localized to the area of the left wrist and forearm. Additionally, the patient complained of moderate pain at sites of tumor involvement on her right arm and scalp. Attempts to adequately manage her left upper extremity pain included a combination of pharmacologic treatments intended to treat neuropathic pain (gabapentin, SNRI, ketamine, opioids) and focused regional analgesia (infraclavicular infusion of local anesthetic). However, the patient developed intolerable side effects including altered mental status and delirium associated with the systemic agents and suboptimal control with the infraclavicular infusion. Given that the most severe pain was well localized, we undertook a diagnostic block of the cutaneous nerves of the left forearm. As this intervention significantly reduced her pain, we subsequently performed neurectomies to the left superficial radial nerve, lateral cutaneous nerve of the forearm and the posterior cutaneous nerve of the forearm. This resulted in immediate and continued relief of her left upper extremity pain without an altered mental status. Residual focal pain from lesions over her right arm and scalp was successfully managed with daily topical applications of lidocaine and capsaicin cream. Successful pain control continued until the patient's death five months later.

Sensibility following Innervated Free Radial Forearm Flap for Penile Reconstruction

The free radial forearm flap has proven to be reliable for penile reconstruction. The purpose of this study was to determine whether neurotization of this flap improved sensation of the reconstructed penis. A long-term follow-up study of 45 patients undergoing penile reconstruction using free radial forearm flap was performed; 28 of the 45 patients received an innervated flap, and 17 received a noninnervated flap. A nerve repair between the dorsal nerve of the penis and the lateral antebrachial cutaneous nerve was performed for innervation. Sensory testing, including pain perception, temperature perception, vibratory threshold, and static two-point discrimination, was performed by one blinded examiner in a standardized pattern. Mean follow-up time was 9.1 years. Mean patient age was 26.4 years (range, 18 to 48 years). Postoperative pain perception and vibratory threshold were similar between the two groups in the proximal part of the neophallus but were significantly better in the innervated flaps (p < 0.01) in the distal part. Noninnervated flaps displayed a pattern of increasing sensibility from the distal part toward the proximal part, whereas innervated flaps regained sensation throughout. The innervated group had a better result of temperature perception and static two-point discrimination in both the proximal and the distal parts. Innervation of free radial forearm flap provides improved sensation to the reconstructed penis. If it is possible to find the functional recipient nerve, innervation should always be conducted.

Musculocutaneous nerve substituting for the distal part of radial nerve: A case report and its embryological basis

In the present case, we have reported a unilateral variation of the radial and musculocutaneous nerves on the left side in a 64-year-old male cadaver. The radial nerve supplied all the heads of the triceps brachii muscle and gave cutaneous branches such as lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of forearm. The radial nerve ended without continuing further. The musculocutaneous nerve supplied the brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis muscles. The musculocutaneous nerve divided terminally into two branches, superficial and deep. The deep branch of musculocutaneous nerve corresponded to usual deep branch of the radial nerve while the superficial branch of musculocutaneous nerve corresponded to usual superficial branch of the radial nerve. The dissection was continued to expose the entire brachial plexus from its origin and it was found to be normal. The structures on the right upper limb were found to be normal. Surgeons should keep such variations in mind while performing the surgeries of the upper limb.

Combined paravertebral plexus block and parasacral sciatic block in healthy dogs

ObjectiveTo evaluate the effectiveness of paravertebral lumbar plexus block combined with parasacral sciatic block to anesthetize one hind limb in awake dogs. Study designRandomized, controlled, blinded experimental study. AnimalsEight healthy mongrel dogs weighing 12.4 ± 4.5 kg and aged 7 ± 2.33 years. MethodsAfter sedation with medetomidine, dogs received B1: bupivacaine 0.25%, 0.2 mL kg−1, B2: bupivacaine 0.5%, 0.2 mL kg−1, B3: bupivacaine 0.25% 0.4 mL kg−1, P1: NaCl 0.2 mL kg−1, P2: NaCl 0.4 mL kg−1. The lumbosacral plexus was blocked through a paravertebral block of the fourth, fifth and sixth lumbar nerves combined with a parasacral block. The relevant nerves were located using a nerve stimulator and injections of each treatment were administered. Degree and durations of sensory blockade were determined through the response to a Halsted clamp pressure on the skin innervated by the saphenous/femoral and lateral cutaneous femoral nerves (lumbar dermatomes) and by the peroneal and tibial nerves. The degree and duration of motor blockade was assessed evaluating the ability to walk normally and proprioception. ResultsP1 and P2 treatments did not show any grade of sensory or motor blockade. The B2 treatment produced a higher degree of sensory blockade compared to B1 and B3 for both lumbar and sciatic dermatomes. There was no significant difference in the degree of sensory blockade comparing B1 to B3. The B2 treatment had greater motor blockade compared to B1 and B3. The duration of sensory and motor blockade was longer in B2 compared to B1 and B3. Conclusion and clinical relevanceWhen the nerve stimulator is used to perform the lumbosacral plexus block, the concentration of the bupivacaine has a more important role than the volume to produce a more solid and longer block.

Assessment of arthroscopic management of femoroacetabular impingement. A prospective multicenter study

Surgical treatment of femoroacetabular impingement can be performed under arthroscopic control, to limit associated morbidity. Encouraged by recent good reports, arthroscopy is replacing alternative techniques for this indication. Arthroscopy enables femoroacetabular impingement to be corrected with a low rate of associated morbidity. To assess the indications for and quality of the technique and its impact on preliminary results and complications. To investigate preoperative prognostic factors. One hundred and eleven hips in 110 patients (78 male, 32 female; mean age, 31 years) were operated on under arthroscopic control for femoroacetabular impingement, by six senior surgeons. Sixty-five patients showed no radiographic sign of osteoarthritis, and 36 showed grade-1 early osteoarthritis on the Tönnis scale. Mean WOMAC score rose from 60.3 preoperatively to 83 (p<0.001) at a mean 10 months' FU (range, 6-18 mo). Seventy-seven percent of patients were satisfied or very satisfied with their result. Patients with early osteoarthritis had significantly lower WOMAC and satisfaction scores than those free of osteoarthritis. Operative crossover to open surgery occurred in only one case. Five patients (4%) had revision: total hip replacement or resurfacing. There were seven complications (6%): three cases of heterotopic ossification, one of crural palsy, one of pudendal palsy, one of labium majus necrosis, and one non-displacement stress fracture of the femoral head/neck junction (managed by non-weight-bearing). There was no palsy of the territory of the lateral cutaneous nerve of the thigh. Results confirmed the efficacy and low associated morbidity of arthroscopy in the management of femoroacetabular impingement. Short-term functional results matched those of the literature. Planning and assessment seem not yet to be fully standardized. Preoperative osteoarthritis on X-ray was associated with poorer functional results. This attitude does not seem to be indicated for hips showing evolved osteoarthritis (>grade 1).

Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein

The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve supplying the lateral aspect of forearm. Because of its close proximity to the biceps brachii tendon (BBT), the lateral epicondyle (LE), and the cephalic vein (CV), surgery and venipuncture in the cubital fossa can injure the LACN. Measurement data regarding the relative anatomy of LACN are scarce. We, therefore, dissected 96 upper extremities from 26 males and 22 females to expose the LACN in the cubital fossa and forearm. The LACN consistently emerged from the lateral margin of BBT. It then pierced the deep fascia distal to the interepicondylar line (IEL) in 84.4% with mean distances of 1.8 ± 1.1 and 1.2 ± 0.9 cm (male and female, respectively). At the level of IEL, the LACN in all cases was medial to the LE (5.9 ± 1.1 cm male and 5.2 ± 0.9 cm female). Two types of branching were observed: single trunk (78.1%) and bifurcation (21.9%). Asymmetry in the branching pattern was observed in 6 males and 1 female. Concerning the relationship to the CV, the LACN ran medially within 1 cm at the level of IEL in 78.7%. Moreover, in 10 specimens, the LACN was directly beneath the CV. In the forearm, the LACN tends to course medial to the CV. Significant differences in the measurement data between genders but not sides were found in some parameters. These data are important for avoiding LACN injury and locating the LACN during relevant medical procedures.

US imaging of the musculocutaneous nerve

To describe the potential value of high-resolution sonography for evaluation of the musculocutaneous nerve (MCN). The normal anatomy of the MCN was evaluated on three cadaveric limbs and correlated with the US images obtained in 15 healthy subjects. Seven consecutive patients with MCN neuropathy were then evaluated with sonography using 17.5 and 12.5-MHz broadband linear array transducers. All patients had abnormal nerve conduction studies and underwent correlative MR imaging on a 1.5-T system. One-to-one comparison between cadaveric specimens and sonographic images showed that the MCN can be reliably identified from the axilla through the elbow, including the lateral antebrachial cutaneous (LAbC) nerve. In the patients group with MCN neuropathy, sonography allowed detection of a wide spectrum of abnormalities. In 5/7 cases, a spindle neuroma was depicted in continuity with the nerve. In one case, US identified focal swelling of the nerve and in another case US was negative. The neuroma was hyperintense on T2-weighted sequences in 75% of cases. In one patient, the nerve showed Gd-enhancement on fat-suppressed T1-weighted sequences. The nerve was never detected on unenhanced T1-scans. Owing to its small-size and out-of-plane course, the MCN may be more reliably depicted with sonography rather than with MR imaging. US is promising for evaluating traumatic injuries of the MCN. By providing unique information on the entire course of the nerve, US can be used as a valuable complement of clinical and electrophysiologic findings.

La neuropraxie de l’aide-opératoire ? Un cas inhabituel de lésion du nerf cutané latéral de l’avant-bras

Summary Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow exension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficent for sensory recovery to be clinically detectable after 12 weeks.

Microanatomical and immunohistochemical study of the human lateral antebrachial cutaneous nerve of forearm at the antecubital fossa and its clinical implications

Changes in the intraneural anatomy with age can cause poor prognosis of nerve repair in patients after nerve injury. The occurrence of Complex Regional Pain Syndrome-Type II, secondary to peripheral nerve injury, is common. The purpose of this study is to asses changes in cross-sectional anatomy of the lateral antebrachial cutaneous nerve of forearm (LCNF) at the antecubital fossa in the fascicular, nonfascicular components (adipose and nonadipose tissue), and sympathetic fibers area with respect to age. For the purpose of the study, 32 human (37-88 years) fresh cadaveric LCNF were collected from left-antecubital fossae and processed for histological, morphometric analysis [total cross-sectional (Asc), fascicular (Af), and nonfascicular area (Anonf)], and immunohistochemical method (tyrosine hydroxylase) for sympathetic fibers. The LCNF's average total cross-sectional area was 3.024 mm(2), and fascicular area was 0.582 mm(2). The average number of fascicles per mm(2) was 3.09. The cross-sectional area in the nerve was mainly occupied by nonfascicular connective tissue (80.75%). There was increased adipose tissue deposition (48.48% of Asc) and decreased collagen fibers (32.24% of Asc) in interfascicular domains without any definite relationship with age. The average sympathetic fiber area was 0.026 mm(2) within the nerve fascicular area without any correlation with age. In LCNF, there was more adipose tissue and less collagen fibers deposition in the interfascicular domains of all age cases, and this may act as an obstacle for nerve fiber regeneration on using LCNF as an interpositional nerve graft.

Role of Minimal Distal Nerve Injury in Complex Regional Pain Syndrome-I

The potential for a role for nerve injury in complex regional pain syndrome (CRPS)-I is implicit in the 1994 IASP diagnostic criteria for CRPS [1]. These unite the syndrome formerly known as reflex sympathetic dystrophy with the syndrome formerly known as causalgia, in acknowledgment of the fact that their clinical presentation (phenotype) and their response to treatment are the same. Although nerve injury is a required part of the definition of CRPS-II, and lack of known nerve injury is part of the definition of CRPS-I, naming and categorizing them together acknowledges the possibility that CRPS-I patients might have occult nerve injuries. There are plausible reasons why nerve injuries might remain undiagnosed in CRPS-I patients. Few of the physicians who care for CRPS patients have specialty training in peripheral nerve, and most neuromuscular specialists do not see CRPS-I patients. Another reason is that many patients with severe allodynia are reluctant to permit detailed neurological examination, much less electromyography and nerve conduction study. Additionally, partial nerve injuries can be sufficient to cause chronic pain without causing the focal losses of neurological function that are used to localize nerve injuries upon examination. However, most importantly, the classical signs of nerve injury gleaned from neurological examination, and the standard test for nerve injury, electromyography, and nerve conduction studies, are insensitive to injuries to the type of axons characteristically injured in CRPS. The possibility of occult nerve injuries in complex regional pain syndrome (CRPS)-I has been evident to peripheral nerve specialists. A number of CRPS-I patients report inciting injuries that are well known to injury sensory nerves. For instance, phlebotomy at the antecubital fossa is an established cause of injury to the medial or lateral cutaneous nerves of the forearm that wind around the basilic and cephalic veins [2], and arthroscopy of the …

The Radial Artery Superficial Palmar Branch Flap: A Modified Free Thenar Flap with Constant Innervation

The free thenar flap is useful for coverage of volar finger defects but has an inconstant innervation based on the presence of either the lateral antebrachial cutaneous nerve (LABC) or the superficial sensory branch of the radial nerve (SSRN). A detailed anatomic study on 30 adult fresh frozen cadavers preinjected with silicone rubber compound to demarcate arterial anatomy documented locations, numbers, and diameters of arteries and skin perforators with surrounding nerves. The palmar cutaneous branch of the median nerve (PCMN) was present within the flap in all cases. However, the LABC and the SSRN were available in only 43.33% and 46.66%, respectively, with neither of them in 33.33% of the cases. The constantly present PCMN allowed the design of a new flap named the radial artery superficial palmar branch (RASP) flap. The RASP flap is large enough to cover volar finger defects and contain direct skin perforators. Because it is constantly innervated, it is an excellent option for coverage of volar finger defects extending to the fingertips.

Treatment of soft tissue defects at the dorsum of hand by retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve

To report the therapeutic effect of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve for the treatment of soft tissue defect at the dorsum of hand. 11 cases with soft tissue defects at the dorsum of hands were treated. The size of soft tissue defects ranged from 3.0 cm x 2.5 cm to 6.5 cm x 4.0 cm. The size of the flaps ranged from 3.5 cm x 3. 0 cm to 7. 0 cm x 4. 0 cm. All the 11 flaps survived. The follow-up period was 2 months to 2 years. The texture and elasticity of the flaps were good. The appearance and function of the hands were satisfactory. The superficial sense was recovered. The wounds at the donor site of forearms were closed primarily in 7 cases, or covered by split-thickness skin grafts in other 4 cases. The appearance of the donor site was satisfactory too. The retrograde island neurovascular flap pedicled with lateral antebrachial cutaneous nerve is an optimal method for soft tissue defects at the dorsum of hand.

Surgical Treatment of Partial Distal Biceps Tendon Ruptures

To demonstrate that surgical repair of partial distal biceps tendon ruptures allows return of supination and flexion strength nearly equal to the contralateral side without compromising range of motion. We performed a retrospective study of 17 patients with unilateral partial biceps tendon ruptures who underwent surgical repair between 2003 and 2009, and who returned for further evaluation and strength testing. The follow-up examination included questionnaires, x-rays, strength testing, and range of motion with comparison to the opposite side. We used the Baltimore Therapeutic Equipment work simulator to objectively test isometric and dynamic elbow flexion and forearm supination strength of both extremities. A total of 17 patients returned for additional testing, 14 of whom had failed nonsurgical treatment. One patient had asymptomatic heterotopic ossification. Two patients reported mild lateral antebrachial cutaneous nerve dysesthesias. There was one partial re-rupture 4 years after the original surgery. The second repair consisted of suture anchor fixation; 15 months after re-repair, the patient remains asymptomatic. Average postoperative Disabilities of the Arm, Shoulder, and Hand score was 9 (range, 0-33). One patient had limited pronation (50 degrees degrees). The average isometric and dynamic elbow flexion was 3% and 11% stronger, respectively, compared with the opposite side. Average isometric supination was 6% and average dynamic supination was 10% weaker. After surgical treatment of partial distal biceps tendon tears, most patients achieved good return of strength with full motion. Surgical treatment of partial distal biceps tendon tears is a viable option after failed nonsurgical treatment. Therapeutic IV.

Sensory Restoration by Lateral Antebrachial Cutaneous to Ulnar Nerve Transfer in Children with Global Brachial Plexus Injuries

Selective peripheral nerve transfers represent an emerging reconstructive strategy in the management of both pediatric and adult brachial plexus and peripheral nerve injuries. Transfer of the lateral antebrachial cutaneous nerve of the forearm into the distal ulnar nerve is a useful means to restore sensibility to the ulnar side of the hand when indicated. This technique is particularly valuable in the management of global brachial plexus birth injuries in children for which its application has not been previously reported. Four children ages 4 to 9years who sustained brachial plexus birth injury with persistent absent sensibility on the unlar aspect of the hand underwent transfer of the lateral antebrachial cutaneous nerve to the distal ulnar nerve. In three patients, a direct transfer with a distal end-to-side repair through a deep longitudinal neurotomy was performed. In a single patient, an interposition nerve graft was required. Restoration of sensibility was evaluated by the "wrinkle test."

The Lateral Cutaneous Nerve of the Calf Revisited

PM&RVolume 2, Issue 6 p. 579-580 In Brief The Lateral Cutaneous Nerve of the Calf Revisited David S. Schneider DO, Corresponding Author David S. Schneider DO [email protected] Lake Cook Orthopedic Associates, 27401 West Highway #22, Barrington, IL 60010Disclosure: nothing to discloseAddress correspondence to D.S.S.Search for more papers by this authorSushma Reddy MD, Sushma Reddy MD Marianjoy Rehabilitation Hospital, Wheaton, ILDisclosure: nothing to discloseSearch for more papers by this author David S. Schneider DO, Corresponding Author David S. Schneider DO [email protected] Lake Cook Orthopedic Associates, 27401 West Highway #22, Barrington, IL 60010Disclosure: nothing to discloseAddress correspondence to D.S.S.Search for more papers by this authorSushma Reddy MD, Sushma Reddy MD Marianjoy Rehabilitation Hospital, Wheaton, ILDisclosure: nothing to discloseSearch for more papers by this author First published: 17 June 2010 https://doi.org/10.1016/j.pmrj.2010.02.003Citations: 1 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume2, Issue6June 2010Pages 579-580 RelatedInformation

Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm

Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks.

Distal biceps tendon tears in women

Is the presentation and outcome of surgical treatment of distal biceps tendon tears different in women than men? From 1999 to 2008, 15 cases of distal biceps tendon tears in 13 female patients were treated surgically at a single institution. Mean age was 63 years (range, 48-79 years). A retrospective review evaluated patient presentation, diagnosis, and treatment. Postoperative outcomes were assessed by physical examination, a patient satisfaction survey, the American Shoulder and Elbow Surgeons (ASES) elbow assessment form, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Two-thirds of the tears were in the dominant arm, of which 7 resulted from a single injury, and 8 reported insidious onset of symptoms. All patients presented with pain in the antecubital fossa. A distinct cystic mass was palpable in 6. Of the 15 cases, 13 were partially detached, 1 was completely detached, and 1 was weakly attached. Fourteen regained full strength, and all had nearly complete range of motion. Mean follow-up was 46 months (range, 2-117 months). Eleven completed a postoperative patient satisfaction survey, ASES elbow, and DASH questionnaire. Mean scores were 95 (range, 58-100) for ASES and 7 (range, 0-43) for DASH. The only complication was a transient lateral antebrachial cutaneous nerve sensory palsy. Distal biceps tendon tears in women present at an advanced age with no history of an acute injury. They are frequently associated with a cystic mass and have a predominance of partial tears. Distal biceps tendon tears in women present differently than in men. The tears are rarely complete and they respond well to surgical repair.

Lateral cutaneous nerve of the thigh injury during gynaecological laparoscopic procedure

This is a case report of a woman who developed severe meralgia paraesthetica due to an injury to the lateral cutaneous nerve of the thigh. The injury occurred during a laparoscopy and adhesiolysis procedure as a result of the positioning of one of the secondary ports close to the inguinal ligament. Symptoms were reported immediately after the procedure with tingling and numbness of the upper lateral aspect of the right thigh. The symptoms persisted for more than 3 months and required strong regular analgesia. She continues to suffer significant neurological symptoms and is considering a nerve decompression procedure. The lateral cutaneous nerve of the thigh varies in its course in the abdominal wall. This is particularly variable while it crosses the inguinal ligament. Hence, any ports placed close to the inguinal ligament near to the anterior superior iliac spine may injure the nerve resulting in meralgia paraesthetica. Injury to the nerve has been reported in different types of procedures, e.g. laparoscopic inguinal hernia repair. We believe that it has not been reported previously after a gynaecological laparoscopic procedure. In this case report, we highlight the possibility of an injury to the lateral cutaneous nerve of the thigh during gynaecological laparoscopic procedures. We review the anatomy and the variations in the nerve’s course that could lead to its injury during minimal invasive gynaecological operations.

A comparative microanatomical study on cross sections of medial and lateral cutaneous nerves of forearm at the antecubital fossa: A cadaveric study

Background The anterior branch of the medial antebrachial cutaneous nerve of the forearm (AMACN) and the lateral antebrachial cutaneous nerve of the forearm (LACN) are used as potential donor grafts for repairing sensory nerves. A higher percentage of connective tissue plays an important role in predicting prognosis after nerve repair. The aim is to perform a comparative study on cross-sectional microanatomy and age related changes in non-fascicular components of the AMACN and LACN. Methods Thirty six fresh human (from both sides of 14 male and 4 female) cadaveric AMACN and LACN were collected at antecubital fossae and studied at different magnifications for morphometric analysis (total cross-sectional area (Asc), fascicular area (Af) and non-fascicular area (Anonf)), after histological (Masson's trichrome stain) processing. Results AMACN and LACN belong to polyfascicular type and showed differences in amount of connective and adipose tissues in non-fascicular areas. In the AMACN, there was less adipose tissue (19.38% in Asc and 25.57% in Anonf) with more collagen fibers (57.28% in Asc and 75.57% in Anonf) and in the LACN, there was more adipose tissue (47.51% in Asc and 58.19% in Anonf) with fewer collagen fibers (34.10% in Asc and 41.76% in Anonf) in interfascicular domains. Conclusions The amount of adipose tissue in LACN non-fascicular area was found to be high at all ages. The presence of less adipose tissue and collagen fibers in the non-fascicular area of the AMACN (below 60 years) could be used for successful nerve grafting when compared to LACN.

Malignant melanoma transformation within a nevus of Ito

The mongolian spot, nevus of Ota, and nevus of Ito are the most common morphologic forms of the dermal melanocytoses, a group of benign pigmented lesions histologically characterized by the presence of melanocytes within the dermis. Nevus of Ito is clinically distinct, presenting with unilateral, bluish gray, patchy discolorations in the skin within the distributions of the posterior supraclavicular and lateral cutaneous brachial nerves. Although all dermal melanocytoses are generally considered benign, rare cases of malignant transformation associated with nevus of Ota have been described. Only one case of malignant melanoma transformation in association with nevus of Ito has previously been reported. We present the second description of malignant melanoma transformation within a nevus of Ito and provide comment on the malignant potential of the dermal melanocytoses.