Multiple Pigmented Lesions Research Articles

Pigmented Lesions of the Oral Cavity.

Pigmented lesions are a common finding in the oral cavity. Oral pigmented lesions may range from solitary to multiple, pinpoint to diffuse, and have a variety of clinical implications. Nearly all solitary pigmented lesions require a biopsy to rule out mucosal melanoma. Oral mucosal melanoma has a grim prognosis and early discovery is of utmost importance. Multiple pigmented lesions in the oral cavity may indicate a systemic condition about which the patient may not be aware. The presentation and management of these various lesions is the focus of this article.

Differential diagnoses of solitary and multiple pigmented lesions of the oral mucosa: Evaluation of 905 specimens submitted to histopathological examination.

The aim was to analyze the frequency, clinical and demographic features of solitary and multiple/diffuse oral pigmented lesions submitted to histopathological examination, and to summarize the features that guide the clinical differential diagnosis. Clinical and demographic data were retrieved from biopsy records and descriptive statistics were performed. Nine hundred and five (0.51%) oral pigmented lesions were retrieved among 177 356 specimens, being 95.9% solitary and 4.1% multiple/diffuse lesions. Regardless the overlapping clinical presentation, age, site, association with amalgam restoration, and a nodular appearance may help in the clinical differential diagnosis of solitary oral pigmentations. Patient's habits, site, and systemic signs and symptoms are helpful in the clinical differential diagnosis of multiple/diffuse lesions. Oral pigmented lesions are a rare diagnosis in oral pathology and solitary lesions are more commonly submitted to biopsy. Some key features help in the differential diagnosis, though biopsy can be warranted in doubtful cases.

PRIMARY ORAL MELANOMA: A CASE REPORT WITH IMMUNOHISTOCHEMICAL FINDINGS

Melanoma is a potentially aggressive and rare malign neoplasm of melanocytic origin. Only 1% occur in oral mucosa, and it is more aggressive compared with the cutaneous counterpart. The tumor occurs more frequently in the hard palate and gingiva. The aim of this study is to report a case of primary oral melanoma in a 70-year-old female patient. Multiple asymptomatic pigmented lesions were observed in the upper vestibular gingiva and hard palate. An incisional biopsy was performed. Microscopic findings revealed proliferation of pleomorphic epithelioid and plasmacytoid cells positive by immunohistochemistry for S-100 protein, HMB-45, Melan-A, and Ki-67 (80%) confirming the diagnostic of oral melanoma. The patient was forwarded to a head and neck surgeon service for treatment. This study showed the importance of histopathologic and immunohistochemical evaluation to determine the morphologic aspects of oral melanoma to establish the final diagnosis.

Multiple Pigmented Lesions of the Breast Following Ipsilateral Breast Carcinoma

Multiple Pigmented Lesions of the Breast Following Ipsilateral Breast Carcinoma

MULTIPLE ORAL MUCOSA PIGMENTATION: IMPORTANCE OF CLINICAL ASPECTS AND MEDICAL INVESTIGATION

Solitary and multiple macules of the oral mucosa are associated with various causes. These lesions may represent different pathologic entities, thus requiring different treatments and follow-up. We present 2 clinical cases of patients with multiple pigmentations on oral mucosa. Case 1: A 31-year-old woman exhibited brown hyperpigmentation macules less than 5 mm in diameter affecting buccal mucosa and tongue borders. Homogeneous hyperpigmentation stripes on nails were also identified. Based on these characteristics and the absence of gastrointestinal signs and symptoms, the diagnosis of Laugier-Hunziker syndrome was established. Case 2: A 68-year-old woman showed multiple pigmented lesions on the tongue. Clinical hypotheses were Peutz-Jeghers syndrome and Laugier-Hunziker syndrome. Medical investigation revealed chronic abdominal pain history, gastrointestinal bleeding, and previous surgery for excision of polyps. In addition, multiple pigmented skin lesions were detected except on the nails, leading to the final diagnosis of Peutz-Jeghers Syndrome. Both patients remain under follow-up. Solitary and multiple macules of the oral mucosa are associated with various causes. These lesions may represent different pathologic entities, thus requiring different treatments and follow-up. We present 2 clinical cases of patients with multiple pigmentations on oral mucosa. Case 1: A 31-year-old woman exhibited brown hyperpigmentation macules less than 5 mm in diameter affecting buccal mucosa and tongue borders. Homogeneous hyperpigmentation stripes on nails were also identified. Based on these characteristics and the absence of gastrointestinal signs and symptoms, the diagnosis of Laugier-Hunziker syndrome was established. Case 2: A 68-year-old woman showed multiple pigmented lesions on the tongue. Clinical hypotheses were Peutz-Jeghers syndrome and Laugier-Hunziker syndrome. Medical investigation revealed chronic abdominal pain history, gastrointestinal bleeding, and previous surgery for excision of polyps. In addition, multiple pigmented skin lesions were detected except on the nails, leading to the final diagnosis of Peutz-Jeghers Syndrome. Both patients remain under follow-up.

LEOPARD syndrome: a case report and literature review

A 36-year-old male presented to the dermatology department with multiple pigmented macular lesions on his skin present for most of his life. Multiple freckles were noted on non-light exposed areas, mainly on his trunk; light exposed areas such as his face were relatively spared. There were no

LEOPARD syndrome: a case report and literature review

A 36-year-old male presented to the dermatology department with multiple pigmented macular lesions on his skin present for most of his life. Multiple freckles were noted on non-light exposed areas, mainly on his trunk; light exposed areas such as his face were relatively spared. There were no

Syndrome du nævus éruptif de l’enfant à propos d’un cas

"Eruptive nevi" is a phenomenon characterized by a rapid appearance of multiple melanocytic nevi. It is mainly developed in three groups of patients: those with systemic immunosuppression, bullous cutaneous disorders, and a melanocytic stimulation drug. We report on the case of an 11-year-old boy who was diagnosed with acute lymphoblastic leukemia. A few months after the beginning of the chemotherapy, he developed multiple pigmented lesions over the skin. Eruptive nevi syndrome has been described in the literature in 29cases in the context of severe bullous disease and in immunosuppression. Nevi most often appear on the trunk and extremities, notably on the feet in the context of immunosuppression. They are localized in areas of bullous lesions in bullous diseases. Due to an increased melanocytic stimulation in eruptive nevi patients, long-term surveillance of individuals who have developed eruptive nevi is required, and increased sun prevention should be suggested.

Melasma-like hyperpigmentation induced by intense pulsed light treatment in Chinese individuals

Background: Symmetric melasma-like hyperpigmentation (MLH) has been identified in several patients following intense pulsed laser (IPL) treatment sessions. These patients exhibited no typical signs of melasma prior to IPL therapy. Objectives: To investigate the incidence of MLH in Chinese patients receiving IPL treatment and to discuss potential causative factors for this condition and potential preventive measures. Methods: 675 patients with skin types III–IV who were treated with IPL were retrospectively studied. Results: MLH was noted in 20 cases (20/675, 2.96%) within 3 months following IPL treatment session. All the patients had a pigmentary disorder prior to their IPL treatment s, the most common being photoaging or the presence of freckles. The lesions seen in 14 of the 20 cases (14/20, 70%) were multiple pigmented lesions along a wide distribution of the skin with undefined borders. Six of the cases had a strong post-treatment local reaction which also may have contributed to the MLH. In 2 cases, the original skin concern became worse following the IPL therapy and may have been a reason for the formation of MLH. In 6 cases, we noted that these individuals were not regular users of sunscreen post-therapy, despite our recommendations, which also may have contributed to the formation of their MLH. Conclusions: The adverse event and formation of IPL-induced MLH seen in Chinese individuals does have a relationship to a primary pigmentary lesion(s) and trend toward melasma prior to the IPL therapy. The IPL parameters chosen should be suitable for the skin condition being treated and should follow the recommendations of the manufacturer's default settings prior to undertaking the treatments. Post-therapy skin care and the use of appropriate sun protection are also important factors in preventing MLH.

Congenital hypertrophy of the RPE related to familial adenomatous polyposis

AbstractIntroduction: Familial adenomatous polyposis is a rare condition found in 1/10000 births. Multiple bowel polyps can lead to bowel cancer if untreated. Multiple pigmented retinal lesions are present in 60 to 80% of patients with this condition. Clinical presentation and imaging: Fundus lesions are classified in five groups: ovals pigmented with halo, small pigmented round , large pigmented round, depigmented round and small hypopigmented. They can be grouped with a bear track aspect. The lesions are asymptomatic A total number of at least four lesions is considered a good marker of the disease. Angiographic aspect is only mask or window depending on the degree of pigmentation. Pathology: Histologically the lesions are made of one or several layers of pigmented hypertrophic epithelial cells. Genetic: familial adenomatous polyposis is linked to a germinal mutation of the APC gene which is localized on the long arm of chromosome 5.

Immunohistochemical features of multifocal melanoacanthoma in the hard palate: a case report

BackgroundMelanoacanthoma (MA) has been described in the oral mucosa as a solitary lesion or, occasionally, as multiple lesions. MA mainly affects dark skinned patients and grows rapidly, showing a plane or slightly raised appearance and a brown to black color. The differential diagnosis includes oral nevi, amalgam tattoos, and melanomas. We report here the case of a 58-year-old black woman who presented multiple pigmented lesions on the hard palate.Case presentationBased on the differential diagnosis of melanoma, a punch biopsy (4 mm in diameter) was performed. The material was fixed in 10% formalin, embedded in paraffin, and stained with hematoxylin-eosin or submitted to immunohistochemical analysis. Immunohistochemistry using antibodies against protein S-100, melan-A, HMB-45, MCM-2, MCM-5, Ki-67 and geminin was performed. Immunohistochemical analysis revealed strong cytoplasmic immunoreactivity of dendritic melanocytes for proteinS-100, HMB-45 and melan-A.Positive staining for proliferative markers (MCM-2, MCM-5, Ki-67) was only observed in basal and suprabasal epithelial cells, confirming the reactive etiology of the lesion. The diagnosis was oral Melanoacanthoma (MA).ConclusionThe patient has been followed up for 30 months and shows no clinical alterations. MA should be included in the differential diagnosis of pigmented lesions of the oral cavity.

Malignant melanoma arising in a plaque‐type blue nevus

Blue nevus is a type of dermal melanocytosis and has a variety of clinicopathological characteristics. A few particular variants are generally accepted as discrete clinicopathological entities. Plaque-type blue nevus (PTBN) is one of the variants of blue nevus. PTBN presents at birth or arises in early childhood, and shows a combination of features found in common blue nevus and cellular blue nevus. In this report, we describe a malignant melanoma arising in association with a PTBN in a 65-year-old male. The tumor appeared as a well circumscribed but partially infiltrative upper-abdominal mass, and was heavily pigmented and consisted of a spindle or epithelioid highly cellular component with mitotic figures and tumor necroses. In the skin around the tumor, multiple pigmented lesions were scattered around the trunk, and these had been recognized since childhood. Histologically, skin lesions showed sparse and wide distribution of the dendritic melanocytes with dense melanin pigments and melanophages between the collagen bundles from the reticular dermis to the abdominal skeletal muscle. We also discuss the histological features and clinical course in our patient in context with previous related literature.

Nevoid Basal Cell Carcinoma Syndrome

Figure 1: Clinical photograph showing frontal bossing and mutiple milia on forehead; Figure 2: Broad nasal root, linear ulcerated pigmented lesion on lower lid of right eye; Figure 3: Multiple pigmented lesions on face and neck; Figure 4: Clinical picture showing multiple palmer pits; Figure 5 (a,b,c): Hughes tarsoconjuctival bridge flap procedure with post auricular skin grafting (stage 1); Figure 5 (d): Clinical photograph after division of tarsoconjunctival flap (stage 2); Figure 6: Histopathological picture showing features of basal cell carcinoma. (Thin arrow-basaloid cells, thick arrow-palisading)

Bilateral choroidal metastases as presentation of dissemination of cutaneous malignant melanoma

AbstractPurpose To report the case of a patient with bilateral choroidal mestastases as the first sign of dissemination of cutaneous malignant melanoma.Methods A 47‐year‐old Caucasian male presented to our emergency department with rapid‐onset blurred vision in his right eye (RE). Ophthalmoscopic examination revealed multiple pigmented placoid lesions located in the posterior pole and half periphery of the retina of both eyes and a serous macular detachment in RE. Optical coherence tomography confirmed the macular neurosensory detachment in the RE Since clinical suspicion of choroidal metastases, we referred the patient to the Oncology Department for systematic study. After an exhaustive study, they concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases.Results The patient underwent palliative treatment with chemotherapy with improvement of the visual acuity and reduction of the macular neurosensory detachment in the RE. Nevertheless the patient died months later of the diagnosis of cutaneous melanoma dissemination.Conclusion Dissemination of cutaneous melanoma to the choroid is rare and is a major prognostic factor. In general the treatment of ocular metastases is palliative, because the presence of metastases indicates hematogenous spread of tumor. The objectives are therefore to maximize the quality of life and restore or preserve vision.

Gorlin syndrome and bilateral ovarian fibroma

INTRODUCTIONGorlin syndrome (GS), also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare hereditary, autosomal dominant disease that affects various systems. Its prevalence is estimated at 1/57,000 to 1/256,000 of the population. It is characterized by basal cell carcinomas, multiple odontogenic keratocysts, skeletal abnormalities and ovarian fibroma, among other disorders. PRESENTATION OF CASETo report the case of a young patient with Gorlin syndrome and bilateral ovarian fibroma. DISCUSSIONA 20-year old patient with Gorlin syndrome presented with facial asymmetry, broad nasal root, dental abnormalities, micrognathism, convergent strabismus, multiple pigmented lesions on the trunk and face, pectus excavatum, kyphoscoliosis and a palpable mass in the abdomen occupying the entire pelvic region. CONCLUSIONGorlin–Goltz syndrome is a hereditary pathology that includes numerous clinical manifestations. Diagnosis is clinical and genetic confirmation is unnecessary.

Multiple Pigmented Bowen's Disease: A Diagnostic and Therapeutic Dilemma.

Bowens' disease (BD) is a precancerous condition of skin and/or mucosa with a predilection towards sun-exposed areas. Extensive literature research failed to reveal any case of multiple pigmented BD in type V Fitzpatrick skin. Multiple BD is a therapeutic challenge with a tendency to recur. Here we present an otherwise healthy Indian male having multiple pigmented lesions of BD on sun-protected sites of the body mimicking malignant melanoma. These lesions were refractory to treatment with different modalities. This paper is an attempt to review the available literature regarding the pigmented variant of multiple BD. Rationale for a therapeutic trial of UVB therapy for multiple arsenic induced BD is also discussed.

Intraepidermal epidermotropic metastatic melanoma: a clinical and histopathological mimicker of melanoma in situ occurring in multiplicity

The distinction between primary melanoma and melanoma metastatic to the skin has major prognostic implications. We report a case of a 67-year-old male with a diagnosis of a superficial spreading melanoma (stage IB) rendered 6 years earlier who presented clinically with an atypical nevus on his left thigh. Histopathological examination showed an intraepidermal melanocytic proliferation that was interpreted as melanoma in situ. Subsequently, 45 additional pigmented macules appeared in crops over a 9-month period. Clinically and dermoscopically, these lesions were extremely polymorphic. Histopathological findings were compatible with melanoma in situ, as each lesion consisted of a wholly intraepidermal proliferation of markedly atypical melanocytes arranged singly and in nests. A complete gastrointestinal study showed multiple pigmented metastatic lesions throughout the stomach and small bowel, which supported a diagnosis of metastatic melanoma with gastrointestinal and epidermotropic skin involvement. Monosomy of chromosome 9 and a BRAF V600E mutation were detected in the primary tumor sample and in macro-dissected secondary lesions. No CDKN2A or CDK4 germline mutations were found. Intraepidermal epidermotropic metastases of melanoma have been rarely described in literature. In this case, histopathology alone was insufficient to distinguish metastatic melanoma from multiple in situ melanomas. The recognition of epidermotropic metastases should be based on the correlation between clinical, dermoscopic, histopathological and molecular findings.

Revised UK guidelines for the management of cutaneous melanoma 2010

These guidelines for the management of cutaneous melanoma present an evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiology, diagnosis, investigation, and follow-up.

Ocular Manifestations of Long-Term Mascara Use

Mascara, a widely used cosmetic, is associated with eye pathology. The authors report 3 cases of eye problems secondary to long-term mascara use. Two patients had multiple pigmented conjunctival lesions; one of these had a history of melanoma of the hand. Conjunctival biopsy revealed nonmelanocytic pigment granules within conjunctival stroma cells in both cases. The other patient had a history of dry eye, and also showed pigment clumping around a punctal plug. The third patient had canalicular obstruction from a mascara-laden dacryolith ("dacryomascaralith"), the first such case reported. A literature review revealed cases of eyelid dermatitis, infectious keratitis, a conjunctival mass ("mascaroma"), and others. Ophthalmologists should be aware of mascara's associated eye problems. The physical findings combined with a high index of suspicion, especially in cases of heavy mascara use, may allow for an accurate diagnosis and spare the patient an otherwise unnecessary invasive procedure.

Multiple skin metastases of malignant melanoma with unusual clinical and histopathologic features in an immunosuppressed patient

Immunosuppressive regimens may have significant impact on the number of pigmented lesions and the clinical appearance of nevi. Whether immunosuppression can also influence the clinical and histopathologic appearance of malignant melanocytic lesions is still a matter of debate. A patient was immunosuppressed because of heart and bone marrow transplantation. A clinically inconspicuous mole was removed from the left flank and was considered to be a papillomatous nevus. After 1 year, the patient developed multiple pigmented lesions over the entire body, which presented clinically as benign papillomatous nevi and histologically as atypical Spitz nevi. Three months later melanoma metastases were removed from the patient's left axilla, which finally resulted in the death of the patient. Thus, in retrospect, the eruptive pigmented lesions have to be considered as cutaneous melanoma metastases. The atypical clinical and histopathologic appearance of the melanocytic lesions as well as the course of disease may have been influenced by the immunosuppression.