Pigmented Naevi Research Articles

Naevus pigmentosus and melanoma

Clinical observations and histological findings support the relationship between pigmented naevi and melanoma. The author describes the morphological characteristics of congenital, acquired and atypical naevi in relation to the appearance of melanoma. On the basis of clinical observations, in harmony with other investigators, the author advises patients to perform self examination and to undergo regular survey of numerous atypical naevi by a dermatologist. In fact, any of the atypical pigmented naevi present in high number may be a precursor lesion. Patients with such lesions are at higher risk of melanoma development.

Intramucosal naevus with pseudoepitheliomatous hyperplasia in the gingiva: A case report

Abstract.This article describes the unusual case of an intraoral pigmented naevus with pseudoepitheliomatous hyperplasia of the gingiva. A 62-year-old man presented with an almost coal-black pigmented and partly white, spotted, dome-shaped swelling on the lingual gingiva of the mandible. Histologically, the lesion consisted of clusters of round-shaped naevus cells containing melanin granules, reactive with both S-100 immunohistochemical stain and Masson–Fontana silver stain, and pseudoinvasive squamous nests, reactive with cytokeratin. The pathogenesis of the present lesion and problems encountered in its differential diagnosis are discussed.

Structural asymmetry as a dermatoscopic indicator of malignant melanoma--a latent class analysis of sensitivity and classification errors.

Asymmetry of pigmented skin lesions is an important indicator of possible malignant melanoma and contributes substantially to the diagnosis of melanoma in the dermatoscopic ABCD rule for melanocytic lesions and other algorithms. However, it may be observer dependent. Dermatoscopic asymmetry cannot be assessed objectively and no golden standard of asymmetry diagnosis exists. The aim of this study was to assess the sensitivity of axis (a-) symmetry using latent class analysis. We analysed ratings from four experts in dermatoscopy of 232 pigmented lesions by latent class analysis (LCA). Possible ratings were 'no asymmetry', 'asymmetry in one axis' and 'asymmetry in two axes'. A subset of melanocytic lesions (blue naevi excluded) was analysed. Based on LCA, the asymmetry of the singular lesion was determined. The sensitivity of 'no asymmetry' was 40-77%, 40-70% for one-axis asymmetry, and 77-92% for two-axes asymmetry. Overestimation of asymmetry was more common than underestimation. Melanomas were significantly more asymmetric than pigmented naevi, atypical naevi and papillomas, but not basal cell cancers. Analysis of the melanocytic subset gave similar results. The median asymmetry of malignant melanomas (1.67, interquartile range 1.81-1.99) was higher than for melanocytic naevi. In conclusion, asymmetry and symmetry are important criteria for diagnosing or excluding malignant melanoma using the dermatoscopic ABCD rule, risk stratification and other diagnostic rules. Using LCA, we minimized observer dependence in the assessment of axis (a-) symmetry. LCA, besides conceptualizing the diagnostic process, enables the assignment of lesions to their true diagnostic class.

The panda naevus: management of synchronous upper- and lower-eyelid pigmented naevi

We report four patients presenting with rare synchronous upper- and lower-eyelid naevi. The distributions and appearances of these naevi resemble the distinctive periorbital pigmentation of the panda. The possible embryological origin of this naevus and an approach to management are discussed.

Skin disorders in relation to oral contraception and other factors, including age, social class, smoking and body mass index. Findings in a large cohort study.

Over the years, a substantial number of scientific papers has been published considering the possible relationship between oral contraceptive use and various skin disorders. We aimed to investigate the possible effects of oral contraceptives and other factors including age, social class, smoking and body mass index on the occurrence of hospital referral for skin disorders within the Oxford Family Planning Association (Oxford-FPA) contraceptive study. We carried out a cohort study with long-term follow up of 17,032 women aged 25-39 years recruited at 17 family planning centres in England and Scotland between 1968 and 1974. The main outcome measure was the pattern of referral to hospital for skin disorders among the participants. The conditions considered (number of women affected in parentheses) were: malignant melanoma (48); other skin cancers (83); benign skin neoplasms (384); boils and cellulitis (334); eczema and dermatitis (327); erythematous disease (54); psoriasis (92); hypertrophic and atrophic conditions (59); diseases of the nails (80); diseases of the hair and hair follicles (74); diseases of the sebaceous glands (362); pigmented naevi (383); and unspecified eruptions (199). Some of these disease categories are broad, which complicates interpretation of the findings. As the data relate to hospital referrals, while most skin disorders are largely managed within primary care, it is difficult to know to what extent our findings can be generalized to disease patterns in the community. None the less, a number of interesting results emerged. These included increased risks (approximately twofold) of referral to hospital for boils and cellulitis in heavy women, for psoriasis in women who smoke, and for pigmented naevi in women of higher social class. Referral for pigmented naevi was reduced by about half in women with a high body mass index. Of the oral contraceptive associations studied, we consider that only an increased risk of referral for eczema or dermatitis in current or recent pill users (relative risk 1.6, 95% confidence interval 1.2-2.1) might reflect a causal relationship. There was no increased risk in past users nor was the risk related to duration of use. These findings are very similar to those reported from the Royal College of General Practitioners oral contraception study. Hospital referral for certain skin disorders was related to age, social class, smoking and body mass index within the Oxford-FPA study. Hospital referral for skin disorders generally seems to be unrelated to oral contraceptive use within the study, the possible exception being eczema and dermatitis, which occur more commonly in current and recent pill users than in non-users.

Prevalence of pigmented naevi in a Swedish population living close to the Arctic Circle.

The prevalence of common naevi and dysplastic naevi was investigated in a Swedish population with a low incidence of melanoma. A total of 201 subjects aged 30-50 years living in northern Sweden participated. The median number of common naevi per individual was 15, and 11% had dysplastic naevi. Higher numbers of common naevi were found in individuals with dysplastic naevi (median 68) and in those who had spent their childhood in southern Sweden (median 44). The prevalence of common naevi and dysplastic naevi was significantly lower than reported from a previously studied population in southern Sweden, with a melanoma incidence 4 times higher than in the north. The strong variability in naevus phenotype, and in melanoma incidence, between different regions of Sweden seems to be due to different levels of sun exposure rather than to differences in constitutional factors.

Urinary excretion of 5-S-cysteinyldopa and 6-hydroxy-5-methoxyindole-2-carboxylic acid in children.

5-S-Cysteinyldopa (5SCD) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) are formed during biosynthesis of melanins. They are used as indicators of pigment formation and markers of melanoma progression in adults and could possibly be used as markers of activity, growth and even malignant transformation in large pigmented naevi in children. We investigated the urinary excretion of these pigment precursor metabolites from 136 children, 5 to 15 years of age. The mean 5SCD excretion was 38.1 mumol/mol creatinine. A significant age-related decrease from a mean of 60.4 mumol/mol creatinine at 5 years of age to 28.0 mumol/mol creatinine at age 15 was found. In a reference group (29 adults, 20-33 years of age) the mean excretion was 48.9 mumol/mol creatinine. The mean excretion of 6H5MI2C was 42.8 mumol/mol creatinine at 5 years of age and 26.1 mumol/mol creatinine at the age of 15. The mean value for the young adults was 33.4 mumol/mol creatinine. No correlation between the mean excretion of 5SCD and 6H5MI2C was demonstrated. We suggest an upper reference level of 90 mumol/mol creatinine for the excretion of 5SCD in the age group 5-11 years and of 60 mumol/mol creatinine in the age group 13-15 years. Corresponding figures for the indole 6H5MI2C are 70 and 60 mumol/mol creatinine. The establishment of reference values in children will make it possible to use 5SCD and 6H5MI2C measurements as diagnostic tools, indicating growth or malignant transformation in giant melanocytic naevi during childhood.

A retrospective study on pigmented naevi within a melanoma case-control study-experience

A retrospective study on pigmented naevi within a melanoma case-control study-experience

Giant congenital naevus of the scalp and cranium: case report and review of the literature

Congenital pigmented naevi are lesions that are usually confined to skin. We report a giant congenital naevus of the scalp which involved skin, galea, full thickness cranial bone, dura and the intracranial venous sinuses. ven literature on giant congenital naevi with direct involvement of underlying bone is reviewed.

580Radiation therapy in Vienna 11/1896 by L. Freund for a 4 year old girl with a pigmented piliferous naevus: details of treatment and outcome with a 77 years follow-up

580Radiation therapy in Vienna 11/1896 by L. Freund for a 4 year old girl with a pigmented piliferous naevus: details of treatment and outcome with a 77 years follow-up

Immunostaining of human melanomas by a monoclonal antibody to B700 mouse melanoma antigen

Previous studies have shown that B700, an albumin-like murine melanoma antigen, has a human homologue termed H700. Polyclonal antibodies to B700 also bind to all cultured human, swine and hamster melanoma cells, suggesting that B700 is a “pan-melanoma” antigen. The objects of this investigation were: (a) to determine if 2-3-3, a monoclonal antibody to B700, can be used to identify human melanomas in formalin-fixed, paraffin-embedded tissues, and (b) to determine the specificity and potential diagnostic value of 2-3-3. Forty-eight of the 49 human melanomas, including spindle melanoma cells, stained positively, as did five of the eight pigmented naevi including cellular spindle naevi. Twenty-six of the 32 human non-melanomatous lesions were negative for 2-3-3 staining (weakly positive on one breast carcinoma and positive on five neural tumours). These results indicate that 2-3-3, a monoclonal antibody to the mouse melanoma antigen B700, can be used to identify H700 in archival specimens. 2-3-3 may have an advantage over HMB45, which is the most commonly used antibody for melanoma diagnosis, because of its immunoreactivity with spindle melanocytic lesions. Antibodies to B700 may prove to be a useful adjunct in the diagnosis of human melanoma and related lesions.

Clinical relevance of cathepsin B-like enzyme activity and cysteine proteinase inhibitor in melanocytic tumours.

We studied the relationship between cathepsin B (CB)-like enzyme activities and cysteine proteinase inhibitor (CPI) activities in lesions of human pigmented naevi (PN), primary melanomas (PM) and metastases/metastatic melanomas (MM). The CB-like enzyme activities in PM and MM were 2.5 and 6.8 times higher than in PN, respectively. The CB-like/CPI ratios in PM and MM were 1.9 and 11.6 times higher than in PN, respectively. CPI had the highest activity in PM and the lowest activity in MM. The disease-free interval of patients with a high CB-like enzyme activity (> or = 80 U/mg protein) and/or a high CB-like/CPI ratio (> or = 7) was shorter than that of patients with a low CB-like enzyme activity (< 80 U/mg protein) and/or a low CB-like/CPI ratio (< 7). Analysis of CB-like enzyme activity and/or the CB-like/CPI ratio may be useful in predicting the prognosis of human malignant melanoma.

Do pigmented naevi in albinism provide evidence of tyrosinase positivity?

We investigated a 4-year-old Japanese boy with oculocutaneous albinism who had a solitary pigmented mole measuring 5 mm in diameter on his back. An electron microscopic tyrosine incubation test and a DOPA reaction test clearly demonstrated the presence of tyrosinase activity in the patient's hypopigmented skin. The presence of tyrosinase activity was confirmed by tests on hair bulb samples. Histopathological evidence showed that the mole was a typical compound cellular naevus with melanin pigmentation. Although no reports to date have focused on the relationship between pigmented naevi in albinism and tyrosinase activity, our findings suggest that the occurrence of pigmented naevi in an albino may indicate the presence of tyrosinase activity.

Bulky naevocytoma of the perineum: A singular variant of congenital giant pigmented naevus

We describe two instances of a previously unrecognized variant of congenital giant pigmented naevus (GPN), presenting as a bulky naevocytic tumour in the perineal region. In both cases the lesion was present at birth and attained massive dimensions. In addition to the characteristic histological patterns found in GPN, which included extensive areas with a neural appearance, these tumours presented an uncommon tendency to form pseudo-follicular structures lined by naevus cells. No features suggestive of malignant transformation were found. Because GPN may associate with an underlying malignancy, accurate diagnosis of this lesion is important in clinical practice.

Malignant Melanoma in Denmark Occurrence and Risk Factors

The age-standardized incidence rate of cutaneous malignant melanoma (CMM) in Denmark increased five- to six-fold between 1943 and 1982. The increased varied by sex and by site, being particularly pronounced for areas of the body normally covered by clothes. A steep increase in risk was revealed for successively younger birth cohorts. Lack of consistency between descriptive epidemiology and indicators for cumulative exposure to sunlight has led to the intermittent exposure hypothesis. Our population-based case-control study, including 474 incident cases of CMM and 926 controls, has further supported this hypothesis and demonstrated that sunbathing is associated with an increased risk of CMM, particularly during childhood and if it leads to sunburning. In addition, the risk of CMM is increased in persons with many pigmented naevi and/or a tendency to freckling. Our study does not support a relationship between CMM and hormonal exposure in women and no association was observed between dietary factors, alcohol intake, tobacco smoking, bathing habits or hair dye use and CMM risk.

Seasonal variations of pigmented naevi. Intercorrelations of clinical and histological variables with special reference to seasonal variation.

During 1984, junctional and compound naevi were registered significantly more often during the summer half-year (May-October) than the total number of naevi, which showed no seasonal variation. A series of 342 of these junctional and compound naevi have been the subject of a blind histological classification. Clinical information was obtained by a questionnaire mailed to the patients. The intercorrelations of 19 histological and 10 clinical variables were studied by chi 2-test. The seasonal variation of these variables was further studied by chi 2-test and by Hewitt's test. Patient's hair colour, eye colour and sex as well as mitoses and localization showed a significant correlation to season of the year. The trends of these findings, compared with the information about tumour duration, indicate a short-term latency effect of UV light on naevi which are excised during the summer half-year.

(28) Giant congenital pigmented naevus

(28) Giant congenital pigmented naevus

Monoclonal S-100 immunocytochemistry of pigmented naevi with tactile-like corpuscles.

We examined 12 cases of pigmented naevi with tactile-like corpuscles by immunohistochemistry using polyclonal and monoclonal antibodies against S-100 protein. Naevus cells, the tactile-like corpuscles, and the attached lamellae and fibroblastic cells gave a strong reaction with S-100 protein and the beta-subunit antibodies. The same cells gave only a weak reaction with the alpha-subunit antibody with the exception of about 4 per cent of corpuscles and 1-1.5 per cent of naevus cells, whether pigmented or not, which gave a strong reaction with this antibody. These results suggest that the non-pigmented naevus cells and the constituent cells of the corpuscles are closely related and the latter might derive from the former by organoid differentiation.

NEOPLASMS Malignant Giant pigmented naevus

NEOPLASMS Malignant Giant pigmented naevus

Association of Skin and Other Lesions with Cervical Dysplasia

Association is reported in a series of 805 patients between cervical dysplasia and the occurrence of lesions in other organs, in particular the skin. The occurrence of associated lesions in these patients was markedly in excess of that in case-matched controls. It was not related to the increased frequency of gynaecological investigation in patients with cervical dysplasia. Pigmented naevi were the most common associated lesions, occurring before and after the diagnosis of cervical dysplasia. Three cases of malignant melanoma were seen in the test group. Gynaecological lesions were also common. The findings are discussed in the light of recent work on viral synergism in genital neoplasia.