Presence Of Melanophages Research Articles

Topical Neuropeptide Y for Ischemic Skin Wounds.

Our objective was to investigate the effects of topically applied neuropeptide Y (NPY) on ischemic wounds. Initially, the animal model for ischemic wound healing was validated using 16 male Sprague Dawley albino rats. In the intervention study, an additional 28 rats were divided into three groups: NPY (0.025%), the positive control insulin-like growth factor-I (IGF-I, 0.0025%), and the hydrogel carrier alone (control). The hydrogel was selected due to its capacity to prolong NPY release (p < 0.001), as demonstrated in a Franz diffusion cell. In the animals, an 8 mm full-thickness wound was made in a pedunculated dorsal ischemic skin flap. Wounds were then treated and assessed for 14 days and collected at the end of the experiment for in situ hybridization analysis (RNAscope®) targeting NPY receptor Y2R and for meticulous histologic examination. Wound healing rates, specifically the percentage changes in wound area, did not show an increase with NPY (p = 0.907), but there was an increase with rhIGF-I (p = 0.039) compared to the control. Y2R mRNA was not detected in the wounds or adjacent skin but was identified in the rat brain (used as a positive control). Light microscopic examination revealed trends of increased angiogenesis and enhanced inflammatory cell infiltration with NPY compared to control. An interesting secondary discovery was the presence of melanophages in the wounds. Our findings suggest the potential of NPY to enhance neovascularization under ischemic wound healing conditions, but further optimization of the carrier and dosage is necessary. The mechanism remains elusive but likely involves NPY receptor subtypes other than Y2R.

Unstable solar lentigo mimicking lentigo maligna melanoma: A case report

Solar lentigo (SL) is a hyperpigmented macule that develops due to chronic ultraviolet exposure. A 35-year-old housewife, presented with an asymptomatic pigmented patch on the right side of her nose for the last 10 years, with a rapid increase in size and variability in pigmentation over the last 3 years. She had no history of excessive sun exposure. Upon examination, there was a solitary, hyperpigmented, well to ill-defined patch of irregular shape and margin, measuring 3 cm * 2.5 cm, with variability in colour and areas of regression, almost covering Right side of nose. The patch appeared light brown with areas of dark brown and black. Differential diagnoses considered were Lentigo maligna melanoma (LMM), Solar Lentigo (SL), and flat seborrheic keratosis. Dermoscopy (Polarised illuco IDS-1100 dermoscope) revealed diffuse brown pigmentation with a faint pigmented network, along with dark brown to black globules and blotches. Due to the asymmetry of pigmentation, a punch biopsy was performed from the area of darkest pigmentation to rule out LMM. In Histology, the epidermis exhibited hyperkeratosis, follicular plugging, acanthosis, and downward elongation of the rete ridges. There was hyperpigmentation of the basal layer, an increased number of melanocytes, and the presence of melanophages in the papillary dermis. The biopsy report was consistent with Solar Lentigo (SL), and we concluded it as unstable solar lentigo (USL). This case is presented due to its clinical and dermoscopic resemblance to LMM and to increase awareness of USL and the importance of periodic surveillance.

Brief Communication on Pathologic Assessment of Persistent Stable Metastatic Lesions in Patients Treated With Anti-CTLA-4 or Anti-CTLA-4 + Anti-PD-1 Therapy.

Despite the wide use of immune checkpoint inhibition for the treatment of melanoma, the mechanisms leading to long-term stable disease are incompletely understood. Patients with metastatic melanoma who had received ipilimumab alone or ipilimumab plus nivolumab 2+years prior and attained at least 6 months of stable disease were identified. Positron emission tomography/computed tomography (PET/CT) was performed. Pretreatment and posttreatment biopsies of areas of stable disease were assessed for tumor, fibrosis, and inflammation. Seven patients underwent PET/CT and tissue biopsy. Fluorodeoxyglucose avid lesions on PET/CT ranged from no activity to an SUV of 22. In 6 patients, the residual stable lesions were composed of necrosis and fibrosis with a prominent pigment containing macrophages and no residual melanoma. In 1 patient, a nodal lesion demonstrated melanoma with active inflammation. In most patients with durable stable disease after treatment with ipilimumab or ipilimumab/nivolumab, residual lesions demonstrated predominantly necrosis and fibrosis consistent with resolving lesions. The presence of melanophages in these samples may suggest ongoing immune surveillance. One patient did demonstrate residual melanoma, indicating the need for ongoing monitoring of this patient population.

30. Semi-automated approaches for digital pathology analyses standardize pathologic assessment of clinical melanoma biopsies

Sequencing technologies have become standard approaches for high-dimensional analysis of clinical tumor biopsies, leading to the identification of relevant molecular correlates and mechanisms for therapeutic response. However, despite advances in sequencing technologies and bioinformatics approaches, conclusions are often limited by the quality, size, and histologic or pathologic features of the collected samples. Sequential slices of tissues can be used to corroborate findings in bulk sequencing data using multiplexed imaging or single stain studies, but their analysis may still require manual assessment by trained pathologists. Here, we demonstrate the utility of the open-source software, Qupath, for digital pathology to standardize the analysis of sequential slides cut from formalin-fixed, paraffin-embedded melanoma tumor biopsies before and during treatment with immunotherapy, individually stained for hematoxylin and eosin (H&E), melanoma tumor cells (S100), or cytotoxic T cells (CD8). By overlaying consecutive images, the densities of melanoma and CD8+ T cells were calculated in consistent regions across biopsy slices, based upon chromogen intensities, for accurate quantitation of CD8 T-cell infiltration. Furthermore, a dermatopathologist identified additional features that may digitally or manually limit the precision of these measurements, such as the presence of melanophages (pigment-laden macrophages) and pigmented melanocytes. These features are especially critical in assessing immunotherapy-treated biopsies, where antitumor immune reactions complicate pathologic review. This semi-automated approach for pathologic assessment demonstrates a standardized workflow for orthogonal validation of bulk sequencing-based metrics, including tumor cellularity and immune cell deconvolution.

815 Translational Research in Skin of Color Spontaneous Repigmentation of Post-Chemical Burn Leucoderma

IntroductionAfter facial burn injuries to skin of color (SOC) patients, repigmentation plays a critical role in post-burn quality of life, given the acquired contrast between preserved skin and achromic scars, and that daily concealment may be difficult. While leucoderma is a well-known side-effect of deep chemabrasion with phenol, phenol-croton oil, and high concentration trichloroacetic acid, mechanisms of repigmentation are still not fully understood, and the observation of spontaneous repigmentation of a deep chemical injury in SOC has not previously been described in the literature. In our study, we present the dynamics of long-term spontaneous facial repigmentation of a Fitzpatrick V chemical burn patient, with microscopic findings of a deep chemical peel SOC animal model.MethodsWe demonstrate spontaneous repigmentation in a 37-year-old female who initially presented with depigmented areas, erosions and eschars on the face, 7 days after accidental deep chemical burn, due to self-application of 70% glycolic acid to improve acne. This is juxtaposed with a SOC porcine experiment, performed with 35% phenol, 1.6% croton-oil, to evaluate depth-of-injury, neocollagenesis band thickness in 21 days, and skin pigmentary safety. A 6mm punch biopsy taken at 21 days underwent Herovici staining to reveal the thickness of collagen type III neocollagenesis, confirm the presence of melanin in the epidermis, and evaluate the presence of melanophages.ResultsOn patient presentation, epidermolysis and areas of deep dermal burns were observed over the forehead and cheeks. At 14 days, multiple leucoderma scars persisted and initial perifollicular repigmentation was noticeable. At 28 days, most of the skin was repigmented; however, many areas had only perifollicular repigmentation and still very severe leucoderma. At 6 months, the skin still had small areas of leucoderma with folicular repigmentation. At 11 months the skin color was fully recovered, with minimal post-inflammatory hyperpigmentation (PIH) over the cheeks.As for the SOC animal model, at 7 days the eschar was detached, and the skin was achromic. At 21 days, skin pigmentation was completely restored without macroscopic signs of PIH. Dermatopathology evaluation revealed microscopic areas of melanophages, a fully recovered epidermal melanin, and a band of over 500 micra of collagen type III.Overall, on follicle-dense areas after chemical burn, we observed progressive full repigmentation over the course of 11 months on the patient, and by day 21 in the porcine SOC model.ConclusionsSpontaneous repigmentation occurred both after accidental deep chemical ablation to the face of a SOC patient, and on the porcine SOC model after deep chemical peel formula application.

Pathology of durable stable disease in melanoma patients treated with ipilimumab, nivolumab, or ipilimumab, and nivolumab combination therapy.

9567 Background: As immunotherapy with checkpoint blockade becomes the backbone of melanoma treatment there is a need to better understand the biology associated with long term benefit. One particularly interesting set of patients are those with prolonged stable disease or response with residual findings on imaging. It is unknown if immunotherapy has led to scarring at the site of prior disease or if there are residual tumor cells being controlled by an ongoing immune response. Evaluating tissue from patients with prolonged responses provides a unique opportunity to determine the composition of residual lesions. Correlation with PET/CT helps determine if this is an accurate modality to reflect presence of residual viable tumor tissue. Methods: Metastatic melanoma patients that have attained long term stable disease after treatment with ipilimumab, nivolumab, or ipilimumab plus nivolumab were identified. Patients must have received ipilimumab, nivolumab or combination therapy 2+ years prior to enrollment and must have had stable disease for ≥ 6 months. Patients were consented and underwent PET/CT scans and biopsies of residual areas of stable disease. Pre- and post-treatment tissue samples underwent pathologic assessment to look at tumor cell content, fibrotic content, and inflammation. Results: Ten patients were consented for evaluation but only 7 met the screening criteria and underwent PET/CT and tissue biopsy. Six patients had FDG avid lesions on PET/CT which ranged in intensity from SUV 2.4-22. One patient had no FDG avidity in the areas of residual disease observed on CT. Biopsies from the residual stable lesions demonstrated predominantly necrosis and fibrosis with prominent pigment containing macrophages. One patient with an axillary nodal lesion with an SUV of 22 had active melanoma on pathology which was resected, and the patient has subsequently remained without progression of disease. Conclusions: Patients with durable stable disease after treatment with ipilimumab, nivolumab or ipilimumab and nivolumab combination therapy represent a unique population of melanoma patients treated with immune checkpoint inhibition. An examination of the residual lesions observed in these patients demonstrated predominantly necrosis and fibrosis consistent with resolving lesions. The presence of melanophages in these samples may suggest some ongoing immune surveillance. One patient did demonstrate residual melanoma suggesting the need for ongoing monitoring of this patient population.

Alopecia por diluição da cor em uma cadela Staffordshire Bull Terrier azul: Relato de caso

Em cães a alopecia por diluição da cor (ADC) é uma das afecções dermatológicas que leva a gradual perda dos pelos em animais que possuem pelagens diluídas, como a azul. Embora relativamente rara, a ADC foi observada em diversas raças. Descreve-se aqui um caso em uma cadela de pelagem azul da raça Staffordshire Bull Terrier, atendida em um hospital veterinário de Pernambuco, Brasil. A cadela apresentava rarefação dos pelos desde os seis meses de idade, e ao exame clinico foi observada alopecia no dorso e flanco. Exames complementares foram requisitados e feitos para descartar outros diagnósticos em potencial tais como infeções parasitárias da pele e doenças de origem endócrina. Realizou-se uma biópsia da pele para avaliação histopatológica, onde foi possível observar a presença de plugs de melanina nos folículos pilosos, distorção posterior dos mesmos, pigmentação adjacente aos folículos e a presença de melanógafos, alterações que sugeriram ADC. Através do resultado do exame histopatológico associado aos sinais clínicos e o histórico do animal, foi possível confirmar o diagnóstico de alopecia por diluição da cor. Não foi realizado tratamento terapêutico nesse caso, tendo em vista que os tratamentos existentes variam em resultado e o tutor optou pela não realização do mesmo.

Oral melanoacanthoma: Case report with review of literature

Oral melanoacanthoma is a rare, benign pigmented lesion that presents most commonly on the buccal mucosa. It is characterized clinically by the sudden appearance and rapid growth of a macular brown-black lesion and histologically by hyperplasia of spinous keratinocytes and dendritic melanocytes. We report a case of oral melanoacanthoma in a 37-year-old Indian male, who presented with an intra-oral brown macular lesion on the right buccal mucosa with a duration of ten days. Microscopic examination revealed acanthosis of stratified squamous surface epithelium with dendritic melanocytes in the basal and suprabasal layers and presence of melanophages in the underlying connective tissue. Based on the history, clinical features and histological presentation, the lesion was diagnosed as oral melanoacanthoma. Keywords: Melanocytes, Melanoacanthoma, Dendritic

Pseudoxanthoma elasticum–like papillary dermal elastolysis: A mimicker of genetic pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE)–like papillary dermal elastolysis (PDE) is an acquired, rare, elastic tissue disorder that presents with multiple asymptomatic, nonfollicular yellowish or normochromic papules, coalescing into symmetrical cobblestone plaques, with a predilection for the neck of postmenopausal women. The condition develops slowly, in months to years, and, although clinically similar to PXE, it is devoid of any systemic implication, being only of esthetic concern. The etiology is unknown, but it is speculated that there is a multifactorial pathogenesis, with the contribution of intrinsic aging, exposure to ultraviolet radiation, abnormal elastogenesis, and genetic factors. The diagnosis is confirmed by histopathology, with special stains specific for elastic fibers revealing loss of elastic plexus in the papillary dermis and the presence of melanophages. Its prevalence is probably underestimated, which reinforces the importance of better clinical and histologic identification to distinguish it from inherited PXE and to avoid extensive systemic investigations and unnecessary medical visits for the patient.

Dermoscopy of Cutaneous Graft-Versus-Host-Disease in Patients After Allogeneic Hematopoietic Stem Cell Transplantation.

IntroductionProgress in the transplant procedure has resulted in a higher proportion of patients with long-term survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Cutaneous graft-versus-host disease (GvHD) occurs often among patients who have undergone allo-HSCT. Routine diagnosis of skin and mucosal lesions is based primarily on clinical evaluation and histopathologic confirmation of skin biopsies. However, biopsy is an invasive method and histopathologic analysis is time-consuming, often accompanied by a lack of clinical correlation. There is therefore an urgent need for non-invasive, reproducible in vivo imaging methods that could be used in patients with cutaneous GvHD—both in the setting of initial diagnosis and during follow-up.The aim of the study reported here was to determine the role of dermoscopic monitoring of skin lesions in allo-HSCT recipients with consecutive histopathologic support as a non-invasive, alternative method to diagnose GvHD.MethodsTwenty patients were examined by dermoscopy upon the manifestation of skin changes in the course of GvHD. Consecutive skin biopsies for histopathologic analysis were obtained from the suspected skin locations determined during dermoscopy.ResultsGraft-versus-host disease was confirmed by histopathology in 19 of the 20 allo-HSCT recipients. Four patients developed symptoms of acute cutaneous GvHD (grade 1, n = 2; grade 2, n = 1; grade 3, n = 1), and 15 patients developed chronic cutaneous GvHD. The most frequent dermoscopic signs (irrespective of whether GvHD was chronic or acute) were vessels and scaling (both n = 14, 73.7%). Hyperpigmentation and white patchy areas were present in eight patients (42.1%). Fair to moderate levels of agreement were found between presence of melanophages in the skin sample and dermoscopic granularity (Cohen’s Kappa [κ] = 0.39), scaling (κ = − 0.3) and vessels (κ = − 0.42). The finding of white patchy areas was inversely associated with lymphocytic infiltration (κ = − 0.55).ConclusionThe results of this study suggest that dermoscopy may be a useful tool for diagnosing cutaneous GvHD in allo-HSCT recipients. Combining the clinical picture with dermoscopic features may bring us closer to a faster and easier diagnosis of GvHD.

Post chikungunya pigmentation in a segmental pattern: A rare presentation

Chikungunya is a viral infection caused by chikungunya virus belonging to family Togaviridae, transmitted by Aedes mosquitoe. It presents with acute onset of fever with debilitating arthralgia/ arthritis. A spectrum of muco-cutanous manifestations have been reported in the literature. We report a case of a 35 years old female presented with non-progressive hyperpigmented macules in a segmental pattern over the left side of the neck for the past 1 month. She had a preceding history of chikungunya diagnosed on clinical and serological grounds just 2 weeks prior to the onset of pigmentation. Histopathology showed increased melanin deposition in the basal layer of the epidermis with presence of melanophages in the upper dermis. There was no basal cell vacuolization or inflammatory infiltrates. These findings were consistent with a diagnosis of post chikungunya pigmentation. Patient responded well to treatment of topical 2% hydroquinone. This unique segmental presentation of post chikungunya pigmentation must be kept in mind when a patient presents with an acquired segmental hyperpigmentary disorder of unknown origin.

In vivo confocal microscopic substrate of grey colour in melanosis

Melanosis is the most common cause of mucosal pigmentation and can be clinically difficult to differentiate from early melanoma (MM). Dermoscopy can help in the distinction between melanosis and MM, but in some instances, melanoses may exhibit overlapping features with MM such as the presence of grey colour. We sought to evaluate whether reflectance confocal microscopy (RCM) can help to better understand the dermoscopic features of melanoses in order to assist clinicians in their diagnosis. All melanoses diagnosed between June 2011 and December 2014 in the Departments of Dermatology of the University of Saint-Etienne (France) and of Modena and Reggio Emilia (Italy), for which dermoscopic and RCM images were available, were included. Twenty-two lesions were biopsied to confirm the clinical diagnosis, whereas the others did not present any change at a follow-up of at least 6 months. The correlation between dermoscopic and RCM features were evaluated by the Spearman's rho correlation coefficient. 55 melanoses were studied: 31 of the oral mucosa and 24 of the genital mucosa. 49% (n = 27) of melanoses exhibited a grey colour under dermoscopy. The grey colour correlated with the presence of melanophages under RCM (ρ = 0.424, P = 0.002). Our findings highlight that the presence of the grey colour on dermoscopy, considered as an alerting feature, is common in melanoses and it is related to the presence of melanin-laden inflammatory cells in the papillary dermis on RCM. When it is present as a 'pure' feature not associated to other colours than brown or to atypical dermoscopical structures, it could be related to the diagnosis of melanosis.

Dermatopathology effects of simulated solar particle event radiation exposure in the porcine model

The space environment exposes astronauts to risks of acute and chronic exposure to ionizing radiation. Of particular concern is possible exposure to ionizing radiation from a solar particle event (SPE). During an SPE, magnetic disturbances in specific regions of the Sun result in the release of intense bursts of ionizing radiation, primarily consisting of protons that have a highly variable energy spectrum. Thus, SPE events can lead to significant total body radiation exposures to astronauts in space vehicles and especially while performing extravehicular activities. Simulated energy profiles suggest that SPE radiation exposures are likely to be highest in the skin. In the current report, we have used our established miniature pig model system to evaluate the skin toxicity of simulated SPE radiation exposures that closely resemble the energy and fluence profile of the September, 1989 SPE using either conventional radiation (electrons) or proton simulated SPE radiation. Exposure of animals to electron or proton radiation led to dose-dependent increases in epidermal pigmentation, the presence of necrotic keratinocytes at the dermal-epidermal boundary and pigment incontinence, manifested by the presence of melanophages in the derm is upon histological examination. We also observed epidermal hyperplasia and a reduction in vascular density at 30 days following exposure to electron or proton simulated SPE radiation. These results suggest that the doses of electron or proton simulated SPE radiation results in significant skin toxicity that is quantitatively and qualitatively similar. Radiation-induced skin damage is often one of the first clinical signs of both acute and non-acute radiation injury where infection may occur, if not treated. In this report, histopathology analyses of acute radiation-induced skin injury are discussed.

Poikiloderma: Differential Diagnosis and Treatment

Despite the cause of poikiloderma, histopathological findings are generally common and nonspecific in any case of poikiloderma and include thinning of stratum basale and stratum spinosum, hydropic degeneration of the basal cell layer, presence of melanophages in the papillary dermis, and dilatation of the papillary dermal capillaries. However, characteristic pathologic features can be also found additionally in relation to some specific causes such as epidermotropism in case of mycosis fungoides.

Study of the Dermoscopic Findings and Their Correlation with Histopathological Findings in Various Lichenoid Dermatoses

Abstract Background: Lichenoid disorders are often difficult to diagnose clinically. Dermoscopy can act as an alternative technique to skin biopsy for diagnosis of various lichenoid dermatoses. Study aim: To study the correlation of dermoscopic with histopathological findings in various lichenoid dermatoses Methods: Fifty patients with clinical picture of lichenoid dermatoses were examined first under the dermoscope, followed by skin biopsy from the same site. The findings of both methods were recorded and correlated. Results: Nonvascular findings were the predominant features on dermoscopy out of which white structures were present in 93.33% of patients of classical lichen planus, 50% of actinic lichen planus, 90% of lichen planus hypertrophicus, 50% of lichen planopilaris and in only the case of lichen simplex chronicus. In classical lichen planus patients, a particular pattern of white structures with linear streaks arranged in a radial manner (starburst pattern) was observed. In lichen planus, it is suggested that the white structures on dermoscopy corresponded histologically to hyperkeratosis. Gray-blue dots or brown punctate areas represented melanophages in dermis. In lichen planus pigmentosus and ashy dermatosis patients, no specific patterns could be observed. In lichen planus hypertrophicus, white structures, corn pearls and comedolike openings appeared to represent hyperkeratosis and hypergranulosis, while pigmentation of variable colors could be due to presence of melanophages in the dermis. Conclusion: Dermoscopy can be a valuable tool for the dermatological diagnosis and may obviate need for skin biopsy.

Extensive regression in pigmented skin lesions: a dangerous confounding feature

Spontaneous regression in melanomas is not an uncommon phenomenon, as it has been described in 10–35% of primary cutaneous lesions [1]. Regression does not appear to predict a more favorable course, since even fully regressed melanomas may progress into metastatic disease [2]. Several dermoscopic features have been correlated with the regression process, including white scar-like depigmented areas and gray-blue, pepper-like granules, which correspond to dermal scarring, pigment incontinence and presence of melanophages [3,4]. Regression may occur not only in melanomas, but also in melanocytic nevi, which similarly may exhibit white areas and gray-blue granules or areas under dermoscopy [5]. Overall, white areas have been proposed to be associated with the fibrosis type of regression and gray-blue areas to the melanosis type of regression of melanocytic tumors [3]. Lichen planus like keratosis (LPLK) is considered to represent a regressed solar lentigo or seborrheic keratosis. Dermoscopy of LPLK at the late stage of the regression process reveals a diffuse gray-blue granular pattern, similar to that observed in regressed melanocytic lesions [6].In this context, when evaluating skin lesions that exhibit high degree of regression, interpretation of dermoscopic findings may be problematic, especially when no other dermoscopic clues can be recognized.

Aberrant expression of HMB-45 in traumatized melanocytic nevi

Assessment of histologic and immunohistochemical maturation (with HMB-45 and anti-Ki-67) may be helpful in differentiating benign melanocytic nevi (BMN) from malignant melanoma. Recently, we reported loss of maturation and aberrant immunohistochemical findings in melanocytic nevi after liquid nitrogen cryotherapy (Adeniran etal, J Am Acad Dermatol 2009;61:341-5). Herein we report a similar phenomenon identified in traumatized melanocytic nevi (TMN). We sought to evaluate the histologic and immunohistochemical findings in early and late stages of traumatized nevi. Twenty-four cases of TMN were retrieved from the pathology archives. These were then assessed by two pathologists (T.L. and A.H.D.) using HMB-45 and MIB-1 (for Ki-67) antibodies. TMN showed some of the following findings: epidermal changes (parakeratosis, ulceration, serum crust, flattening of the epidermis) and dermal changes including fibrosis and the presence of melanophages. In some cases, there was architectural disorder of the overlying melanocytes, with crowding in the basal layer, but without significant pagetoid spread. Occasionally, the dermal scar contained larger, more epithelioid-appearing melanocytes than those beneath the scar. Fifty-four percent of TMN lacked obvious immunohistochemical maturation with HMB-45, since nevus cells within the scar or directly beneath it were strongly labeled. None of the TMN showed appreciable labeling for Ki-67. The exact clinical duration between trauma and biopsy could not be determined. Loss of maturation with HMB-45 in TMN can be a diagnostic pitfall in challenging cases. Concurrent evaluation of MIB-1 expression, along with the characteristic histologic features of trauma, should allow the correct diagnosis to be reached.

Pseudoxanthoma elasticum–like papillary dermal elastolysis: A large case series with clinicopathological correlation

Pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE) is a rare acquired elastic tissue disorder. To date, less than 20 cases have been reported. We report a case series of 17 patients presenting with PXE-like PDE and discuss the clinicopathological correlation. Seventeen cases of PXE-like PDE were collected prospectively and evaluated for common demographic, clinical, and histopathological features. All patients were women with a mean age of 61.8 years. The lateral sides and back of neck were the most common sites of involvement (100%), followed by the supraclavicular region (41.2%) and the axilla (35.3%). Systemic involvement was absent in all cases, and in 7 patients the discovery of PXE-like PDE was an incidental finding. The main histopathologic features included complete loss (82.4%) or marked reduction (17.6%) of elastic fibers in the papillary dermis and the presence of melanophages in the same zone (88.2%). Our results require validation with a larger series. Our findings help to differentiate PXE-like PDE from similar elastic tissue disorders based on the selective elastic tissue elimination in the papillary dermis and the presence of melanophages in the same zone as a possible consequence of subclinical junctional photodamage. PXE-like PDE is likely underdiagnosed rather than rare, and dermatologists should be aware of its similarity to inherited PXE to spare unnecessary investigations because of the lack of systemic involvement. Clinicopathologic correlation is critical as hematoxylin-eosin staining is nonspecific and elastic tissue stains are necessary to make the correct diagnosis.

A Case of Linear Lichen Planus Pigmentosus

Lichen planus pigmentosus (LPP) is chronic pigmentary disorder that shows diffuse or reticulated hyperpigmented, dark brown macules on the sun-exposed areas such as the face, neck and other flexural folds. Clinically, it is different from classical lichen planus because LPP has a longer clinical course and it manifests with dark brown macules. In case of LPP, involvement of the scalp, nail or mucosal area is rare. The histopathological findings of the lesions show an atrophic epidermis, the presence of melanophages and a vacuolar alteration of the basal cell layer with a sparse lymphohistiocytic lichenoid infiltration. Although there have been a few reports of LPP, there have only 3 cases of linear LPP along the lines of Blaschko in the Korean dermatologic literature. Our patient had lesions on the neck and chin with a linear pattern. In this report, we describe a very rare case of LPP with a linear distribution related to Blaschko's lines on the neck and chin areas.

Regresión en el melanoma: problemas en su definición e implicación pronóstica

Between 10 % and 35 % of all melanomas show histological regression. That is, there is an area within the melanoma where the tumor retreats or disappears to be progressively replaced by fibrosis with presence of melanophages and variable degrees of inflammation, and neovascularization. Such regression is generally considered an indicator of poor prognosis in melanoma, although a number of studies contradict this affirmation.In this review, we summarize the leading articles about the influence of regression on melanoma prognosis. The results of these studies are very inconsistent, and so the prognostic significance of regression is somewhat controversial. We believe that some of these differences can be explained by differing criteria for regression and so we propose clear histological criteria to define early and sustained regression.