Type Of Nevus Research Articles

Blue-Whitish Veil-like Structure as the Primary Dermoscopic Feature of Combined Nevus

The combined nevus is a clinical simulator of melanoma, and clinical examination alone can be inadequate to diagnose this melanocytic pigmented skin lesion. Dermoscopy is a useful tool to differentiate the features related to each type of nevus. We report two cases of combined nevi dermoscopically characterized by a diffuse blue-whitish pigmentation similar to the blue-whitish veil, suggesting the diagnosis of melanoma.

Is melanocytic nevus with focal atypical epithelioid components (clonal nevus) a superficial variant of deep penetrating nevus?

We compare features of two similar nevi which may be confused with melanoma: deep penetrating nevus (DPN), and nevus with focal atypical epithelioid component (NFAEC). Clinical/demographic and histologic information regarding 146 DPN and 81 NFAEC were compared. Patient outcomes were ascertained via a questionnaire solicited to the referring physicians. Clinical features were similar for each type of nevus. Histologically, all lesions demonstrated identical aggregates of epithelioid melanocytes. DPN more often extended into the deep dermis or subcutaneous tissue, while NFAEC was typically confined to the superficial dermis. NFAEC more often demonstrated a junctional component (P < .001) and coexistent common nevus with congenital features (P = .035). DPN more often demonstrated adnexal spread (P < .001). A subgroup with overlapping features was identified. With an average of 6.4 years follow-up, there were just two recurrences, and no metastases. This retrospective study utilized tissue specimens from a single reference laboratory; ergo, some inherent selection bias exists. Specimens were randomly selected for P53 immunostaining, leading also to potential sampling error. DPN and NFAEC show considerable similarity, differing mainly in the depth of extent for the lesion. It is possible that NFAEC represents a more superficial variant of DPN. A subgroup with overlapping features, but intermediate depth, supports such a relationship.

Junge Patientin mit Pfortader- und Mesenterialvenenthrombose sowie Proteus-Syndrom

In the 26th year of life a young woman suffered a portal and mesenteric thrombosis followed by portal hypertension with splenomegaly, esophageal varices and pancytopenia. After splenorenal shunt surgery and splenectomy hematologic parameters resolved rapidly. Also, she was suffering of Proteus syndrome, which is an extremely rare and sporadic hamartomatous disorder characterized by a variety of cutaneous and subcutaneous tumors including vascular malformations, several types of nevi, partial gigantism of the hands and/or feet and cystic visceral affections. It has been demonstrated that concurrence of several prothrombotic risk factors occur relatively often in patients with portal vein thrombosis. An extensive investigation of thrombophilic factors revealed reproduced high anti-beta2-glycoprotein I antibody titers together with mildly increased homocysteine levels. Other coagulation parameters were normal or negative. The presence of myeloproliferative moglobinuria was ruled out. Together with the history of recurrent superficial thrombophlebitis and portal vein thrombosis in the absence of other underlying diseases allowed for diagnosis of primary antiphospholipid syndrome being aggravated by hyperhomocysteinemia and vascular malformations caused by Proteus syndrome. Because of combined risk factors for further thrombembolisms permanent oral anticoagulant therapy was initiated.

Morphologic Changes of Acquired Melanocytic Nevi With Eccentric Foci of Hyperpigmentation (“Bolognia Sign”) Assessed by Dermoscopy

Melanocytic nevi with eccentric foci of hyperpigmentation ("Bolognia sign") can be considered as a melanoma-simulating type of acquired melanocytic nevus. We report on the morphologic changes of this type of melanocytic nevus over a 39-month period of dermoscopic follow-up. A 5-year-old girl had a 4-mm brown papule with a peripheral blue-black area on her right upper arm. The eccentric focus of the hyperpigmentation corresponded dermoscopically to a blue-gray area of pigmentation associated with irregular brown-black globules or dots and partially with a superficial black network. After 39 months, a globular type of acquired melanocytic nevus was detectable, which clinically and dermoscopically appeared to be completely benign. A nearly identical situation was observed in 5 other melanocytic nevi, underlining the involution of the pigmented foci in these nevi. The histopathologic diagnoses of 2 lesions were consistent with a compound type of acquired melanocytic nevus with eccentric foci of hyperpigmentation. Dermoscopy allows identification of a morphologic pathway of modifications, probably typical for this type of melanocytic nevus in children, and therefore enables avoidance of surgical excision with attendant hypertrophic scarring in children. Conversely, in adults, when dermoscopic follow-up of melanocytic nevi reveals eccentric foci of hyperpigmentation, surgical excision of the lesion is indicated.

Expression of sex hormone receptors and cell cycle proteins in melanocytic lesions of the ocular conjunctiva

Both dermal and ocular melanocytic nevi have been reported to undergo changes during pregnancy. This has been proposed to be related to hormonal influences; however, few studies have provided any proof. We therefore set out to evaluate the expression of sex hormone receptors and cell cycle proteins in melanocytic lesions of the ocular conjunctiva. Formalin-fixed, paraffin-embedded material from 76 tumors--69 conjunctival nevi, 5 specimens of primary acquired melanosis (PAM), and 2 conjunctival melanomas--were included in a tissue microarray (TMA) format. The TMA sections were analyzed by immunohistochemistry with antibodies for progesterone and estrogen receptors, and cell cycle-related proteins (p16, MIB1-Ki67). Progesterone receptors were highly (96%) and similarly expressed in all lesions. In addition, progesterone receptor expression showed a tendency to increase with age (p=0.06). In contrast, estrogen receptor expression was completely absent in all tumors. The cell cycle regulator p16 was expressed in 97% of the lesions. The proliferation marker MIB1-Ki67 was expressed at low levels (mean+/-SD: 13+/-14%) in 79% of the lesions. No differences of expression were found between the different lesions and nevi types. The mean age of the patients was highest in conjunctival melanoma (70+/-22 years), followed by PAM (60+/-19 years) and nevi (36+/-18 SD years). The different types of nevi also showed significant age dependency (junctional 25+/-17 years, compound 34+/-17 years, dermal 49+/-15 years). Our findings reveal the expression of progesterone, but not estrogen, in melanocytic lesions of the ocular conjunctiva. In benign conjunctival lesions, p16 and MIB1-Ki67 expression was comparable to that in benign nevi of the skin.

The melanocytic nevus described by Clark et al. What is its nature? What should it be named? An answer from history and from logic

The article by Shapiro et al., which summarizes a survey of respondents on the words or phrases they use to identify the melanocytic nevus described by Clark et al. in 1978, shows that over 70% of The American Society of Dermatopathology (ASDP) members and nearly 85% of The American Academy of Dermatology (AAD) members preferred one of the following phrases: ‘‘dysplastic nevus’’, ‘‘nevus with architectural disorder’’, ‘‘atypical nevus’’, or ‘‘atypical melanocytic hyperplasia’’. Only about 11% of the ASDPmembers and less than 5% of the AAD members identified the nevus as either a ‘‘Clark’s nevus’’ or a ‘‘compound nevus’’, thereby avoiding the designations ‘‘dysplastic’’, ‘‘architectural disorder’’, and ‘‘atypical’’. This article revealed one important fact about the nature of the melanocytic nevus that has for over 26 years eluded and confounded dermatopathologists, pathologists, and dermatologists alike. The fact is that the disparate, inconsistent nomenclature applied to this particular type of melanocytic nevus reflects a conceptual conundrum that exists in the minds of susceptible histopathologists. This nomenclature results in producing confusion and uncertainty and implies that melanoma cannot be excluded in these lesions vis-a-vis the pairing of the terms ‘‘atypical’’, ‘‘dysplastic’’, or ‘‘disordered’’ (implying that one cannot exclude malignancy) with ‘‘melanocytic nevus’’ (a phrase of certainty that refers to a hamartoma or benign neoplasm). The actual melanocytic nevus in question is, however, either a hamartoma or a benign neoplasm that never killed anyone and never will. Its diagnosis should, therefore, be clean, clear, and unequivocal. What is the origin of this uncertainty? Why have 26 years, two consensus conferences (resulting in no consensus), and tens of millions of dollars of National Institutes of Health’s grant money failed to produce a rational, uniform approach to the diagnosis of this type of melanocytic nevus? In my opinion, there are several reasons for this failure, chief among which are:

Nevus Psiloliparus and Aplasia Cutis: A Further Possible Example of Didymosis

Nevus psiloliparus is a distinct type of mesodermal nevus of the scalp characterized by absence or paucity of hair, and presence of an excessive amount of fatty tissue. It is considered a hallmark of encephalocraniocutaneous lipomatosis, a rare disorder comprising a variety of cutaneous, ophthalmologic, and neurologic defects. We report two infants with encephalocraniocutaneous lipomatosis with nevus psiloliparus on the scalp in close association with aplasia cutis congenita. This unusual association may be considered a further example of didymosis, for which we propose the term, didymosis aplasticopsilolipara.

Nevus sebaceus with psammomatous calcified spherules in the apocrine glands

To the Editor: Nevus sebaceus is a distinct clinicopathologic type of epithelial nevus.1 Apocrine glands in nevus sebaceus are frequently observed,2 but calcification in apocrine glands is a rare finding.

Oral Nevi-A Clinicopathological Study of 29 Cases

Oral nevi are uncommon oral mucosal lesions. Twenty-nine cases of oral nevi including 21 intramucosal, 2 compound, and 6 common blue nevi were analyzed in this study. These 29 nevi were excised from 8 male and 19 female patients. Two patients each had 2 nevi. The mean age of patients at the time of diagnosis was 33 (range, 7~56) years. The more-common sites for oral nevi were the hard palate (12 cases) and vermilion border (9 cases). All 6 common blue nevi were located on the hard palate. The greatest dimension of the lesion was ≧1 cm in 3 cases and ＜1 cm in 24 cases. Excisional biopsy was the treatment of choice in 27 cases and wide excision in 2 cases. No recurrence of these lesions was found after surgical excision. Type A, type B, type C, and multinucleated giant nevus cells were found in 23 (100%), 19 (83%), 14 (61%), and 12 (52%) of 23 cases of intramucosal and compound nevi. The mean percentages of type A, type B, and type C nevus cells in total nevus cells were 73%±25%, 17%±15%, and 11%±18% in 23 cases of intramucosal and compound nevi, respectively. All 23 cases of intramucosal and compound nevi more or less contained nevus cells with pigmentation which varied from 1% to 91% (mean, 20%±26%). We concluded that the most-common type of oral nevi is an intramucosal nevus. Intramucosal and compound nevi were composed of approximately 3/4 of type A and 1/4 of type B and type C nevus cells. Oral nevi in this study occurred more often in female patients and in the third and fourth decades of life. The more-commonly affected sites were the hard palate and vermilion border. About 90% of these oral nevi were smaller than 1 cm.

Carbon Dioxide Laser Therapy for an Inflammatory Linear Verrucous Epidermal Nevus: A Case Report

The treatment of an inflammatory linear verrucous epidermal nevus (ILVEN), an uncommon type of epidermal nevus, is still controversial. The use of laser therapy is a recently reported method. Although various results have been reported with the use of the laser in the treatment epidermal nevis, the authors have not seen any report on the use of the carbon dioxide laser in ILVEN treatment. They present case of ILVEN treated with the carbon dioxide laser. All symptoms (erythema, excoriation, granulation, and pruritus) disappeared. Instead, a pale pigmentation was seen.

Dermoscopic features of combined melanocytic nevi.

In order to investigate the possible role of dermoscopy in the non-invasive classification of combined nevi, we analyzed dermoscopic features of a series of combined nevi consecutively excised. Two dermatologists expert in dermoscopy retrospectively evaluated all images based on the presence of dermoscopic findings to analyze which epiluminescence microscopy features were more frequently associated with each type of combined nevus. Dermoscopy may provide useful information in the non-invasive diagnosis of combined nevi, allowing a conservative management, but this may be limited to combined nevi including a blue nevus component. Conversely, combined nevi including a Spitz nevus component may be difficult to classify even by dermoscopy, thus requiring careful monitoring or surgical excision.

Mutations of the BRAF Gene in Benign and Malignant Melanocytic Lesions

A single-point mutation in exon 15 of the BRAF gene has recently been reported in a high percentage in cultured melanoma cells and in 6 of 9 primary melanomas examined. To evaluate the impact of the T1796A BRAF mutation, we screened primary melanomas, various types of nevi and lesions where a melanoma developed in an underlying nevus. We could detect the mutation in 28 of 97 (29%) melanomas and in 39 of 187 (21%) nevi, including blue nevi (0/20) and Spitz nevi (0/69), which did not carry the mutation. In melanomas with an underlying nevus, either the mutation was present in both the laser-microdissected nevus cells and the laser-microdissected melanoma cells (3/14) or both lesions were negative for the BRAF mutation except one case. In conclusion, mutations in exon 15 of the BRAF gene are nonspecific for progression of a nevus to a melanoma. Other so far unknown cofactors seem to be of importance.

A distinctive type of widespread congenital melanocytic nevus with large nodules

We report an unusual case of congenital melanocytic nevus presenting in a 19-year-old African woman as widespread papules and variably sized nodules and tumors affecting the entire body, including the palms, soles, and oral mucous membrane. Histopathologic examination of 3 representative skin lesions showed mainly dermal aggregations of round to oval, focally pigmented, monomorphous melanocytes, arranged in nodular and plexiform patterns. Scattered areas with spindle-shaped dendritic melanocytes surrounded by fibrosis were also noted in the center of the lesions. The clinical and histopathologic findings were similar to those in 2 other previously reported cases, except that in 1 of the earlier cases the skin nodules were composed of spindle-shaped cells, suggesting a type of blue nevus. The findings in our case indicate a broader spectrum of morphologic features in this condition, with dermal aggregations of melanocytes showing congenital features, representing a common histopathologic denominator. Based on this observation, we suggest the term “widespread congenital dermal nevus with large nodules” to be the most appropriate for this rare, but distinctive, type of congenital nevus. (J Am Acad Dermatol 2003;49:732-5.)

Klinische Wertigkeit einer dermatoskopischen Klassifikation von Clark‐Nävi

Hintergrund und Fragestellung: Ziel dieser Studie war es, die klinische Wertigkeit einer dermatoskopischen Klassifikation von Clark‐Nävi zu untersuchen. Patienten/Methodik: Die dermatoskopischen Bilder von 268 konsekutiven Läsionen, die klinisch und dermatoskopisch als Clark‐Nävi imponierten, wurden von zwei Dermatologen ohne Kenntnis der histologischen Diagnose begutachtet. Die begutachteten Läsionen wurden in Anlehnung an das von Hofmann‐Wellenhof vorgeschlagenen Klassifikationsschema für Clark‐Nävi in 12 verschiedene Grundtypen unterteilt. Ergebnisse: Insgesamt vorherrschend war der retikulär‐homogene Typ (n = 64, 23,9 %) gefolgt vom globulär‐homogenen Typ (n = 32, 12 %) und vom homogenen Typ (n = 30, 11,2 %). In bezug auf die Klassifikation fand sich insgesamt eine moderate bis gute Übereinstimmung zwischen den Untersuchern (kappa = 0,58). Die höchste Übereinstimmung fand sich beim peripher hyperpigmentiertenTyp (kappa = 0,83). Histologisch wurden siebzehn (6,3 %) Läsionen als Melanome befundet. Die meisten Melanome fanden sich, je nach Untersucher, beim peripher hyperpigmentierten Typ und beim homogenen Typ. Kein Melanom fand sich beim globulären Typ, retikulär‐globulären Typ und zentral hyperpigmentierten Typ. Schlußfolgerungen: Eine dermatoskopische Klassifikation von Clark‐Nävi ist praktisch anwendbar und erlaubt mit Einschränkungen eine gewisse Risikoeinschätzung, die das klinische Management von Clark‐Nävi erleichtern kann.

Dermoscopic classification of Clark’s nevi (atypical melanocytic nevi)

Clark’s nevi (atypical melanocytic nevi) are acquired melanocytic lesions that are well known clinically by physicians and especially by dermatologists. Clark’s nevi are named for Wallace H. Clark, Jr., who first drew attention to this particular type of nevus in studies of numerous melanocytic nevi in patients with concomitant melanomas. This melanocytic nevus, originally designated B-K mole, has also been called dysplastic nevus or atypical mole. We prefer to use the nomenclature set forth by Ackerman and Magana-Garcia and designate these acquired melanocytic lesions as Clark’s nevi. © 2002 by Elsevier Science Inc. All rights reserved.

Dermoscopic classification of Spitz/Reed nevi

First described in 1948 by Sophie Spitz as “melanoma of childhood,” Spitz nevus is a benign, melanocytic neoplasm histopathologically characterized by cytoarchitectural features resembling melanoma but exhibiting a benign biologic behavior.[1] In later studies, Arthur Allen and Sophie Spitz [2] recognized this melanocytic lesion as a distinct type of nevus that, over the years, has been variably named benign juvenile melanoma, spindle-cell and epithelioid nevus, and nevus of large-spindle and/or epithelioid cells. Spitz nevus typically occurs in childhood and adolescence, although it may be present at birth or develop in patients >20 years of age. Whites seem to be more frequently affected than African and Asian populations, although under-diagnosis of these nevi in black individuals has been hypothesized.

Dermoscopic classification of atypical melanocytic nevi (Clark nevi).

To create a dermoscopic classification of atypical melanocytic nevi (Clark nevi) and to investigate whether individuals bear a predominant type. Digital dermoscopic images of Clark nevi were classified according to structural features, ie, reticular, globular, or homogeneous patterns or combinations of these types. The nevi were also characterized as central hypopigmented or hyperpigmented, eccentric peripheral hypopigmented or hyperpigmented, or multifocal hypopigmented or hyperpigmented. Two pigmented skin lesion clinics. We examined 829 Clark nevi on 23 individuals. A reliable dermoscopic classification of Clark nevi and frequency of different dermoscopic types. Using the dermoscopic classification, the 829 Clark nevi were classified as follows: 221 (26.7%) as reticular, 167 (20.1%) as reticular-homogeneous, 148 (17.9%) as globular-homogeneous, 112 (13.5%) as reticular-globular, 89 (10.7%) as homogeneous, 84 (10.1%) as globular, and 8 (1.0%) as unclassified. Most individuals were prone to a predominant type of Clark nevus. Seven individuals (30%) showed a single type of Clark nevus in more than 50% of their nevi and 5 (22%) in more than 40% of their nevi. The proposed dermoscopic classification of Clark nevi is easily applicable and allows a detailed characterization of the different dermoscopic types of Clark nevi. Knowledge of these dermoscopic types should reduce unnecessary surgery for benign melanocytic lesions. Exact classification of the different types of Clark nevi is a necessary prerequisite for further clinical, dermoscopic, and histopathologic studies, which will give new insights in the biology of acquired melanocytic nevi.

Epithelioid blue nevus: neoplasm Sui generis or variation on a theme?

The epithelioid blue nevus has recently been associated with the Carney complex, which is characterized by myxomas, spotty skin pigmentation, endocrine overactivity, and schwannomas. Using the general criteria proposed by Carney and Ferreiro, similar lesions were identified in 33 patients with no evidence of the Carney complex. Those lesions presented on the face, trunk and extremities of 15 males and 18 females. The mean age was 35 years, much older than those in the Carney complex (mean 16.3 years). Clinical diagnoses included malignant blue nevus, atypical nevus, melanoma, congenital nevus, and dermatofibroma. The lesions were symmetric, predominantly dermal melanocytic proliferations arranged as short fascicles, small nests, and single cells. Large polygonal and epithelioid melanocytes with moderate pleomorphism, and occasional nuclear pseudoinclusions were admixed with heavily pigmented dendritic and spindled melanocytes and melanophages. Rare mitotic figures were seen in some cases. The neoplasms showed a morphologic spectrum that encompassed a group of combined blue nevi with epithelioid melanocytes and other Spitz's nevus characteristics. These epithelioid combined nevi (ECN) fell into three phenotypes with morphologies that most closely paralleled those pictured by Carney and Ferreiro in the Carney complex: the classic or Carney complex pattern (ECN-CC), those that showed overlap with deep penetrating nevus (ECN-DPN), and those that have many dermal Spitz's nevus features, [BLue + SpITZ's nevus; (ECN-BLITZ)I. In six cases, there was such an admixture of features that it was difficult to ascribe them to one of the groups. Nine lesions had associated banal congenital nevus. Follow-up that averaged over 2.5 years (31 months) (range 6-162 months) showed no evidence of malignancy or recurrent disease after excision. Epithelioid combined nevus is a type of combined nevus with blue nevus and Spitz's nevus features, which may or may not be associated with the Carney complex. It shows morphologic overlap with the epithelioid blue nevus described by Carney (ECN-CC), deep penetrating nevus (ECN-DPN), and blue nevus with intradermal Spitz's (desmoplastic) nevus (ECN-BLITZ). Epithelioid combined nevus is thought to be a fitting nosologic designation for all of these lesions.

"Tubular Spitz's nevus" an artifact of fixation?

Spitz's nevi may contain numerous tubule-like structures. This phenomenon has been described as "tubular Spitz's nevus" and has been attributed to either apoptosis in the center of nests of melanocytes or tubular metaplasia of melanocytes. In order to study this peculiar phenomenon, we reviewed 31 Spitz's nevi from our teaching collection. Empty spaces vaguely resembling tubules were found in 15 Spitz's nevi, all of which were examples of the epithelioid-cell type of Spitz's nevus. Histopathologically and immunohistochemically, there was no evidence of apoptosis within or around tubule-like structures. Empty; spaces in the center of nests ranged from distinctive tubule-like structures to only slight separation of melanocytes from one another. Furthermore, empty spaces were also seen around nests, often in combination with distinctive tubule-like changes. Our findings suggest that so-called "tubular" structures in epithelioid Spitz's nevi result from retraction of tissue secondary to fixation in formalin. "Tubular Spitz's nevus" seems to represent an artifact rather than a distinctive variant of Spitz's nevus.

Segregation von Pigmentzellanomalien bei Kreuzungen zwischen dem Münchener Miniaturschwein Troll und der Deutschen Landrasse

Abstract. Title of the paper: Segregation of melanocytic lesions in crosses among the Munich Miniature Swine Troll and German Landrace Since 1986, a line of Munich Miniature Swine (MMS) Troll showing a high incidence of spontaneous benign and malignant cutaneous melanocytic lesions has been established at the University of Munich. In order to study me inheritance of cutaneous melanocytic lesions in the Munich Miniature Swine Troll, we established the F1-, F2-, BIDL-, and BITroll-generations, starting with one melanoma-bearing MMS Troll boar and four non-affected sows of the German Landrace (DL) as founder animals. A total of 176 animals were available, 27 in the F1-, 111 in the F2-, 19 in the B|DL-, and 14 in the BITroll-generation. Benign melanocytic lesions with two distinct forms of basal melanocytic hyperplasia or nests of hyperplastic melanocytes like in human junctional nevus were observed in 10 (41,7%) F1-, 20 (18%) F2-, 2 (10,5%) BIDL-, and 7 (50%) BITroll-animals. Malignant melanomas were found in four (3,6%) F2- and one (7,1%) BITroll-animals, but did not occur in the F1- and BIDL-generations. The observed segregation pattern suggests a different mode of inheritance for benign melanocytic lesions and melanomas, respectively. An influence of SLA haplotypes could not be observed. However, a significant influence of coat colour on the occurence of melanoma could be found in the F2-generation. While around 65% of F2-animals had the German Landrace dominant white colour, melanomas were only found in black and red animals. Benign lesions of the junctional nevus type, too, were only found in black animals. A possible explanation is the lack of melanocytes in the skin of dominant white pigs caused by a mutation of the KIT-gene, which leads to a failure of melanoblast migration and development