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PubMed2000

Malignant melanoma with paradoxical maturation.

Typically, melanocytic nevi "mature" (i.e., exhibit a morphologic shift to smaller or spindle cells with progressive depth in the dermis). In contrast, most malignant melanomas (conventional MMs) lack maturation, and are composed of large pleomorphic cells throughout. The authors describe a series of melanomas with paradoxical maturation mimicking the pattern of nevi. Seventeen primary invasive melanomas with paradoxical maturation (IMPs), two epidermotropic metastatic melanomas with maturation (EMMMs), 13 compound nevi (CN), and 14 conventional MMs without apparent maturation were analyzed by histologic, cytomorphometric, and immunohistochemical techniques. With increasing dermal depth, both CN and IMPs had smaller nuclear and cellular areas, and decreased expression of Ki-67, glycoprotein (gp)100 (with HMB-45), and tyrosinase. IMPs had significant differences from conventional MMs; namely, smaller nuclear and cytoplasmic areas (deep), and decreased expression of Ki-67 (superficial and deep), gp100 (deep), and tyrosinase (deep). IMPs also had notable differences from CN: namely, larger nuclear and cellular areas, more confluence, more mitotic figures, increased Ki-67 and gp100 expression in both the superficial and deep portions, and more melanin (deep). The two EMMMs exhibited histologic and immunohistochemical features similar to the primary IMPs. IMP, because of its mimicry of nevus, can present a diagnostic hazard. The authors propose histologic, morphometric, and immunohistochemical criteria that facilitate recognition and accurate diagnosis of this unusual variant of melanoma.

Adolescent↗
PubMed1995

Role of high-resolution magnetic resonance imaging for differentiating melanin-containing skin tumors.

RATIONALE AND OBJECTIVES: The aim of the study was to evaluate the use of high resolution magnetic resonance imaging (MRI) for differentiation of melanin-containing skin tumors. METHODS: Twenty-seven melanocytic nevi and 18 malignant melanomas were examined by high resolution MRI. Signal intensities and signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of the tumors were determined in enhanced (T1, T2, water-suppression, and fat-suppression sequences) and contrast-enhanced images (T1 and fat-suppression sequences). The differences were tested for significance by a Wilcoxon test. RESULTS: Malignant melanomas differed from melanocytic nevi in that they displayed a higher SNR in T2-weight and unenhanced and contrast-enhanced fat-suppression scan. Malignant melanomas exhibited a higher CNR than did benign lesions in unenhanced and contrast-enhanced fat-suppression sequences with dermis as reference tissue (P < 0.05) and in enhanced fat-suppression sequences with subcutis as reference tissue (P < 0.05). CONCLUSIONS: The usefulness of SNR and CNR analysis on MRI for the differentiation of malignant skin tumors from benign skin tumors of the melanin-containing system is limited. Clinical and histologic examinations are, further, the important step in evaluation of melanin-containing skin tumors.

Adipose Tissue↗
PubMed1996

Infrequent mutation of p16INK4 in sporadic melanoma.

Loss of heterozygosity of chromosome region 9p21 occurs commonly and early in sporadic melanoma, suggesting the involvement of a tumor suppressor gene at this locus in the pathogenesis of this neoplasm. Although germline mutations and deletions of the p16INK4 gene located at 9p21 have been reported in familial melanoma, the relative contributions of mutation and deletion in sporadic melanoma are at present unclear. In this study, we investigated 26 cases of sporadic cutaneous melanoma (14 of which demonstrated loss of heterozygosity at 9p21) for mutations of p16INK4. One tumor with allelic loss of 9p contained a CC-->TT mutation at codons 57/58, altering an arginine to a stop codon, consistent with bi-allelic inactivation of p16INK4 in this case. No mutations were identified in any of the other melanomas, or in one benign intradermal nevus with atypical features and two Spitz nevi that also showed loss of heterozygosity of 9p. The inactivation of both copies of p16INK4 in the one case of melanoma adds support to the theory that p16INK4 is important in the development of sporadic cutaneous melanoma, although allelic loss or other methods of inactivation of p16INK4 rather than point mutation appears to be numerically more important. The low frequency of mutation of p16INK4 in cases of sporadic melanoma with loss of heterozygosity of 9p is, however, also consistent with there being another tumor suppressor gene near this locus that is involved in some cases of sporadic melanoma.

Base Sequence↗
PubMed2004

Sclerotic fibroma-like change in various neoplastic and inflammatory skin lesions: is sclerotic fibroma a distinct entity?

Sclerotic fibroma was first described in association with Cowden's disease by Weary et al. in 1972. In 1989, Rapini and Golitz detailed 11 cases of solitary sclerotic fibroma (SFS) in the absence of Cowden's disease, suggesting the term SFS of the skin. Classic histological features include hypocellular, hyalinized bands of collagen sharply demarcated from the surrounding skin. Numerous authors have described sclerotic fibroma-like changes in other entities including melanocytic nevi, dermatofibromas, lipomas, tendon sheath fibromas, giant cell collagenomas, neurofibromas, angiofibromas, erythema elevatum diutinum, and folliculitis. Dissension has arisen, with some dermatopathologists asserting that sclerotic fibroma is just an evolutionary end-point of a previous lesion. Others contend that SFS is a distinct lesion and cite recurrent cases and/or proliferation marker studies to corroborate this view. We detail the histopathological findings of lesions consistent with the classic description of SFS and compare these to sclerotic changes observed in an intradermal nevus, blue nevus, erythema elevatum diutinum, neurofollicular hamartoma, angiofibroma, neurofibroma, accessory nipple, and dermatofibromas. Sclerotic fibroma-like change may be seen in a variety of lesions and may represent a common reaction pattern in the skin.

Adolescent↗
PubMed1994

Surface microscopy of naevi and melanomas--clues to melanoma.

In this present study, 260 histologically confirmed melanocytic skin tumours (188 benign naevi and 72 malignant melanomas; from 1989 to 1990) were investigated with regard to valid surface microscopical criteria of malignancy. The tumours were analysed using a system which assessed eight components. Most melanomas were characterized by the following pattern: asymmetrical pigment distribution, more than three colours, black pigment, peripheral stripes, and asymmetrical depigmentation. The results were evaluated statistically by contingency tables and logistic regression procedures. On the basis of the classification derived, the sensitivity and specificity were determined for lesions from 1991, and were 0.9 and 0.85, respectively. Many melanocytic naevi were not identified by the above criteria, or were found only occasionally. Pigment network was often absent in naevi and melanomas, and was not decisive for the diagnosis. The present investigation demonstrates that in vivo diagnosis of pigmented melanocytic lesions can be improved by surface microscopy.

Color↗
PubMed1993

Effective detection of plantar malignant melanoma.

BACKGROUND: As the sole of the foot is the most prevalent site of malignant melanoma in non-Caucasians, early detection of the neoplasm at this anatomical site is very important. In our previous study, we proposed a clinical guideline that acquired melanocytic lesions on the sole larger than 7 mm in maximum diameter should be examined histologically. METHODS: Eighty-one Japanese patients with the complaint of plantar pigmented lesions were screened at our dermatology clinic during 3 years using the 7-mm criterion. RESULTS: Of the total 80 melanocytic lesions on the sole, 14 lesions were larger than 7 mm in maximum diameter, excluding congenital lesions. Diagnoses of the 14 "large" lesions were as follows: advanced malignant melanoma, 8 lesions; early malignant melanoma (malignant melanoma in situ), 1 lesion; acquired melanocytic nevus, 4 lesions, and volar melanotic macule, 1 lesion. CONCLUSIONS: The present study confirmed the validity of the 7-mm criterion for the early effective detection of plantar malignant melanoma.

Adolescent↗
PubMed2004

The clinical appearance of clonal nevi (inverted type A nevi).

BACKGROUND: The term "clonal nevus" is used to describe a variant of melanocytic nevus that histologically exhibits a localized proliferation of pigmented epithelioid dermal melanocytes within an otherwise ordinary nevus (Ball NJ, Golitz LE. Melanocytic nevi with focal atypical epithelioid cell components: a review of seventy-three cases. J Am Acad Dermatol 1994; 30: 724-729). Reports to date have focused on the histologic appearance of these lesions. AIM: To characterize the clinical appearance of clonal nevi. METHODS: Clinical and histologic examinations were performed of a single clonal nevus from each of five patients (two men and three women; age range, 37-80 years). RESULTS: All nevi were round to oval in shape with smooth, well-defined borders. They were uniformly tan to light brown in color, except for a single blue-gray to blue-black focus of hyperpigmentation. The diameters of the nevi ranged from 2.5 to 10 mm. In individual nevi, the hyperpigmented focus was either centrally or eccentrically located and measured 1-2 mm in diameter. Histologically, these lesions showed banal melanocytes associated with a localized proliferation of melanocytes with abundant pigmented cytoplasm in the dermis, admixed with melanophages. CONCLUSIONS: The appearance of clonal nevi--tan with a focus of blue-gray to blue-black pigmentation--allows one to recognize the lesion clinically.

Adult↗
PubMed1997

Identification of melanoma risk factors in the Polish population.

BACKGROUND: There is a great deal of literature regarding malignant melanoma risk factors all over the world. However, such data concerning the Polish population has not been published as of yet. OBJECTIVE: To identify the importance of melanoma risk factors including number and distribution of common and atypical nevi of the patients, phenotypic features, and environmental conditions. METHODS: This is a case-control study of 74 melanoma patients and 300 controls. We used histopathological examination to confirm diagnosis of melanoma. Epiluminescence microscopy was introduced for differential diagnosis of all pigmented lesions. RESULTS: The mean number of common nevi in melanoma patients was significantly higher compared with the control group (22.1 vs 15.2; P < 0.05). Atypical nevi in the melanoma patients group and in the control group were encountered in 16.2% and 6.6%, respectively (P < 0.05). In the melanoma group more patients with fair complexion, intense sun exposure, and sunburn were identified compared with the control group. CONCLUSION: It was stated that an increased number of nevi (especially atypical ones), fair skin, and blue/green eyes, as well as intense UV exposure and sunburns, are important risk factors for melanoma development.

Adult↗
PubMedDate not supplied

Nonlipidized juvenile xanthogranuloma: a histologic and immunohistochemical study.

Among all patients with a pathologic diagnosis of juvenile xanthogranuloma (JXG) seen at our institution from 1983 to 1994, we identified five patients with an unusual histologic pattern that differed from the classic juvenile xanthogranuloma (CJXG) with foamy cells and Touton giant cells. Four of these five cases, which we termed nonlipidized juvenile xanthogranuloma (NJXG), were seen in infants. The histologic features include a monomorphic infiltrate with absent or few foam cells and Touton giant cells. There is little inflammation, and mitotic figures are easily found. Four cases exhibit a diffuse sheetlike pattern while one is trabecular. Immunoperoxidase staining was done. All lesions are consistently positive for factor XIIIa as opposed to only focally positive or negative in CJXG and negative in Langerhans cell histiocytosis (LCH). The S-100 was negative. NJXG represents an atypical histologic variant of JXG, which may suggest a malignant or aggressive tumor. The follow-up, however, indicates that these lesions behave in a fashion similar to those of CJXG. The differential diagnosis should be made with LCH, intradermal nevus, and reticulohistiocytosis. The immunoperoxidase findings help to differentiate NJXG from these entities.

Child, Preschool↗
PubMed2007

Changes of epidermodysplasia verruciformis in benign skin lesions: the EV acanthoma.

Foci of histological changes of epidermodysplasia verruciformis (EV) were noted in five benign skin lesions. These skin lesions included an intradermal nevus, a pigmented seborrheic keratosis, an isolated papule on the forearm, a perianal lesion, and an acantholytic acanthoma. Because the changes resembled true EV so strongly despite the absence of clinical EV in these patients, we searched for EV-human papilloma virus (HPV) types in these skin lesions. Polymerase chain reaction (PCR) analysis on the formalin-fixed, paraffin-embedded blocks was performed. As a positive control, we included tissue from two HIV-positive patients with clinical EV proven by biopsy. Studies were also performed on five other archived biopsies that did not show changes of EV on multiple tissue sections. A nested PCR method detected EV-HPV types in three of the five benign skin lesions showing EV changes as well as in the positive controls. EV changes and EV-HPV can be found incidentally on biopsy in the absence of clinical EV; when such changes are the major histopathological finding in an isolated skin lesion, the lesion should be termed an EV acanthoma.

Acanthoma↗
PubMed2004

Relative frequency of solitary melanocytic lesions of the oral mucosa.

BACKGROUND: Solitary pigmented lesions of melanocytic origin are uncommon in the oral mucosa. These lesions include the oral and labial melanotic macule, oral melanocytic nevus, oral melanoacanthoma, oral melanoma and atypical melanocytic proliferation. The purpose of the study was twofold: to report a large series of solitary melanocytic lesions from one source, and to determine the relative frequency of these lesions. METHODS: The study was based on a systematic search of the files of the Pacific Oral and Maxillofacial Pathology Laboratory, University of the Pacific, San Francisco for solitary pigmented melanocytic lesions (benign and malignant) accessed during the years 1984-2002. RESULTS: Of the 89 430 biopsies accessed during the 19-year period, 773 (0.83%) cases of solitary pigmented melanocytic lesions in the oral mucosa were identified. Oral and labial melanotic macules were the most common melanocytic lesions comprising 86.1% of the entire group and 0.7% of the total number of accessed biopsies. The vermilion border and gingiva were the most common sites (31.1% and 31.0% respectively). Oral melanocytic nevi comprised 11.8% of the entire melanocytic group and 0.1% of the total number of biopsies. The most common site was the palate (44%). Intramucosal nevi were the most common (64%), followed by compound nevi (16.5%) and common blue nevi (16.5%). Junctional nevi were uncommon (3.0%). Oral melanoacanthoma comprised only 0.9% of the entire melanocytic group and 0.008% of the total number of biopsies. Oral melanoma and atypical melanocytic proliferation were the least common lesions each comprising 0.6% of the entire melanocytic group and 0.006% of the total number of biopsies. The most common site for oral melanoma was the palate (60%). CONCLUSION: The palate was the most common location for both melanocytic nevi and oral melanoma. Thus, all melanocytic lesions in the palate should be viewed with caution and biopsy is recommended to rule out melanoma. Further studies are required to elucidate the entity of oral atypical melanocytic proliferation.

Adolescent↗
PubMed2002

Imaging skin pathology with polarized light.

Linearly polarized light that illuminates skin is backscattered by superficial layers and rapidly depolarized by birefringent collagen fibers. It is possible to distinguish such superficially backscattered light from the total diffusely reflected light that is dominated by light penetrating deeply into the dermis. The method involves acquisition of two images through an analyzing linear polarizer in front of the camera, one image (I(par)) acquired with the analyzer oriented parallel to the polarization of illumination and one image (I(per)) acquired with the analyzer oriented perpendicular to the illumination. An image based on the polarization ratio, Pol=(I(par)-I(per))/(I(par)+I(per)), is created. This paper compares normal light images, represented by I(per), and Pol images of various skin pathologies in a pilot clinical study using incoherent visible-spectrum light. Images include pigmented skin sites (freckle, tattoo, pigmented nevi) and unpigmented skin sites [nonpigmented intradermal nevus, neurofibroma, actinic keratosis, malignant basal cell carcinoma, squamous cell carcinoma, vascular abnormality (venous lake), burn scar]. Images of a shadow cast from a razor blade onto a forearm skin site illustrate the behavior of Pol values near the shadow edge. Near the shadow edge, Pol approximately doubles in value because no I(per) photons are superficially scattered into the shadow-edge pixels by the shadow region while I(par) photons are directly backscattered from the superficial layer of these pixels. This result suggests that the point spread function in skin for cross-talk between Pol pixels has a half-width-half-max of about 390 microm.

Adult↗
PubMed1984

Solcoderm treatment of epidermal growths including intradermal nevi.

Solcoderm was used in the management of various epidermal growths in 372 patients with 1,002 lesions, including condyloma acuminatum, verruca plana, basal cell epithelioma, intradermal nevus, seborrheic and solar keratosis. No antiseptic precautions or local anesthesia were used during the treatment. The results seem promising and suggest that Solcoderm is a simple, safe, and efficient method for the management of these tumors. Cosmetic results were excellent. It is especially recommended when the lesions are in difficult to manage locations for surgical or other known chemical or physical methods, when the patient is not fit for surgical procedures, and when local anesthesia is contraindicated.

Acetates↗
PubMedDate not supplied

[Essential primary cutis verticis gyrata]

OBJECTIVE: To report a rare case of a child with essential primary Cutis verticis gyrata. REPORT: Nine-year-old boy with extensive hypertrophy of scalp skin, with a cerebriform appearance. No underlying neurologic and ophthalmologic disorders were found, and no other cases were described in his family. COMMENTS: The diagnosis of primary Cutis verticis gyrata was established by thickening of the scalp and absence of neurologic and ophthalmologic abnormalities. Differential diagnosis comprises secondary conditions such as: cerebriform intradermal nevus, pachydermoperiostosis, acromegaly, and inflammatory diseases of the scalp. This is the first report of a child with this form of Cutis verticis gyrata.

Journal Article↗
PubMed1993

Recurrent compound naevus of gingiva.

A case is described of a compound naevus of the gingiva. It was unusual in that it showed a number of recurrences and these appeared to be related to the hormonal status of the patient.

Adult↗