Histopathology of cellular naevi and malignant melanomas.
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Humans↗
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[APPEARANCE OF A BENIGN TYPE SCHWANNOMA BESIDE A CELLULAR NEVUS INCOMPLETELY REMOVED SURGICALLY].
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Adolescent↗
The surgical treatment of melanoma.
Some melanomas arise from compound and junctional nevi. Since there is a relatively high incidence of malignant diseases on the soles of the feet and the genitalia, routine removal of nevi developing in those areas is recommended."Juvenile melanomas" are active, cellular nevi occurring in prepubertal children. The clinical course is probably benign. The tenet of excision and dissection in continuity where feasible of the primary melanoma and the regional lymph nodes is reemphasized. When continuous dissection is not possible, regional node dissection is recommended as a separate procedure. Major amputations for melanomas of the extremities are not recommended for the usual case.
Amputation, Surgical↗
Histomorphologic pattern of skin lesions in Kathmandu Valley: a retrospective study.
A total of 85 skin biopsies were analyzed to see the pattern of skin disorders in Kathmandu Valley. Clinico-histopathological correlation was done to see for the inconsistency between clinical and histopathological diagnosis and also to analyse for the false positive diagnosis of melanoma in such lesions. The age of the patients ranged from 10 to 88 years. No gender predominance was observed. Five percent of the lesions were located on head and neck region and rest were distributed over chest, back and extremities. Clinically 21 (24.7%) out of 85 cases showed hyperpigmentation and were diagnosed as melanocytic lesions. Intradermal nevus emerged as the single largest disorder with a total of 11 cases (12.9%). Capillary hemangioma cases constituted the second largest group with a total of 9 cases (10.6%). Seborrhoeic Keratosis (8.2%), Verrucous vulgaris (8.2%) Neurofibroma (7.1%), Nonspecific granulomatous lesions (4.7%) and melanoma (3.5%) formed the other major groups of disorders. Morphea (1.2%), Psoriasis (1.2%) and fungal lesions (1.2%) commonly seen in other studies were not found to be common among the skin disorders in the present study.
Adolescent↗
Induction of different morphologic features of malignant melanoma and pigmented lesions after transformation of murine melanocytes with bFGF-cDNA and H-ras, myc, neu, and E1a oncogenes.
Malignant melanomas show a remarkable degree of heterogeneity because of different morphologic features, biologic behavior, and prognosis. In this communication, the authors attempted to correlate morphologic heterogeneity of melanomas with transformation by different activated oncogenes; they studied the histologic features of melanocytic lesions induced by murine melanocytes transformed by basic fibroblast growth factor (b-FGF-cDNA) or H-ras, neu, myc, and E1a oncogenes, and the lesions were compared with those observed in human pathology. Tumors formed after grafting onto syngenic mice or subcutaneous injections in nude mice were studied. In syngenic mice, benign melanocytic lesions reminiscent of intradermal nevus were observed with melanocytes transformed with b-FGF-cDNA, and myc and E1a oncogenes. Benign lesions were also formed by neu-transformed melanocytes when they were grafted concomitantly with keratinocytes, whereas malignant tumors were formed by the same cells when grafted alone or together with fibroblasts. In contrast, H-ras melanocytes always formed malignant tumors. In nude mice, b-FGF-transformed melanocytes induced benign lesions, whereas transformed melanocytes by the other oncogenes formed malignant tumors with distinctive and homogeneous morphologic features that depended on the transforming oncogene. Melanomas with either epithelioid cell, spindle cell, small round cell, and anaplastic cell growth patterns could be distinguished after transformation with H-ras, neu, E1a, and myc oncogenes, respectively. These various histologic types are analogous to those that may be observed in human melanomas, even within the same tumor. These studies suggest a possible molecular mechanism for tumor heterogeneity in which distinct oncogenes or oncogenelike activities can be activated in different tumors or discrete parts of the same tumor.
Animals↗
[A case of Merkel carcinoma with facial localization].
A case of Merkel carcinoma is reported. It concerns a 40-year-old lady, who had first noticed the lesion one year before she came to our observation. The authors point out the rarity of this tumour, whose not distinctive gross appearance (firm, sessile tumour with well circumscribed margins; hyperhemic overlaying skin; slowly increasing volume) may suggest other macroscopic diagnoses such as intradermal nevus or nodular basalioma. The authors also point out the usefulness of a prompt correct clinical diagnosis of this lesion, whose clinical behaviour may be highly aggressive.
Adult↗
Electron microscopic study of nevic corpuscle.
An intradermal nevus, in which a number of nevic corpuscles were clearly observed, was studied, using the electron microscope. Nevic corpuscles contained laminated cells consisting of flattened cytoplasmic processes stretching across the corpuscles to form a complicated labyrinth. The perikaryon of these cells contained premelonosome-like dense bodies and other organelles including mitochondria, rough-surfaced endoplasmic reticulum, free ribosomes, and Golgi apparatus. Neither axons nor dendrites were found in these areas. From these observations, it was concluded that the nevic corpuscles were composed exclusively of nevus cells and could be clearly distinguished from Meissner corpuscles. This view would support the idea of a unitary origin of nevus cells. In addition, an isolated cilium found in a laminated cell is briefly discribed.
Adult↗
[Notes about cutis verticis gyrata (author's transl)].
A case of so-called, "Pseudo"-Cutis verticis gyrata naevocellularis is described. The possible malignant degeneration of this disease, which can also be described as "cerebriform intradermal nevus" is discussed. In this context, a classification of the "Cutis verticis gyrata" is suggested.
Adult↗
Systematized epidermal nevi: case report and review of clinical manifestations.
A 19-year-old woman developed papillary and pigmentary changes of the skin over her entire body with extensive eyelid involvement causing trichiasis. A four-lid blepharoplasty with rotation of the anterior lid lamella led to resolution of the ocular symptoms and secondary cosmetic improvement. Histologic examination of the tissue demonstrated epidermal nevi which are congenital abnormalities of surface or adnexal epithelium. This patient was diagnosed with systematized epidermal nevus as described by Lever's classification. There is a high association of epidermal nevi with other systemic abnormalities; that association is known as "epidermal nevus syndrome" (ENS).
Adult↗
[Cutis verticis gyrata: reduction surgical treatment].
Cutis verticis gyrata (CVG) is a rare cause of acquired scalp thickening; in its primary form, the disease does not show any bone involvement. A 19-year old man had noticed a moderate thickening of the scalp at the age of 15. He progressively developed ridges and furrows in the occipital and parietal areas: after a four-year period, there were ten sagittal and irregularly parallel folds. There was neither pain nor pruritus, and the hair had a normal appearance. Complete neurological examination was unremarkable and the patient was of normal intelligence. All biological investigations, including STH and TSH levels, were normal. X-ray examination and tomodensitometry did not show any bone involvement. Our patient was treated by surgical reduction of the scalp areas involved under general anesthesia, with a very good result. This is a typical case of primary CVG. Differential diagnosis of primary cutis verticis gyrata comprises pachydermoperiostosis, cerebriform intradermal nevus and many secondary conditions associated with hypertrophy and folding of the scalp. A relatively simple surgical treatment results in a major reduction of the scalp thickening, and avoids maceration.
Adult↗
Skin regeneration for giant pigmented nevus using autologous cultured dermal substitutes and epidermis separated from nevus skin.
We have developed a modality of treatment of giant pigmented nevus of intradermal type. This method involves application of autologous cultured dermal substitute (CDS), followed by grafting of epidermis separated from the patient's nevus skin. To prepare the wound bed, autologous CDS was applied onto a full-thickness skin defect after complete excision of the nevus. The excised nevus skin was preserved for 1 week, after which the epidermis was separated from the nevus skin by enzymatic treatment with dispase. The epidermis thus obtained was grafted onto the resulting wound bed. This procedure was used to treat a giant pigmented nevus on a 7-year-old patient. The grafted region was soft with good tone 1 year after epidermis grafting. These results indicate that the present method can achieve complete excision of giant nevus, with esthetically acceptable results, although it requires careful monitoring for a long time.
Child↗
The innervation of intradermal nevi. On the nevus-axon relations.
In the study of the histogenesis of intradermal nevi, the nevus cell-Schwann cell relationship has been a matter of long debate. We have demonstrated a dense axonal supply in the intradermal nevi by protein gene product 9.5 (PGP 9.5) immunohistochemistry. There were small nerve bundles between nevus cell nests and numerous individual axons in the nests of all the intradermal nevi studied. The distribution of these axons was more dense in the deeper and middle portions than in the superficial portion of the nevi. The significance and morphogenesis of this rich axonal supply in the intradermal nevi remain obscure, but this nevic neurotropism suggests an intimate mutual interaction between nevus cells and axons: possibly, some activities of nevus cells stimulating axonal proliferation, or nevus cell migration into the preexisting nerves. The presence of the proliferated axons may have some influences upon Schwannian transformation of the nevus cells. The mode of contact between nevus cell and axon, the presence of true Schwann cells surrounding the proliferated axons and the demonstration of myelin structure should be investigated by further electron microscopic study.
Adult↗
Epithelioid blue nevus: a rare variant of blue nevus not always associated with the Carney complex.
Epithelioid blue nevus is a rare variant of blue nevus that has been recently described in patients with Carney complex. Some of the patients with Carney complex have multiple epithelioid blue nevi and a familial history of similar lesions is often recorded. Epithelioid blue nevus consists of an intradermal melanocytic nevus composed of polygonal epithelioid cells laden with melanin. Neoplastic cells show no maturation at the base of the lesion and, in contrast with the usual stromal changes in blue nevi, epithelioid blue nevus exhibits no fibrosis of the dermis. We have studied three cases of epithelioid blue nevus in three patients with no evidence of Carney complex. The lesions were solitary and there was no family history of similar lesions. Therefore, epithelioid blue nevus is a distinctive variant of blue nevus that may also appear as a sporadic lesion and is not always associated with Carney complex.
Adult↗
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.
Adolescent↗
Benign atypical junctional melanocytic hyperplasia associated with intradermal nevi: a common finding that may be confused with melanoma in situ.
Over the past few years, consultation cases thought to represent melanoma in situ have been received that consisted of otherwise normal intradermal nevi with an abnormal but benign junctional proliferation of melanocytes that we have termed benign atypical junctional melanocytic hyperplasia. In order to evaluate the incidence of this feature, 400 cases of intradermal nevi were reviewed. Of these, 25 (6.2%) qualified for inclusion, making this a rather common phenomenon. Clinically, patient ages ranged from 18 to 64 years (mean, 35 years), with a male to female ratio of 1:1. Face (40%) and back (32%) were the most common locations. Histologically, the lesions were predominantly dome-shaped with an intradermal component consisting of conventional nevus cells. Most importantly, each lesion exhibited prominent individual nevomelanocytic cells dispersed at uneven intervals along the dermoepidermal junction in insufficient numbers to be considered compound nevi. The cells exhibited abundant pale to clear cytoplasm, an increased nuclear:cytoplasmic ratio, and often exhibited prominent nucleoli. However, these lesions could be distinguished from melanoma in situ by the lack of several features including lateral spread, upward epidermal migration, marked cytologic atypia, finely granular "smoky" melanin pigment, mitotic figures, and a subjacent host inflammatory response. All cases behaved in a benign fashion. Although benign atypical junctional melanocytic hyperplasia is a relatively common histological curiosity, it is a potential pitfall in the diagnosis of pigmented lesions.
Adolescent↗
Malignant melanoma arising intradermally in a small congenital nevus of an adult.
The occurrence of a malignant melanoma in a small congenital nevus is a rare event. A malignant melanoma arising intradermally in a small congenital nevus in an adult has not been previously reported. The clinical implications and known information about the prognosis of intradermal malignant melanomas are discussed.
Aged↗
p53 expression is rare in cutaneous melanomas.
Alterations in the tumor-suppressor gene p53 are common in many types of human malignancies, but the potential role of p53 in the pathogenesis of cutaneous melanoma is controversial. The gene product, p53 protein, is normally present in very small amounts in noncancerous tissues. Missense mutations lead to accumulation of mutant p53 in the cells, which makes it detectable immunohistochemically in many cancers. Formalin-fixed, paraffin-embedded sections of 14 primary invasive melanomas, 3 cutaneous melanoma metastases, and 10 predominantly intradermal melanocytic nevi were reacted with a panel of three anti-p53 monoclonal antibodies (mAbs) (PAb240, PAb1801, and DO7) and a mAb against Ki-67 (MIB-1), a marker of cellular proliferation. p53 was not detected in morphologically normal epidermal melanocytes or nevus cells. A single primary invasive melanoma, having a very high index of proliferation (Ki-67 expression in > 50% of cells), had diffuse nuclear labeling with all three anti-p53 mAbs used. Abnormalities of p53 expression occur rarely in cutaneous melanomas, but overexpression of p53 may occur in a subset of melanomas with a high index of proliferation.
Aged↗
Aberrant DNA methylation silences the novel heat shock protein H11 in melanoma but not benign melanocytic lesions.
BACKGROUND: The heat shock protein H11 is silenced in melanoma cell lines, where its forced expression by demethylation with Aza-C triggers apoptosis. OBJECTIVE: To examine whether H11 is silenced by aberrant DNA methylation in melanoma as compared to nevi and normal skin tissues. METHODS: Cell suspensions from benign intradermal nevi, atypical nevi and malignant melanoma tissues were used in reverse-transcriptase PCR and methylation-specific PCR. Paraffin-embedded tissues were stained with H11 antibody. RESULTS: H11 is methylated in 60-75% of melanoma and atypical nevi, but not in normal skin or most benign nevi. Methylation is inversely correlated with H11 expression. CONCLUSION: The heat shock protein H11 is silenced by aberrant DNA methylation in melanoma, but not benign melanocytic lesions or normal skin melanocytes. The data suggest that H11 is a promising target for the molecular therapy of melanoma.
Apoptosis↗