Características clínico dermatoscópica de pacientes pediátricos con nevos melanocíticos congénitos / Dermatoscopic clinical characteristics of pediatric patients with congenital melanocytic nevi

Introducción: El nevo melanocítico congénito es una lesión pigmentada melanocítica, que está generalmente presente en el momento del nacimiento. La dermatoscopia es una técnica útil en el diagnóstico de los nevos. Objetivo: Examinar las características clínicas y dermatoscópicas de pacientes pediátricos con nevos melanocíticos congénitos. Métodos: Investigación de tipo descriptivo transversal. La población incluyó 340 pacientes pediátricos que asistieron a la consulta de dermatoscopia del Hospital Pediátrico Universitario "José Luis Miranda", Santa Clara, entre abril 2016- abril de 2017. La muestra quedó constituida por 128 pacientes con diagnóstico de nevos melanocíticos congénitos. Los datos obtenidos se analizaron a través del paquete estadístico SPSS 21.0. Se emplearon los métodos de la estadística descriptiva. Resultados: El cambio clínico más frecuente fue el crecimiento en 76 (47,8 por ciento) nevos. La localización más comprometida fue en los miembros superiores con 28 (17,6 por ciento) nevos. Existió una relación estadísticamente significativa (p< 0,05) entre el tamaño de los nevos y la localización en zonas fotoexpuestas con la presencia de cambios clínicos. El patrón en empedrado (27,7 por ciento) fue el más frecuente; sin embargo, el patrón globular (24,5 por ciento) se observó en todas las localizaciones. Ninguno de los nevos detectados empeoró hacia el melanoma maligno. Conclusiones: La mayoría de los nevos melanocíticos congénitos en este trabajo aparecieron desde el nacimiento. La presencia de cambios clínicos fue más evidente en las regiones fotoexpuestas. No se observó ningún nevo con estructuras o patrones dermatoscópicos relacionados con malignidad(AU)

Introduction: Congenital melanocytic nevi is a melanocytic pigmented lesion, which is usually present at birth. Dermatoscopy is a useful technique in the diagnosis of nevi. Objective: To examine the clinical and dermatoscopic characteristics of pediatric patients with congenital melanocytic nevi. Methods: Cross-sectional descriptive type research. The data obtained were analyzed through the SPSS 21.0 statistical package. The methods of descriptive statistics were used. Results: The most common clinical change was growth, in 76 (47.8 percent) nevi. The most compromised location was in the upper members with 28 (17.6 percent) nevi. There was a statistically significant relation (p< 0.05) among the size of the nevi and the location in photoexposed areas with the presence of clinical changes. The cobbled pattern (27.7 percent) was the most common; however, the globular pattern (24.5 percent) was observed in all locations. None of the detected nevi worsen towards malignant melanoma. Conclusions: Most congenital melanocytic nevi are shown from birth. The presence of clinical changes was most evident in photoexposed regions. No nevi was observed with dermatoscopic structures or patterns related to malignancy(AU)

Nevo melanocítico congénito gigante / Giant congenital melanocytic nevi

Resumen Los nevos melanocíticos congénitos gigantes (NMCG) son lesiones melanocíticas secundarias a la migración anormal de los melanoblastos durante la embriogénesis. Afectan aproximadamente a 1 de cada 20,000 nacidos vivos y suelen estar presentes desde el nacimiento. Estas lesiones se distinguen porque cambian sus características morfológicas con el tiempo y aumentan su tamaño de forma paralela al crecimiento del niño, alcanzando un diámetro ≥ 20 cm en la edad adulta. La importancia de los NMCG radica en las complicaciones a las que se encuentran asociados, principalmente al desarrollo de melanoma o melanosis neurocutánea, además del impacto psicológico y social que generan en la mayoría de los casos, por lo que quienes los padecen requerirán de un seguimiento multidisciplinario a largo plazo. Actualmente, el manejo de los niños con NMCG continúa siendo controversial, ya que no existe un tratamiento de elección, por lo que este deberá ser individualizado de acuerdo con las características del nevo y las necesidades específicas de cada paciente.

Abstract Giant congenital melanocytic nevi (GCMN) are melanocytic lesions secondary to the abnormal migration of melanoblasts during the embryogenesis, affecting approximately one in 20,000 live births. They are usually present since birth and are distinguished by changing their morphological characteristics within time, and increasing their size parallel to the growth of the child, reaching a diameter ≥ 20 cm in adulthood. The importance of the GCMN lies in the complications associated to them; mainly the development of melanoma or neurocutaneous melanosis, in addition to the psychological or social impact that generates in most of the cases. Therefore, individuals with GCMN will require a multidisciplinary long-term follow-up. Currently, the management of children with GCMN is still controversial since there is no treatment of choice. Consequently, the treatment must be individualized according to the characteristics of the nevus and the specific needs of each patient.

Clinical Analysis of Serial (Staged) Excision for Congenital Melanocytic Nevi: A Single-center Experience / 대한피부과학회지

BACKGROUND: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.OBJECTIVE: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.METHODS: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.RESULTS: The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium–aluminum–garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.CONCLUSION: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.

Application of mesh acellular allogeneic dermal matrix and split thickness autogenous skin to treat giant congenital melanocytic nevi in children / 中华整形外科杂志

Objective@#To explore the methods and the long-term outcome of composite skin graft with mesh acellular allogeneic dermal matrix(allo-ADM)and split thickness autogenous skin giant congenital melanocytic nevi in infants.@*Methods@#From January 2012 to February 2017 our department applied acellular allogeneic dermis matrix(allo-ADM)with split thickness autogenous skin to treat 55 Giant congenital melanocytic nevi in infants and children aged 3 months to 5 years and 10 months, an average age was 1 years and 2 months, the area of 1%-25% TBSA. There were 12 cases of head and face, 28 cases of trunk and 15 cases of limbs. In operation, giant congenital melanocytic nevi was totally or partially resected, and using allo-ADM and split thickness autogenous skin graft to cover the wounds. Pressured gauze was removed 2 weeks after surgery, and at the same time the cicatricial rehabilitation was performed. The follow-up point was at 3 months, 6 months, 1 year, 2 years, to observe composite skin′ color, softness, and pathological examination of giant nevus and composite skin after 1 years were performed.@*Results@#2 weeks after transplantation the composite skin survival rate in 70%-100%; 38 cases were followed up for more than 2 years. For patients, over 1 years postoperatively, the composite skin presented soft and flexible, and the color were closed to the normal skin.@*Conclusions@#Acellular allogeneic dermis matrix with split-thickness autogenous skin to composite transplantation can effectively improve the appearance and function of giant congenital melanocytic nevi in infants and children, and avoid the scar formation due to the adoption of full thickness skin. The key is to ensure the early survival rate of composite skin graft.

Clinicopathologic analysis of four cases of desmoplastic melanocytic nevus / 中华皮肤科杂志

Objective To investigate pathological characteristics and differential diagnosis of desmoplastic melanocytic nevus.Methods Four cases of desmoplastic melanocytic nevus were analyzed based on the clinical manifestations and histological,immunohistochemical and fluorescence in situ hybridization (FISH) features.Results Of the 4 cases,2 were male and 2 were female.Their age ranged from 19 to 30 years with the average age being 26.5 years.The skin lesions were located on the extremities in 3 cases,on the vulva in 1 case.Histologically,the lesions were bilaterally symmetrical intradermal nevus.Nevus cells appeared epithelioid and/or fusiform,some were clustered or scattered in the proliferative fibrous tissue.None of lymphocyte aggregation,necrosis or ulceration was observed.Immunohistochemical examination showed positive staining for S100 and Melan A in 3 cases,positive staining for P16 in 2 cases,Ki-67-1abeling index less than 5％ in all the 4 cases,and negative staining for factor XⅢ (FXⅢ) and CD34 in 2 cases.FISH assay showed no copy-number variations in gene loci 6p25 (RREB1),6q23 (MYB),6p11.1-q11.1 (Cep6) and 11q13 (CCND1) in desmoplastic nelanocytic nevus.Conclusion Desmoplastic melanocytic nevus is a kind of histologically unique,benign melanocytic nevus,and immunohistochemical staining for Ki-67,S-100,Melan A and FXmand FISH assay on melanoma can be helpful for the differential diagnosis between cutaneous fibrous histiocytoma and melanoma.

Immunohistochemical Expression of WT1 in Malignant Melanomas and Melanocytic Nevi / 대한피부과학회지

BACKGROUND: Malignant melanomas represent pigmented skin lesions and should be distinguished from melanocytic nevi. However, differential diagnosis of malignant melanomas and melanocytic nevi is often challenging. Wilms' tumor 1 (WT1) protein is a specific immunomarker of Wilms' tumor, and several studies revealed that various malignant tumors have WT1 expression. OBJECTIVE: The purpose of this study was to evaluate the usefulness of WT1 staining for differentiating malignant melanoma from melanocytic nevi. METHODS: We selected 50 cases of melanocytic nevi (12 cases of junctional nevi, 19 of compound nevi, and 19 of intradermal nevi) and 35 cases of malignant melanoma (7 cases of malignant melanoma in situ and 28 cases of invasive melanomas) from clinicopathologically proven cases in the Department of Dermatology of Yeungnam University Medical Center. Immunohistochemistry analysis of WT1 was performed, and the labeling index of WT1 expressions was measured. RESULTS: The mean labeling indices of junctional nevi, compound nevi, intradermal nevi, malignant melanoma in situ, and invasive melanomas were 1.9%±2.8%, 23.6±21.2%, 25.7±23.5%, 5.7±5.2%, and 66.1±32.0%, respectively. The labeling index of malignant melanoma in situ was higher than that of junctional nevi. The labeling index of invasive melanoma was higher than those of compound nevus and intradermal nevus. When the WT1 cut-off point to distinguish melanomas from melanocytic nevi was 27.2%, the sensitivity and specificity were 68.6% and 74%, respectively. When a WT1 cut-off point of 75% was used, the sensitivity and specificity were 40% and 100%, respectively. The mean labeling indices of stages I, II, III, and IV malignant melanoma were 29.5%±30.4%, 68.8%±33.9%, 79.5%±6.4%, and 77.7%±18.8%, respectively, and those of Tis, T1, T2, T3, and T4 were 5.7%± 4.8%, 8.0%±0%, 69.5%±18.5%, 61.9%±28.6%, and 78.6%±30.0%, respectively. CONCLUSION: WT1 staining could be a potential diagnostic tool for differentiating malignant melanomas from melanocytic nevi because the WT1 labeling indices of melanomas were significantly higher than those of melanocytic nevi. WT1 staining may be helpful in predicting the depth and prognosis of malignant melanomas.

Evaluación de reactividad inmunohistoquímica con método del Complejo Avidina­Biotina (ABC) / Evaluation of immunohistochemical reactivity with Avidin-Biotin Complex (ABC) method

Inmunohistoquímica es toda técnica que permite detectar in situ componentes celulares y extracelulares por medio de anticuerpos específicos, empleando sistemas de detección enzimáticos. Dentro de los métodos inmunohistoquímicos, la técnica del complejo avidina­biotina(ABC) es ampliamente utilizada debido a su alta sensibilidad. El objetivo del presente estudio fueevaluar la reactividad inmunohistoquímica del anticuerpo 4C4.9 para la detección de la proteínaS-100, utilizando el método ABC. Para la evaluación de la reactividad inmunohistoquímica se utilizaron 2 biopsias de piel humana con diagnóstico histopatológico de melanoma maligno nodular ulcerado y nevus melanocítico intradérmico, provenientes del Laboratorio de Investigación en Biotecnología Animal de la Universidad de La Frontera, Temuco, Chile. Se utilizó el Kit VECTASTAIN®como método de detección, la dilución del anticuerpo 4C4.9 fue 1/250 y la temperatura de incubación fue a 4 ºC ó 37 ºC por 18 horas. Para validar la técnica, se realizó un control positivo y otro negativo para 4C4.9. Los resultados de la tinción inmunohistoquímica por el método del complejo ABC mostraron tinción positiva para la proteína S-100, tanto en melanoma maligno nodular ulcerado, como en nevus melanocítico intradérmico, incubados durante 18 horas a 4 ºC ó 37 ºC. Sin embargo, la inmunotinción fue más intensa cuando el anticuerpo primario se incubó a 37 ºC. Para una correcta interpretación de los resultados, es necesario tener en consideración que la reacción antígeno-anticuerpo se ve influenciada por diversos factores, como la concentración del anticuerpo, el tiempo y la temperatura de incubación. En conclusión, nuestros resultados sugieren incubarlas muestras con el primer anticuerpo (4C4.9) en una dilución de 1/250 en agua destilada, incu-bando durante 18 h a 37 ºC. Se recomienda la utilización del anticuerpo 4C4.9 como apoyo al diagnóstico y diagnóstico diferencial.

Immunohistochemistry is anytechnique that can detect cellular and extracellular components in situ by means of specific antibodies,using enzymatic detection systems. Among immunohistochemical methods, the technique ofavidin - biotin complex (ABC) is widely used because of its high sensitivity. The aim of this study was to evaluate the immunohistochemical reactivity of the4C4.9 antibody for detection of S-100 protein using the ABC method. For the evaluation ofimmunohistochemical reactivity 2 biopsies of humanskin were used with histopathological diagnosis ofulcerated malignant melanoma and melanocyticintradermal nevi from the Research Laboratory onAnimal Biotechnology of the Universidad de La Fron-tera, Chile. The Kit VECTASTAIN® was used asdetection method, the dilution the 4C4.9 antibodywas 1/250 and incubation temperature was at 4 °Cor 37 °C for 18 hours. To validate the technique, apositive control and a negative for 4C4.9 was performed. The results of immunohistochemicalstaining by the method of ABC complex showed positive staining for protein S-100 both in ulcerated malignant melanoma and melanocytic intradermalnevi, incubated for 18 hours at 4 °C or 37 °C.However, immunostaining was more intense when the primary antibody was incubated at 37° C. For acorrect interpretation of the results, it is necessary to take into consideration that the antigen-antibody reaction is influenced by various factors such as the concentration of antibody, time and temperature ofincubation. In conclusion, our results suggest incubating the samples with the first antibody (4C4.9)at 1/250 dilution in distilled water, incubating for 18h at 37 ºC. However, immunostaining was moreintense when the primary antibody was incubated at37° C. For a correct interpretation of the results, it isnecessary to take into consideration that antigen-antibody reaction is influenced by various factors suchas the concentration of antibody, time and temperature of incubation. In conclusion, our results suggest incubating the samples with the first antibody(4C4.9) at 1/250 dilution in distilled water, incubating for 18 h at 37 ºC. The use of the antibody 4C4.9 is recommended to support the diagnosis and differential diagnosis.

The Importance of Eosinophilic Cytoplasmic Inclusion Bodies in Melanocytes as a Clue to Distinguish between Benign and Malignant Melanocytic Lesions.

Aim: Since early diagnosis and treatment of melanoma can significantly improve patients’ prognosis, discovering new criteria to help differentiate between benign and malignant melanocytic lesions is of significance. In this study we aim to clarify the relationship between the presence of intracytoplasmic eosinophilic inclusion bodies inside melanocytes and the nature of the melanocytic lesion. Methods: Medical records and pathology slides pertaining to 187 patients with melanocytic lesions who had undergone biopsy in Razi Hospital between March 2014 and March 2015 were gathered. Slides were re-examined by a dermatopathologist using a light microscope. Clinical and pathological data were analyzed using SPSS. Results: A total of 196 specimens from 187 patients were studied. The median age of our patients was 42.26 years and 61.5% of them were female while 38.5% were male. The specific eosinophilic intracytoplasmic inclusion bodies were observed in 14 specimens; 8 of which were intradermal nevi and the remaining 6 were from compound nevi. These bodies tended to be present in lesions with congenital features. We found no correlation between age, sex or location of the lesion with the presence of aforementioned bodies. Conclusion: Eosinophilic inclusion bodies present in the cytoplasm of melanocytes are associated with benign melanocytic lesions and are mostly observed in cells with abundant vacuolated cytoplasm and in lesions with congenital features. Therefore these bodies can be helpful in diagnosing benign and longstanding lesions and differentiating them from malignancies.

Clinical Characteristics of Benign Eyelid Tumors

PURPOSE: To report the relative frequency and clinical characteristics of patients with benign eyelid tumors. METHODS: A retrospective study of 192 consecutive patients admitted to Korea University Ansan Hospital with benign eyelid tumor between January 2009 and December 2014 was undertaken, and clinical records including age, sex, involved site, and pathology of tumors were reviewed retrospectively. All eyelid tumors were confirmed histopathologically. RESULTS: The sexual distribution revealed 87 males and 105 females with benign eyelid tumors. The mean age at diagnosis was 42.6 +/- 19.2 years. Molluscum contagiosum (5.5 +/- 3.5 years) and pilomatrixoma (14.0 +/- 15.6 years) were generally found in younger individuals, while seborrheic keratosis (60.2 +/- 15.8 years) and squamous cell papilloma (50.5 +/- 13.4 years) occurred predominantly in elderly patients. Tumors were most common on the upper lid (63.0%). The four most frequent subtypes were melanocytic nevus (37.5%), epidermal cyst (8.3%), squamous cell papilloma (5.7%), and seborrheic keratosis (5.2%). CONCLUSIONS: The most common histopathological diagnosis of benign eyelid tumors was melanocytic nevus. The results of this study provide epidemiological information that will be useful for diagnosis and therapy of such tumors.

Giant Congenital Melanocytic Nevi with Hemangioma : A Case Report in a Newborn / 대한주산의학회잡지

Giant congenital melanocytic nevi are very rare skin lesions with an estimated prevalence of 1 in 20,000 live births, and have high risk of malignant melanoma development and leptomeningeal melanocytosis. Hence, its early and exact diagnosis in the neonatal period is important and essential. Only seven cases of giant congenital melanocytic nevi have been reported in Korea, of which none of the cases were associated with hemangioma. Herein, the authors describe a case of giant congenital melanocytic nevi with huge hemangioma with the pathologic findings that exhibited benign and provide a literature review.

Efficacy and Safety of 1,064 nm Q-switched Nd:YAG Laser Treatment for Removing Melanocytic Nevi

BACKGROUND: Until recently, the removal of melanocytic nevi has been performed with a CO2 laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi. OBJECTIVE: The objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi. METHODS: Two thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy. RESULTS: About 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO2 or Er:YAG laser treatments. CONCLUSION: Use of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi.

Neurocutaneous melanosis: hydrocephalus and intracranialhypertension - rare case

Objective: report a case of neurocutaneousmelanosis in Belém, Pará. Case report: a 13-yearsoldboy, with history 8 months later presented paroxistic absence recurrent seizures controlledwith carbamazepine. At three years old, the seizures became generalized type, associated tonistagmus and incipient apendicular ataxia. Until 11 years old, he had neurologic exam stable,without diagnostic, when presented persistent holocranial headache, nausea, morning vomit,oftalmoparesis type III pair lesion on the right and somnolence. At general exam, it was founduncountable melanocytic nevi in his dorsum, buttocks, left arm, thorax and right shoulder. MRIstudy was performed and suggested CNS melanicytic infiltration. The patient underwentventriculoperitoneal derivation and presented good evaluation, asymptomatic.Conclusion: theearly diagnostic is very important, considering the possibility to precocious neurosurgicalintervention, allowing the increase of survival in these patients.

Objetivo: relatar um caso de melanoseneurocutanea em Belém, Pará. Relato de caso:adolescente, 13 anos de idade, gênero masculino, com história de crises convulsivasparoxísticas, tipo ausência, recorrentes, controladas com uso de carbamazepina. Aos três anosde idade, as crises tornaram-se do tipo generalizada, associada com nistagmo e ataxiaapendicular incipiente. Até 11 anos de idade, o paciente teve quadro neurológico estável, semdiagnóstico, quando apresentou cefaléia persistente holocraniana, náusea, vômitos pela manhã,sonolência e oftalmoparesia por lesão do III par craniano à direita. No exame geral, foramencontrados incontáveis nevos melanocíticos no dorso, nádegas, braço esquerdo, tórax e ombrodireito. A RNM sugeriu infiltração melanocítica do SNC. O paciente foi submetido a derivaçãoventrículo-peritoneal e apresentou boa evolução, ficando assintomático após o procedimento.Conclusão: o diagnóstico precoce é muito importante, considerando a possibilidade deintervenção neurocirúrgica precoce, permitindo o aumento da sobrevida nesses pacientes

Multiple Congenital Melanocytic Nevi Associated with Developmental Delay / 대한피부과학회지

Multiple congenital melanocytic nevi (MCMN), defined as the distribution of more than three small- or medium- sized congenital melanocytic nevi (CMN) on the body without a giant CMN, is a rare disease comprising about 4% of patients with CMN. Because MCMN accompanies neurodevelopmental delay, including seizures in 25% of patients as well as the risk of malignant melanoma, it must be carefully followed-up. We report a case of MCMN with developmental delay in a 19-month-old Korean boy. He had a history of febrile seizure when he was 18 months old. He showed a speech delay after the 1-year-follow up, even though there was no evidence of neurocutaneous melanosis (NCM) on brain magnetic resonance imaging (MRI) at the first visit. As MRI has a low sensitivity for detecting NCM in patients with MCMN older than 4-months, close neurodevelopmental assessments should be considered to provide a chance for early rehabilitation.

A Case of Congenital Melanocytic Nevus Clinically Improved by Fractional Carbon Dioxide Laser Treatment / 대한피부과학회지

Congenital melanocytic nevi are cosmetically disfiguring, pigmented skin lesions that are present at birth. A 61-year-old man presented with an asymptomatic 3x2 cm sized black-colored patch involving the helix, antihelix and triangular fossa of the left auricle, and the lesion had been there since birth. The patient refused surgical removal and so we tried fractional carbon dioxide laser treatment for cosmetic improvement only. Clinical improvement was observed after 18 treatment sessions. We report a case of congenital melanocytic nevus within the auricle, and this was treated with fractional carbon dioxide laser.

Dermoscopic Patterns of Acral Melanocytic Nevi in Koreans / 대한피부과학회지

BACKGROUND: Melanocytic nevi are frequently found in acral skin. Benign melanocytic lesions on acral sites may be difficult to differentiate from early acral melanoma by visual examination even for experienced dermatologists. Dermoscopy is a noninvasive method for evaluating pigmented skin lesions. OBJECTIVE: The purpose of this study was to investigate the clinical and dermoscopic features of acral melanocytic nevi in Koreans. METHODS: We studied 57 patients with acral melanocytic lesions using standard clinical assessment and dermoscopy. The patients were examined for acral melanocytic nevi clinically and by using a dermoscope with a digital imaging system, and the acral nevi larger than 7 mm and the suspicious lesions were excised and examined histopathologically. RESULTS: Sixty five acral melanocytic nevi were observed in 57 patients. Individual lesions were located on the soles (n=32), palms (n=11), and volar aspect of the fingers or toes (n=22). The most common dermoscopic pattern was the parallel furrow pattern (52.3%). The other patterns seen were a latticelike pattern (21.6%), a fibrillar pattern (9.2%), a reticular pattern (6.2%), a globular pattern (4.6%), a nontypical pattern (4.6%) and a transition pattern (1.5%). The frequency of distribution of the fibrillar and reticular patterns was significantly different (p=0.033, p=0.015). CONCLUSION: Dermoscopy proved to be a useful instrument for the evaluation of acral melanocytic lesions. In our series of acral nevi, we observed 7 dermoscopic patterns with varying distributions on anatomical sites. We think that further studies on acral melanocytic nevi with digital follow-up are needed to clarify their evolution.

Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side

BACKGROUND: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. OBJECTIVE: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. METHODS: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. RESULTS: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. CONCLUSION: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.

Frecuencia de tumores benignos durante el periodo de 2000-2006 en el Hospital General Dr. Manuel Gea González / Frequency of benign tumors at the Hospital General Dr. Manuel Gea Gonzalez: record review between 2000-2006

Antecedentes: Los tumores benignos de la piel se definen como el crecimiento autónomo de tejido sin relación con el patrón normal de crecimiento tisular, que persiste después del estímulo que le dio origen. Prácticamente todos los humanos presentan algún tumor benigno, pero la mayoría de las veces no se busca atención ya que no producen molestias. Son escasos los registros sobre la frecuencia de los tumores benignos. El objetivo de este estudio fue informar el número de tumores benignos en el Departamento de Dermatología de nuestro hospital. Material y métodos: Se realizó un estudio retrospectivo en el que se revisaron los registros de histopatología del periodo 2000 a 2006. Se registró año, número de biopsia, sexo, edad, topografía, diagnóstico clínico y diagnóstico histológico. Resultados: Se analizaron 9436 registros de biopsias, de las cuales 3765 fueron tumores benignos, de éstos se eliminaron 595 biopsias por falta de datos, para un total de 3170. Los tumores más frecuentes por grupo histopatológico en forma descendente fueron los tumores melanocíticos, quistes, tumores fibrosos, vasculares, de la epidermis, de tejido adiposo, del pelo, neurales, glandulares, sebáceos, de cartílago y hueso, y de músculo liso. Los tumores más frecuentes en general fueron nevos melanocíticos, quistes epidermoides, queratosis seborreicas, granulomas piógenos, lipomas y dermatofibromas. Conclusiones: Los tumores benignos más frecuentes fueron los melanocíticos constituidos por nevos de unión, intradérmicos y compuestos, y los quistes epidermoides. Esta serie proporciona información de los tumores benignos más comunes en un servicio dermatológico.

BACKGROUND: Benign skin neoplasms are defined as autonomous growing tissue unrelated to normal growing of the skin, that persist even after the originating stimulus dissapears. Almost all human beings have a certain number of benign cutaneous neoplasms and many never seek medical attention. There is a dearth of information regarding the frequency of these tumors. The aim of this study was to record the number of benign tumors studied at the Dermatology Department of a medical facility. MATERIAL AND METHODS: A retrospective study analyzed medical records between 2000 and 2006. We included year of admission, number of biopsies, sex, age, tumor location, histological and clinical diagnoses. RESULTS: We analyzed 9,436 biopsies of which 3,765 constituted benign neoplasms; 595 were not included and our total sample was 3,170 tumors. The most frequent tumors according to histopathological diagnoses in descending order were: melanocytic, cutaneous cysts, fibrous tumors, vascular tumors, epidermal tumors, fat tumors, tumors with hair differentiation, neural tumors, glandular tumors, tumors with sebaceous differentiation, cartilage and bone tumors, and smooth muscle tumors. The most common benign tumors were: Melanocytic nevi, epidermal cysts, seborrheic keratoses, pyogenic granulomas, lipomas and dermatofibromas. CONCLUSIONS: Melanocytes represented by melanocytic nevi (junctional, intradermic and compound) were the most frequent benign neoplasms, followed by epidermoid cysts. Our results illustrate the most common benign tumors observed in a dermatology department.

A Case of Congenital Melanocytic Nevi with Unusual Cutaneous Manifestation / 대한피부과학회지

Congenital melanocytic nevi occur in approximately 1~3% of newborns and are usually classified according to their size. Giant congenital melanocytic nevi are associated with an increased risk of development of melanoma. Thus, careful follow-up is mandatory. Generally congenital melanocytic nevi are round to oval in shape and have a regular, smooth, and well-demarcated border. Histopathologic finding shows junctional nevi, compoud nevi or dermal nevi pattern. We report a case of congenital melanocytic nevi with unusual cutaneous manifestation as an oval shaped patch with an irregular border and speckled pigmentation on the left calf of a 25 year-old female. The histologic findings revealed diffuse infiltration of the dermis by nevomelanocyte.

Immunohistochemical Study for MAPK Expression in UV Irradiated Melanocytic Nevi / 대한피부과학회지

BACKGROUND: In contrast to the relationship between UV exposure and nonmelanoma skin cancers, molecular evidence for the involvement of UV radiation in melanocytic tumorigenesis is quite limited. Mitogen-activated protein kinase (MAPK) is an important molecule in transducing extracellular signals from the cell surface to the nucleus. The MAPK family includes ERK (extracellular signal- regulated protein kinase), JNK (stress-activated c-Jun N-terminal kinase), and p38 kinases. Various growth factors and cytokines, as well as other signals such as UV light are able to activate MAPK, resulting in a variety of cellular responses including proliferation, differentiation and apoptosis. OBJECTIVE: The purpose of our study was to investigate the effect of UV irradiation on the expression of MAPK in melanocytic nevi. METHOD: Melanocytic nevi from ten healthy volunteers were partially covered, irradiated with a defined UV dose, and excised after 1 week. healthy The irradiated and non-irradiated area were examined separateted by immunohistochemistry using p-ERK, p-JNK, and p-p38 monoclonal antibodies. RESULTS: In the non-irradiated area of melanocytic nevus, p-ERK, p-JNK, and p-p38 were undetectable in nevus cells. After irradiation, p-ERK expression was observed in nevus cells in 7 cases, and p-p38 was stained diffusely in the cytoplasm of nevus cells in 6 cases, but there was no immunoreactivity of p-JNK. CONCLUSION: We suggest that a single UV irradiation of melanocytic nevi can stimulate both p-ERK and cytoplasmic p-p38 expression, but not p-JNK.