Pigmented lesions of the conjunctiva: The sheep and the wolf

Background: Pigmented lesions in the conjunctiva can be baffling to both the patients and the treating ophthalmologist because of their varied range of presentation and overlapping clinical features. The lesions range from incidental pigment deposition such as mascara and complexion?associated melanosis to malignant melanoma which poses a risk to life. Similarly, the management ranges from observation at regular intervals to aggressive surgery like exenteration. Purpose: We wanted to present a crisp and precise video of the good, bad, and ugly pigmented lesions of the conjunctiva, highlighting their specific clinical features important for the diagnosis and their management. Synopsis: This video describes the myriad of pigmented conjunctival lesions, their diagnostic characteristics, and management based on oncological principles. Link: https:// drive.google.com/file/d/1BYJ51rQtqjwM6e73BwrrLqdC1EoX A8Eu/view?usp=sharing. Highlights: Pigmented lesions can have variable presentation and close mimics, therefore, it is important to differentiate and identify the lesions accurately. This video highlights different pigmented lesions and their individual characteristic features

Aplicación del láser de helio-neón en pacientes con melasma facial / Use of helium-neon laser in patients with melasma: en

Introducción: El melasma facial consiste en una hiperpigmentación que se origina por un incremento de la melanina epidérmica o dérmica, o ambas, y se localiza en las áreas fotoexpuestas, lo cual afecta, en ocasiones, la autoestima de hombres y mujeres. Objetivo: Evaluar la efectividad del tratamiento con láser de helio-neón en pacientes con melasma facial. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica en 34 pacientes con diagnóstico clínico y dermatoscópico de melasma facial, atendidos en la consulta de dermatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso en Santiago de Cuba, de enero del 2019 a igual mes del 2020, para lo cual se conformaron dos grupos: uno de estudio, que recibió tratamiento con láser, y el otro de control, tratado con crema de hidroquinona a 2 %. La información fue procesada y resumida en valores absolutos y porcentaje; asimismo, se utilizó la prueba paramétrica de homogeneidad de la Χ2, con un nivel de significación α=0,05. Resultados: En general, la mayoría de los pacientes correspondieron al grupo etario de 39-48 años (35,3 %) y al sexo femenino (82,3 %), tenían color de la piel mestizo (76,5 %) y lesiones de tamaño mediano (58,8 %). Si bien no existieron diferencias estadísticamente significativas entre las respuestas terapéuticas de cada grupo de estudio, en los pacientes tratados con láser de helio-neón la mejoría clínica fue evidente a los 3 meses de finalizada la intervención (70,6 %). Conclusiones: El tratamiento con láser de helio-neón fue efectivo en los pacientes con melasma.

Introduction: Melasma is a hyperpigmentation caused by an increase in epidermal or dermal melanin concentration, or both, and it is located on photoexposed cutaneous regions. It affects sometimes men's and women's self-esteem. Objective: To evaluate the effectiveness of helium-neon laser treatment in patients with melasma. Methods: A quasi-experimental study of therapeutic intervention in 34 patients with clinical and dermoscopic diagnosis of melasma, who were assisted at the Dermatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2019, to the same month in 2020, for which two groups were formed: the study group, that received laser treatment, and the control group, treated with 2% hydroquinone cream. The information was processed and expressed in absolute values and percentage; likewise, the Χ2 test for homogeneity was used, with a significance level of α=0.05. Results: In general, most of the patients belonged to 39-48 age group (35.3%) and were female (82.3%), with mixed skin color (76.5%) and medium-sized lesions (58.8%). Although there were no statistically significant differences between the therapeutic responses of each study group, clinical improvement in patients treated with helium-neon laser was evident 3 months post-intervention (70.6%). Conclusions: Helium-neon laser treatment was effective in patients with melasma.

Nevo de Ota bilateral: presentación de un caso de distribución poco frecuente / Bilateral nevus of Ota: an unusual presentation

RESUMEN El Nevo de Ota, es una melanocitosis dérmica que se desarrolla por un defecto embrionario en la migración de los melanocitos desde la cresta neural a la piel y mucosas. Presentamos una paciente de 32 años, con Nevo de Ota bilateral de presentación infrecuente.

ABSTRACT Nevus of Ota is a dermal melanocytosis that develops due to an embryonic defect in the migration of melanocytes from the neural crest to the skin and mucous membranes. We report a 32-year-old female patient with a bilateral nevus of Ota with a rare manifestation due to its unusual distribution.

Analysis of 14 cases of melanosis caused by 1, 8-dinitronaphthalene and 1, 8-diaminonaphthalene / 中华劳动卫生职业病杂志

14 workers in the 1, 8-diaminonaphthalene workshop of a chemical company in Nantong City had symptoms or signs of varying degrees of pruritus and pigmentation of the face, neck and waist. Pathological examination of skin biopsies showed hyperkeratosis, the basal cells were liquefied and denatured. Seven workers were eventually diagnosed with occupational melanosis. To explore the causes of occupational melanosis caused by exposure to 1, 8-dinitronaphthalene and 1, 8-diaminonaphthalene, and to provide reference for the prevention and treatment of occupational melanosis in the future, this paper reported 14 cases of melanosis in the skin of workers in chemical industry.

Analysis of the clinical characteristics of 69 cases of occupational melanosis / 中国职业医学

Objective To summarize the clinical characteristics of patients with occupational melanosis. Methods Diagnostic data of 69 patients with occupational melanosis was analyzed using retrospective analysis. Results The main occupational hazards for the 69 patients with occupational melanosis were coal tar, petroleum and its fractionated products, pigments and dyes and their intermediates, rubber additives and rubber products. The median length of occupational exposure and disease latency were 8.0 and 6.0 years, respectively, with a highly positive correlation between them (Spearman correlation coefficients=0.962, P<0.01). Skin lesions were mainly found on exposed areas such as the face-to-neck and limbs, prevalence of 94.2% and 75.4% respectively. And 78.3% of patients had skin lesion on more than two sites. The lesions were mostly in the form of irregular flakes (59.4%), with a gray-black color (44.9%). About 43.5% of patients experienced skin itching. Complete blood count, liver function, and kidney function were all within normal ranges. Skin biopsy results showed that epidermal hyperkeratosis, thinning of the spinous layer, liquefaction degeneration of basal cells, increased superficial dermal melanocytes, and infiltration of lymphocytes, histiocytes, and melanocytes around the blood vessels. Reflectance confocal microscopy (RCM) detection showed focal liquefaction degeneration of basal cells in the lesions, with a significant infiltration of melanocytes and inflammatory cells in the dermal papillae and superficial layers. Conclusion The primary target organ of occupational melanocytes is the skin, and no damage to other organs was identified thus far. Results from skin biopsies and RCM examinations can be used for differential diagnosis.

Role of transient receptor potential channels in melanocytes and their related diseases / 中华皮肤科杂志

Transient receptor potential (TRP) channels are a special type of non-selective cationic channel family located on the cell membrane or organelle membrane, and notably expressed in melanocytes. This review summarizes recent research progress in biological functions of TRP channels in melanocytes and their involvement in the pathological process of pigmented skin diseases and melanoma, so as to provide a new theoretical basis for the prevention and treatment of melanin-related diseases.

A CLINICO-EPIDEMIOLOGICAL STUDY OF FACIAL HYPERMELANOSIS AT A TERTIARY CARE CENTER, ANANTHAPURAM.

Background: A group of heterogenous entities having the common clinical feature of altered facial pigmentation have been informally called as facial melanoses. Since, the cosmetic disfigurement is easily visible, it has a lot of impact on the psychological well being of the person. To assess the patients of facial hyper Aim: pigmentary disorders for demographic , etiological and clinical profile. A prospective clinical study was conducted in a tertiary care ce Methods: nter in Ananthapuram over period of 6 months. 100 patients with facial hyper pigmentary disorders were assessed by detailed history and clinical examination. In our study, most common age group Results: which sought treatment was 30-50 years. Female were predominantly affected. five different facial melanosis were observed which included melasma, postinfiammatory hyperpigmentation, reihl's melanosis, exogenous ochronosis,topical steroid damaged face. Reihl's melanosis was the most common disorder reported by 30 patients out of 100. Limitations: Dermoscopy could not be done to resource constraint. Conclusion: Increase in awareness and concern with appearance has led to an increase in reported incidence of facial melanosis in both sexes. Prior application of over-the-counter products poses difficulty in correct evaluation and treatment. Psychological evaluation forms an integral part of the treatment of these patients.

Melanosis neurocutánea: reporte de un caso y revisión de la literatura / Neurocutaneous melanosis. Case report and literature review / Melanose neurocutânea: relato de caso e revisão da literatura

RESUMEN Introducción: la melanosis neurocutánea es un trastorno congénito no hereditario que se caracteriza por la asociación de nevus pigmentados múltiples o de gran tamaño y una excesiva proliferación de melanocitos en el sistema nervioso central. La incidencia es similar en ambos sexos, y se observa historia familiar de melanoma en un único caso. Presentación del caso: se trata de un neonato masculino que nace en Hospital General de Luanda en Angola, con mancha melánica gigante que se extiende desde el cuello, cara, tórax, abdomen, espalda y miembros superiores, requiere una vigilancia de las lesiones dérmicas y un control de las crisis convulsivas. Discusión: se realizaron revisiones de la literatura médica disponible sobre el tema, consultando el programa de genética Oxford, y se tomaron fotos de las características clínicas sobresalientes. Por lo general los síntomas neurológicos son de temprana aparición en la etapa neonatal o de lactante con presencia de convulsiones de difícil control, al crear un pronóstico reservado. Conclusiones: se considera importante el seguimiento del neurodesarrollo de forma multidisciplinario para intervención oportuna si fuera necesario.

ABSTRACT Introduction: neurocutaneous melanosis is a non-hereditary congenital disorder characterized by the association of multiple or large pigmented nevi and an excessive proliferation of melanocytes in the central nervous system. The incidence is similar in both sexes, and a family history of melanoma is observed in a single case. Case presentation: this is a male neonate born at the General Hospital of Luanda in Angola, with a giant melanic spot that extends from the neck, face, chest, abdomen, back and upper limbs, requires surveillance of dermal lesions and control of seizures. Discussion: reviews of the available medical literature on the subject were conducted, consulting the Oxford genetics program, and photos of outstanding clinical features were taken. Usually the neurological symptoms are of early onset in the neonatal or infant stage with the presence of seizures that are difficult to control, creating a reserved prognosis. Conclusions: it is considered important to monitor neurodevelopment in a multidisciplinary way for timely intervention if necessary.

RESUMO Introdução: a melanose neurocutânea é uma doença congênita não hereditária caracterizada pela associação de nevi pigmentado múltiplo ou grande e uma proliferação excessiva de melanócitos no sistema nervoso central. A incidência é semelhante em ambos os sexos, e um histórico familiar de melanoma é observado em um único caso. Apresentação do caso: trata-se de um recém-nascido no Hospital Geral de Luanda, em Angola, com um ponto melanico gigante que se estende do pescoço, rosto, tórax, abdômen, costas e membros superiores, requer vigilância de lesões dérmicas e controle de convulsões. Discussão: foram realizadas revisões da literatura médica disponível sobre o tema, consultando o programa de genética de Oxford e fotos de características clínicas de destaque. Geralmente os sintomas neurológicos são de início precoce no estágio neonatal ou infantil com a presença de convulsões de difícil controle, criando um prognóstico reservado. Conclusões: é considerado importante monitorar o neurodesenvolvimento de forma multidisciplinar para intervenção oportuna, se necessário.

Melanosis tubae et ovarii: An overlooked entity?

Melanosis is a rare benign entity defined by the deposition of brownish-black pigment in a wide variety of organs especially the gastrointestinal tract, peritoneum, fallopian tubes and ovaries. Melanosis of the fallopian tube is widely known as pigmentosis tubae. Literature has mentioned ovarian teratomas and serous cystadenomas to be associated with the ovarian and peritoneal melanosis. We report five such cases of tubo-ovarian melanosis. The cases include mature teratoma and serous cystadenoma as well as melanosis of the fallopian tubes with otherwise normal ovarian histology. The importance of recognising this entity lies in its differential diagnosis.

Melanocytic lesions of the central nervous system: a case series / Lesiones melanocíticas del sistema nervioso central: una serie de casos

ABSTRACT Background: Melanocytic lesions of the central nervous system (CNS) are an infrequent, broad and diverse group of entities, both benign and malignant, found in all age groups, with imaging findings ranging from well-circumscribed focal lesions to diffuse leptomeningeal involvement. On MRI, they are usually distinguished by a high signal on T1WI sequences, given the paramagnetic effect of melanin, thus making it difficult to differentiate among them. Objective: To describe the imaging and epidemiological characteristics of a retrospective series of CNS melanocytic lesions. Methods: MR images of 23 patients with CNS melanocytic lesions diagnosed between January 2012 and June 2018 were analyzed. Results: Most patients were female (14/23; 61%), with a median age of 47 years (range: 3 weeks to 72 years). The primary melanocytic lesions accounted for 8/19 cases (42.1%), which included neurocutaneous melanosis, meningeal melanocytomas and primary malignant melanomas. Secondary melanocytic lesions (metastatic) accounted for 10/19 cases (52.6%). There was one case of a tumor with secondary melanization, from a melanocytic neuroectodermal tumor of infancy. There were also four cases of primary ocular melanomas. The most frequent findings were the cerebral location, high T1WI signal and marked contrast-enhancement. Conclusions: The present review describes the wide variety of melanocytic lesions that could affect the CNS, emphasizing the MRI characteristics. Knowledge of the imaging, clinical and epidemiological characteristics of CNS melanocytic lesions is essential for their correct interpretation, given the significant overlap between lesion features and the variable prognosis.

RESUMEN Antecedentes: Las lesiones melanocíticas del sistema nervioso central (SNC) corresponden a un grupo infrecuente, amplio y diverso de entidades, tanto benignas como malignas, encontradas en todos los grupos etarios, con hallazgos imagenológicos que van desde lesiones focales bien circunscritas hasta un compromiso leptomeníngeo difuso. A la RM se distinguen por la alta señal en la secuencia T1WI, dado el efecto paramagnético de la melanina, haciendo difícil la diferenciación entre ellas. Objetivo: Describir las características epidemiológicas y de de una serie retrospectiva de lesiones melanocíticas del SNC. Métodos: Revisión de imágenes de RM de 23 pacientes con lesiones melanocíticas del SNC diagnosticadas entre enero de 2012 y junio de 2018. Resultados: La mayoría de los pacientes fueron mujeres (14/23; 61%), con edades comprendidas entre las 3 semanas de vida hasta los 72 años. Las lesiones melanocíticas primarias representaron 8/19 (42,1%), incluyendo: melanosis neurocutáneas, melanocitomas meníngeos y melanomas malignos primarios. Las lesiones melanocíticas secundarias (metastásicas) representaron 10/19 casos (52,6%). Hubo un caso de tumor con melanización secundaria (tumor neuroectodermico melanocítico de la infancia). Se incluyeron cuatro casos de melanomas oculares primarios. Los hallazgos más frecuentes fueron la localización cerebral, el aumento de señal T1 y el acentuado realce con el gadolinio. Conclusiones: Se describe la amplia variedad de lesiones melanocíticas encontradas en el SNC, enfatizando sus características a la RM. El conocimiento de sus características imagenológicas, clínicas y epidemiológicas es fundamental para su correcta interpretación, dado la notable superposición entre las presentaciones de las lesiones y lo variable de sus pronósticos.

Melanosis gingival: diagnóstico y terapéutica de su implicación estética. Revisión de la literatura / Gingival Melanosis: Diagnosis and Therapy of Its Aesthetic Involvement. Literature Review

ABSTRACT: Gingival hyperpigmentation is produced by excessive melanin deposit, generating a dark gum coloring. Although it does not constitute a health issue, in some cases it usually represents an aesthetic problem that can affect psychologically, for which there are currently several treatment alternatives such as: surgery with scalpel, laser therapy, abrasion, cryosurgery, electrosurgery, among others. The aim of this literature review was to analyze the available information about gingival melanosis and the therapeutics that can be applied to improve the appearance of patients with this condition. Articles in English and Spanish, published during the period 2000-2020 in the PubMed, Medline, Scielo, Cochrane and Lilacs databases, were reviewed. It was concluded that the selection of the technique will depend on each particular case, however, the laser is the most relevant.

RESUMEN: La hiperpigmentación gingival se produce por el depósito excesivo de melanina, generando una coloración oscura de la encía. Aunque no constituye un inconveniente para la salud, en algunos casos suele representar un problema estético que puede afectar psicológicamente, por lo cual, en la actualidad existen diversas alternativas de tratamiento como: cirugía con bisturí, terapia láser, abrasión, criocirugía, electrocirugía, entre otros. El objetivo de esta revisión de la literatura fue analizar la información disponible acerca de la melanosis gingival y la terapéutica que puede ser aplicada para mejorar el aspecto de los pacientes con esta condición. Se revisaron artículos en inglés y español, publicados durante el período 2000-2020 en las bases de datos PubMed, Medline, Scielo, Cochrane y Lilacs. Se concluyó que la elección de la técnica dependerá de cada caso en particular, sin embargo, el láser es el más destacado.

Melasma en el 2021: actualización en la patogénesis y en el enfrentamiento terapéutico / Melasma in 2021: update on the pathogenesis and therapeutic coping

El Melasma es una patología con alta prevalencia a nivel mundial presente en alrededor de un 10% de la población Latinoamericana. Se caracteriza por ser una hipermelanosis cutánea adquirida que ocurre con más frecuencia en cara y cuello de mujeres con fototipos de piel III-VI de Fitzpatrick. Su patogenia aún no ha sido completamente dilucidada; sin embargo, existe evidencia que respalda la asociación del melasma con la radiación ultravioleta, la luz visible, la estimulación hormonal, factores genéticos y procesos inflamatorios. Su diagnóstico es fundamentalmente clínico, y es apoyado por instrumentos de medición que nos permiten objetivar la severidad e impacto en la calidad de vida de los pacientes afectados. El tratamiento continúa siendo un desafío ya que, si bien existen múltiples terapias que han demostrado efectividad, aún no han logrado una remisión completa, presentando una alta tasa de recurrencia. Dentro de las opciones terapéuticas destacan los tratamientos tópicos combinados, los peelings químicos y las terapias basadas en láser, sin embargo, lo más importante es hacer énfasis en la fotoprotección como medida preventiva. En esta revisión pretendemos actualizar sobre los últimos avances tanto de la fisiopatología como del tratamiento del melasma

Melasma is a pathology with a high prevalence worldwide, present in approximately 10% of the Latin American population. It is a cutaneous hypermelanosis that presents itself more frequently on the face and neck of women with Fitzpatrick skin phototypes III-VI. Its pathogenesis has not yet been fully elucidated, however, there is evidence that supports its association with ultraviolet radiation, hormonal stimulation, genetic factors, and inflammatory processes. Its diagnosis is fundamentally clinical, and is supported by clinical scores that allow us to objectify the severity and impact on the quality of life of patients who suffer from it. Treatment continues to be a challenge since, although there are multiple therapies that have demonstrated effectiveness, they have not yet achieved a complete and / or definitive remission of the disease, presenting a high recurrence rate. Treatment options include combined topical therapy, chemical peels and laser-based treatments. Much emphasis has been placed lately on photoprotection of the skin as a preventive measure. In this review we intend to update the latest advances in both the pathophysiology and treatment of melasma

Evaluation of ex vivo melanogenic response to UVB, UVA, and visible light in facial melasma and unaffected adjacent skin,

Abstract Background: The independent role of solar radiation in the differential melanogenesis between melasma and adjacent skin is unknown. Objectives: To assess the melanogenic responses of skin with facial melasma and of the adjacent skin to UVB, UVA, and visible light, in an ex vivo model. Methods: This was a quasi-experimental study involving 22 patients with melasma. Facial melasma and adjacent skin samples were collected and stored in DMEM medium, at room temperature. One fragment was placed under the protection from light, while another was exposed to UVB, UVA, and visible light (blue-violet component): 166 mJ/cm2, 1.524 J/cm2, and 40 J/cm2, respectively. Subsequently, all samples were kept for 72 hours in a dark environment and stained by Fontana-Masson to assess basal layer pigmentation, dendrites, and melanin granulation. Results: Effective melanogenesis was observed in the basal layer in melasma and in the normal adjacent skin after all irradiations (p< 0.01), with the following median increment: UVB (4.7% vs. 8.5%), UVA (9.5% vs. 9.9%), and visible light (6.8% vs. 11.7%), with no significant difference between anatomical sites. An increase in melanin granulation (coarser melanosomes) was observed only after irradiation with UVA and only in the skin with melasma (p= 0.05). An increase in the melanocyte dendrite count induced by UVB radiation was observed in both anatomical sites (p≤ 0.05). Study limitations: Use of an ex vivo model, with independent irradiation regimes for UVB, UVA, and visible light. Conclusions: Melanogenesis induced by UVB, UVA, and visible light was observed both in melasma and in the adjacent skin. The morphological patterns suggest that different irradiations promote individualized responses on the skin with melasma.

Utilización de láser diodo en tejidos blandos: reporte de 3 casos / Use of diode laser in soft tissue: report of 3 cases

Existen diversas condiciones anatómicas o alteraciones mucogingivales que pueden afectar tanto el normal funcionamiento como la estética gingival de piezas dentarias e implantes dentales. Si bien los tratamientos de estas condiciones se han realizado tradicionalmente con bisturí, el desarrollo tecnológico ha permitido que actualmente se pueden realizar con láser. Existen diferentes tipos de láser, siendo el diodo uno de los más utilizados debido a su menor tamaño, portabilidad, fácil configuración y menor costo. El láser ha adquirido mayor popularidad en cirugías de tejido blando dado sus múltiples beneficios: menor tiempo operatorio, control del sangrado y de la hemostasia, reducción de la cantidad de anestesia, posibilidad de no requerir suturas y minimización del dolor e inflamación postquirúrgica. El propósito de este trabajo es presentar la resolución de tres casos clínicos a los cuales se les realizaron los procedimientos de frenectomía labial, remoción de melanosis gingival y resección de fibroma irritativo mediante el uso de láser diodo. Para desarrollar todos los procedimientos se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia que varió entre 2 y 2.5 W en modo continuo utilizando una pieza quirúrgica con una punta de 300 µm (E 3-4), la que fue activada antes de empezar. Posterior a la cirugía se bioestimuló para disminuir el dolor y edema postoperatorio utilizando la punta de dolor a 4 W por 30 segundos a una distancia de 1 cm directo en la zona intervenida a todos los casos. La conclusión arroja que en todos los casos, el láser de diodo permitió un resultado exitoso. El procedimiento fue seguro, la técnica fue sencilla y de tiempo clínico reducido. El postoperatorio ocurrió con ausencia de dolor o molestias, generando una mayor satisfacción del paciente. Cabe señalar que la técnica depende de la habilidad del profesional que la realiza.

There are various anatomical conditions or mucogingival alterations that can affect the normal functioning and the gingival aesthetics of teeth and dental implants. Although the treatments of these conditions have been traditionally performed with a scalpel, technological development has allowed that they can be now performed with lasers. There are different types of lasers, being the diode one of the most used due to its smaller size, portability, easy configuration, and lower cost. The laser has become more popular in soft tissue surgeries due to its multiple benefits: shorter operating time, control of bleeding and hemostasis, reduction in the amount of anesthesia, possibility of not requiring sutures, and minimization of post-surgical pain and inflammation. The purpose of this work is to present the resolution of three clinical cases which underwent labial frenectomy procedures, removal of gingival melanosis and resection of irritative fibroma using diode laser. To develop all the procedures, a 940 nm diode laser equipment (Biolase®, USA) was used with a power that varied between 2 and 2.5 W in continuous mode, using a 300 µm tip (E 3-4), which was activated before starting. After surgery, biostimulation was carried out to reduce postoperative pain and edema using the pain tip at 4 W for 30 seconds at a distance of 1 cm directly in the operated area in all cases. In all cases, the diode laser allowed a successful result. The procedure was safe, the technique was simple, and the clinical time was short. The postoperative period occurred with the absence of pain or discomfort, generating greater patient satisfaction. It should be noted that the technique depends on the skill of the professional who performs it.

Presentación clínica de pigmentación melánica fisiológica / Clinical presentation of physiologic melanin pigmentation

Las pigmentaciones de la cavidad oral son comunes, éstas pueden representar diversas entidades clínicas, desde cambios fisiológicos hasta cambios malignos. Las pigmentaciones en la encía se conocen como pigmentaciones melánicas o melanosis gingival; en la encía se observan como tinciones oscuras ocasionadas por la acumulación de melanina en la zona. Éstas se consideran comunes, pueden representar variación normal en la pigmentación de melanina de la mucosa oral, hasta representar procesos malignos. En general, las personas de piel más oscura presentan frecuentemente mayor pigmentación de melanina oral que las personas de piel clara. Las variaciones en la pigmentación fisiológica oral están determinadas genéticamente a menos que estén asociadas con alguna enfermedad subyacente (AU)

Pigmentation of the oral cavity is common, it can represent diverse clinical entities, from physiological changes to malignant changes. Gum pigmentations are known as melanic pigmentations or gingival melanosis, and are observed as dark stains caused by the accumulation of melanin in the localized area. These are considered common, they can represent normal variation in melanin pigmentation of the oral mucosa, or malignant processes. In general, people with darker skin often exhibit greater pigmentation of oral melanin than people with fair skin. Variations in oral physiological pigmentation are genetically determined unless they are associated with some underlying disease (AU)

Un caso de melanosis neurocutánea: el lado oscuro del nevus melanocítico congénito gigante / A case of neurocutaneous melanosis: the dark side of the giant congenital melanocytic nevus

RESUMEN La melanosis neurocutánea es una facomatosis, no hereditaria, caracterizada por la proliferación de melanocitos y de depósitos de melanina en el sistema nervioso central, asociada a un nevus melanocítico congénito gigante o a múltiples nevus melanocíticos satélites. CASO CLÍNICO. Una mujer joven con nevus melanocítico congénito gigante y satelitosis, presentó hipertensión intracraneana asociada a hidrocefalia comunicante. Se le practicó derivación del líquido cefalorraquídeo con mejoría parcial, luego presentó convulsiones y afectación medular cervical que la llevó a la ventilación mecánica prolongada y finalmente a la muerte. La resonancia magnética evidenció lesiones en las leptomeninges. CONCLUSIONES. La melanosis neurocutánea debe considerarse en pacientes adultos con nevus melanocítico congénito que presenten manifestaciones clínicas neurológicas.

SUMMARY Neurocutaneous melanosis is a non-hereditary phakomatosis, characterized by the proliferation of melanocytes and melanin deposits in the central nervous system associated with a giant congenital melanocytic nevus or multiple melanocytic nevi satellites. CLINICAL CASE. A young woman with congenital giant melanocytic nevus and satelitosis, presented with intracraneal hypertension associated with communicating hydrocephalus. She was treated with cerebrospinal fluid shunt with partial improvement; but she worsened, presenting seizures and later cervical spinal cord involvement that led to prolonged mechanical ventilation and eventually death. MRI showed lesions in leptomeninges. CONCLUSIONS. Neurocutaneous melanosis should be considered in adult patients with congenital melanocytic nevus and clinical neurological manifestations.

Standardization of organoid culture for evaluation of melanogenesis induced by UVB, UVA and visible light

Abstract Background: Organoid cultures are primary cultures that maintain architectural characteristics and the relationships between cells, as well as the extracellular matrix. They are alternatives for pathophysiological or therapeutic investigation rather than animal and in vitro tests. Objective: Development of a cutaneous organoid culture model, aiming at the study of radiation-induced melanogenesis. Method: A validation study, which involved biopsies of the skin of the back of the adult ear. One sample was irradiated with different doses of UVB, UVA, or visible light (VL); the other was maintained in the dark for 72 h. The viability of the tissues was evaluated from the morphological and architectural parameters of the histology, and the expression of the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) gene, by real-time polymerase chain reaction (PCR). The radiation-induced melanin pigmentation was standardized according to the doses of each radiation and evaluated by digital image analysis (Fontana-Masson). Results: The primary skin culture was standardized at room temperature using DMEM medium. The doses of UVB, UVA, and VL (blue light) that induced differential melanogenesis were: 166 mJ/cm2, 1.524 J/cm2, and 40 J/cm2. The expression of the GAPHD constitutional gene did not differ between the sample of skin processed immediately after tissue collection and the sample cultured for 72 h in the standardized protocol. Study limitations: This was a preliminary study that evaluated only the viability and integrity of the melanogenic system, and the effect of the radiation alone. Conclusions: The standardized model maintained viable melanocytic function for 72 h at room temperature, allowing the investigation of melanogenesis induced by different forms of radiation.

Associação de luz intensa pulsada e laser Erbium: Yag 2940nm para tratamento de lentigo na face / Association of intense pulsed light and Erbium: Yag 2940 nm laser for treatment of lentigo on the face

O lentigo solar está presente em 90% da população com mais de 50 anos de idade, apresentando-se como manchas hipercrômicas em regiões fotoexpostas, que aumentam com o envelhecimento e são mais frequentes em peles claras. Há diversas modalidades terapêuticas com melhores resultados quando associadas. Descrevemos o caso de um homem de 62 anos, fototipo II de Fitzpatrick, com queixa de máculas acastanhadas em dorso nasal há oito anos. Foi submetido à biópsia de pele, e o estudo histológico confirmou ser lentigo solar. O paciente foi tratado com seis sessões de luz intensa pulsada associada a laser de Erbium: YAG 2940nm, com bom resultado clínico

Solar lentigo is present in 90% of the population over 50 years of age andcharacterizes as hyperchromic spots in photoexposed regions. It increases with aging and is more frequent in light skin. There are several therapeutic modalities, which achieve better results whenassociated. We describe the case of a 62-year-old man with Fitzpatrick skinphototype II, complaining of brownish macules in nasal dorsum for eight years. The patient underwent a skin biopsy, and the histological study confirmed solar lentigo. The patient was treated with six sessions of Intense Pulsed Light associated with Erbium-Yag2940 nm Laser with a good clinical result

Prevalence of Oromucosal Lesions in Relation to Tobacco Habit Among North Indian Population

Background: Smoking, drinking and chewing tobacco producthave been positively associated with oral lesions. The objectiveof the present study was to determine the prevalence oforomucosal lesions in relation to tobacco habit among a NorthIndian population.Materials and Methods: The present retrospective study wasstudy conducted among 1840 patients who reported in thedepartment of dentistry at NSCB Medical College Jabalpur MP.Along with patient's demographic details, information regardingthe type of habits, duration, frequency, site of placement,period of contact with mucosa, and history of discontinuation ofhabit were recorded using a standardized interviewer-basedquestionnaire. The diagnoses of clinically suspicious lesionswere confirmed by biopsy. Tobacco-related OMLs werediagnosed based on the clinical features. The collected datawere tabulated, and frequency and distribution tables of OMLswere generated using Statistical Package for Social Sciencesversion 21 (SPSS for Windows, Version 21.0. Chicago, SPSSInc.).Results: In the present study total patients were 3250 in which1840 patients were having habits. 58.69% males were havinghabits and 41.30% females were having habits. 67.59% maleswere smokers, 21.85% males were chewers and 10.55%males were having mixed smokers. 63.15% males weresmokers, 28.94% males were chewers, and 7.89% maleswere having mixed smokers. 36.90% patients were smokers,42.38% patients were chewers and 20.71% patients werehaving both smoking and chewing habits. The prevalence oftobacco coated tongue (31.57%) was highest in femaleswhereas in males prevalence of smoker’s melanosis (30.46%)was highest among all oromucosal lesions.Conclusion: Our study concluded that in both males andfemales smoking tobacco habit was more common thanchewing. The prevalence of tobacco coated tongue washighest in females whereas in males prevalence of smoker’smelanosis was highest among all oromucosal lesions.

Exploratory Study of Epidermis, Basement Membrane Zone, Upper Dermis Alterations and Wnt Pathway Activation in Melasma Compared to Adjacent and Retroauricular Skin

BACKGROUND: Melasma is a chronic acquired focal hypermelanosis which pathogenesis has not been fully elucidated. Classical pathophysiologic studies have analysed the affected and perilesional areas, but little is known about the status of sun-protected skin, which is subjected to the same endogenous and genetic factors.OBJECTIVE: To assess the histological characteristics of melasma compared to adjacent and retroauricular skin.METHODS: Skin samples were collected from 10 female from: melasma, perilesional area and retroauricular. The samples were stained (haematoxylin-eosin, periodic acid-Schiff, Fontana-Masson, picrosirius red, toluidine blue and Verhoeff), immunolabelled for CD34 and Wnt1. The data from the skin sites were analysed simultaneously by a multivariate model.RESULTS: Melasma skin exhibited noteworthy stratum corneum compaction, greater collagen heterogeneity, solar elastosis, higher number of mast cells, basement membrane zone (BMZ) damage, Wnt1 expression, pendulum melanocytes, higher cellularity and vascular proliferation at the superficial dermis. Stratum corneum compaction, collagen heterogeneity and BMZ abnormalities were variables associated to melasma that not follow a continuum through retroauricular to adjacent skin. Mast cell count was the variable that disclosed correlation with the most other abnormalities as well as had the greater contribution in the multivariate model.CONCLUSION: In addition to melanocyte hyperactivity, melasma skin exhibits alterations in the epidermal barrier, upper dermis and BMZ, which differ from the adjacent sun-exposed skin and retroauricular skin, indicating a distinct phenotype, rather than a mere extension of photoageing or intrinsic ageing. Mast cells appear to play a central role in the physiopathology of melasma.