Presentación clínica de patologías no malignas que simulan leucemia cutis: a propósito de dos casos / Clinical presentation of non-malignant diseases mimicking leukemia cutis: A report of two cases

La infiltración cutánea por células leucémicas conocida como leucemia cutis es una presentación infrecuente de esta patología y constituye un desafío diagnóstico. Los diagnósticos como infecciones, otras patologías neoplásicas con afectación cutánea y los trastornos histiocíticos, entre otros, constituyen los principales diagnósticos diferenciales, ya que configuran un escenario pronóstico y terapéutico diferente. Se presentan dos pacientes que fueron diagnosticados inicialmente como leucemia cutis, cuyo diagnóstico final fue de patologías no malignas.

The infiltration of leukemia cells into the skin, known as leukemia cutis, is a rare presentation of this disease and accounts for a diagnostic challenge. The main differential diagnoses include infections, other neoplastic diseases with skin involvement and histiocytic disorders, among others, as they entail different prognostic and therapeutic approaches. Here we describe two patients who were initially diagnosed with leukemia cutis, whose final diagnosis was of non-malignant diseases.

Carcinoma neuroendocrino de la piel: Carcinoma de células de Merkel. Revisión de la Literatura, a propósito de un caso / Neuroendocrine skin carcinoma: Merkel cell carcinoma. Review of literature, about a case

El carcinoma de células de Merkel, también llamado carcinoma neuroendocrino de la piel, es un tipo de cáncer de piel muy poco frecuente que generalmente aparece como un nódulo de color carne o rojo azulado, más frecuentemente en región facial, cabeza y cuello. El carcinoma de células de Merkel se desarrolla principalmente en personas mayores ya que la exposición al sol a largo plazo o un sistema inmunitario débil pueden aumentar el riesgo de desarrollarlo. Las células de Merkel se encuentran en la base de la capa más externa de la piel (epidermis) y están conectadas a las terminaciones nerviosas que son responsables del sentido del tacto. Tiende a crecer rápido y diseminarse a otras partes del cuerpo. Por tanto, las opciones de tratamiento para el carcinoma de células de Merkel dependen de si el cáncer se ha diseminado más allá de la piel

Merkel cell carcinoma, also called neuroendocrine skin of the skin, is a very rare type of skin cancer that generally appears as a bluish meat or red color nodule, more frequently in the facial, head and neck region. Merkel cell carcinoma develops mainly in older people since long -term exposure or a weak immune system can increase the risk of developing it. Merkel cells are at the base of the outermost layer of the skin (epidermis) and are connected to nerve endings that are responsible for the sense of touch. It tends to grow quickly and spread to other parts of the body. Therefore, the treatment options for Merkel cell carcinoma depend on whether cancer has spread beyond the skin

Análisis estadístico de la práctica quirúrgica oncológica de piel, en nuestra especialidad / Statistical analysis of skin cancer surgical practice in our specialty

El cáncer de piel es el más frecuente de todos los tipos de cáncer del ser humano, por lo cual el conocimiento y diagnóstico correcto de la patología oncocutánea, así como la formación impartida a los especialistas de nuestra área, es de vital importancia a la hora de jerarquizar el diagnóstico temprano y lograr un adecuado tratamiento de forma oportuna. El correcto abordaje terapéutico del cáncer cutáneo y sus variantes es de primordial importancia en el manejo quirúrgico de los cirujanos plásticos, por lo cual la Comisión de Oncología Quirúrgica de tumores de piel de la Sociedad Argentina de Cirugía Plástica Estética y Reparadora (SACPER) decide realizar y difundir la siguiente encuesta anónima a los miembros de la SACPER. En esta encuesta evaluativa, se obtuvieron datos sobre el estado actual de formación de los cirujanos de nuestro país, la ejecución de las prácticas relacionadas con el abordaje, la resección o la reconstrucción posterior relacionados a dicha patología.

The knowledge and correct diagnosis of the oncocutaneous pathology, as well as the training provided to the specialists in our area, is of vital importance when prioritizing early diagnosis and achieving adequate treatment. The correct therapeutic approach to skin cancer and its variants is of paramount importance in the surgical management of plastic surgeons, for which we decided to carry out an anonymous survey of the members of the Argentine Society of Aesthetic and Reconstructive Plastic Surgery (SACPER). In this questionnaire, we obtained valuable information about the current state of training of surgeons in our country, the execution of practices related to the approach, resection, or subsequent reconstruction related to said pathology.

Nevus azul celular parotídeo, una tumoración inusual / Parotid cellular blue nevi, an unusual mass

Introducción: el nevus azul celular es una tumoración melanocítica dérmica benigna. En ocasiones, puede ser falsamente diagnosticada como lesiones malignas, entre ellas, el melanoma. Caso clínico: se trata de una mujer de 37 años que presentó una masa parotídea izquierda de cuatro meses de evolución correspondiente con un nevus azul celular. Discusión: la región de la cabeza y cuello es la tercera en frecuencia, tras la sacrococcígea y las extremidades. Ante una tumoración melanocítica, es importante la confirmación diagnóstica, debido a las similitudes, tanto clínicas como anatomopatológicas, del nevus azul celular con el melanoma maligno. Conclusiones: es muy importante el diagnóstico diferencial correcto, para lo cual es de ayuda el uso de las tinciones inmunohistoquímicas. El tratamiento de esta tumoración es la exéresis quirúrgica con márgenes, esto presenta un comportamiento benigno y baja tasa de recidiva.

Introduction: Cellular blue nevi is a benign dermal melanocytic tumor. Occasionally, it can be falsely diagnosed as malignant lesions, including melanoma. Clinical case: This is a 37-year-old woman who presented with a left parotid mass of four months of evolution, corresponding with a cellular blue nevi. Discussion: The region of the head and neck is the third in frequency, after the sacrococcygeal and the extremities. During the study of a melanocytic tumor, diagnostic confirmation with a biopsy is important, due to the similarities, both clinical and pathological, of cellular blue nevi with malignant melanoma. Conclusions: the correct differential diagnosis is very important, for which immunohistochemical study is helpful. The treatment of this tumor is the surgical excision with margins, presenting benign behaviour and low recurrence rate.

Regressing eruptive disseminated pigmented Spitz (Reed) nevi in a young adults

Abstract Eruptive disseminated Spitz nevi is a rare clinical presentation that features an abrupt widespread eruption of Spitz nevi. Spontaneous regression of these nevi has been rarely reported in previous literature. The authors of the present study report the case of a 30-year-old man who presented eruptive disseminated Spitz nevi that appeared within a week and started regression in the following years.

Immunohistochemical Markers in the Differential Diagnosis of Melanoma and Nevus in Humans

SUMMARY: Immunohistochemistry allows in situ detection of cell and extracellular components through specific antibodies. The objective was to compare the immunohistochemical expression patterns of the S-100, HMB-45 and MART-1 proteins for differential diagnosis of malignant melanoma and melanocytic nevus in human skin biopsies. Thirty-nine biopsies of human tissue were used. They were divided into two groups: 19 in malignant melanoma and 20 in melanocytic nevi. Next, the samples were fixed with paraformaldehyde and processed following the protocol for inclusion. Then, immunohistochemical staining was performed. Finally, the histological and qualitative analysis of the samples was carried out. S-100, HMB-45, and MART-1 markers showed positive immunoreaction in melanoma biopsies. HMB-45 marker was generally present with weaker expression than S-100 and MART-1 in melanocytic nevus biopsies. No expression pattern was observed which specifically associates one or more markers with some types of histopathological diagnosis. Immunohistochemistry is fundamental in differential diagnosis of melanomas and melanocytic nevi. However, there is no antibody or set of antibodies which allows unequivocal diagnosis between melanoma and nevus. It is therefore necessary to analyze with care the expression pattern and location of the lesion using standard morphological characteristics.

RESUMEN: La inmunohistoquímica permite la detección in situ de componentes celulares y extracelulares a través de anticuerpos específicos. El objetivo de nuestro estudio fue comparar los patrones de expresión inmunohistoquímica de las proteínas S-100, HMB-45 y MART-1 para el diagnóstico diferencial de melanoma maligno y nevo melanocítico en biopsias de piel humana. Se utilizaron treinta y nueve biopsias de tejido humano, las que fueron divididas en dos grupos: 19 en melanoma maligno y 20 en nevos melanocíticos. A continuación, las muestras se fijaron con paraformaldehído y se procesaron siguiendo el protocolo convencional para su inclusión. Luego, se realizó la tinción inmunohistoquímica. Finalmente, se realizó el análisis histológico y cualitativo de las muestras. Los marcadores S-100, HMB- 45 y MART-1 mostraron inmunorreacción positiva en biopsias de melanoma. El marcador HMB-45 estuvo generalmente presente con una expresión más débil que S-100 y MART-1 en biopsias de nevo melanocítico. No se observó ningún patrón de expresión que asocie específicamente uno o más marcadores con algunos tipos de diagnóstico histopatológico. La inmunohistoquímica es fundamental en el diagnóstico diferencial de melanomas y nevos melanocíticos. Sin embargo, no existe ningún anticuerpo o panel de anticuerpos que permita un diagnóstico inequívoco entre el melanoma y el nevo. Por tanto, es necesario analizar con cuidado el patrón de expresión y la localización de la lesión utilizando características morfológicas estándar.

Total body mapping in the follow-up of melanocytic lesions: recommendations of the Brazilian Society of Dermatology

Abstract Total body mapping comprises photographic documentation of the entire body surface followed by digital dermatoscopy of selected melanocytic lesions, aiming to compare their evolution over time and identify new lesions. As this is an exam based on comparative analysis of serial dermoscopic body images, standardization of the technique for performing total body mapping is essential. Prepared by specialists from the Brazilian Society of Dermatology, using the modified Delphi method, this article provides recommendations for carrying out total body mapping in Brazil, regarding its indications, technical aspects, and the issuing of the report.

Recurrence of melanoma in the scar after excised Spitz nevus in a 17-year-old child

Abstract Melanoma in childhood is rare and its diagnosis is more difficult than in adults, as it often presents histologic features overlapping with the Spitz nevus. The authors report the case of a 17-year old boy who was first diagnosed with Spitz nevus, however, the final diagnosis made after the excision of the tumor arising in the scar was changed to melanoma. The case in this present study emphasizes the importance of the differential diagnosis of skin tumors in young patients.

Tumores cutáneos de colisión / Cutaneous collision tumors

Los tumores de colisión consisten en neoplasias compuestas por dos poblaciones celulares distintas que mantienen una clara diferenciación de sus bordes y que se encuentran adyacentes una de otra en la misma muestra histopatológica. Esta asociación puede corresponder a dos tumores malignos, dos benignos o uno maligno y uno benigno. Son infrecuentes y, en ocasiones, representan un desafío clínico para la detección correcta de ambas neoplasias. Se presenan los casos de tres pacientes con tumores cutáneos de colisión, de estirpe melanocítica combinada con queratinocítica; en dos de ellos ambas neoplasias fueron malignas y en uno, se asociaron una lesión maligna y una benigna.

Collision tumors consist of neoplasms composed of two different cell populations that maintain a clear differentiation of their borders, and that are adjacent to each other in the same histopathological sample. This association can correspond to two malignant tumors, two benign, or one malignant and one benign. They are infrequent and, at times, represent a clinical challenge for the correct detection of both neoplasms. Three cases of cutaneous collision tumors of a melanocytic line combined with a keratinocytic line are presented, two of them in which both neoplasms were malignant and one that associated a malignant and a benign lesion.

Aggressive parotid gland and neck metastasis caused by cutaneous squamous cell carcinoma of the scalp: a case report / Metástasis agresiva de glándula parótida y cuello causada por carcinoma cutáneo de células escamosas decuero cabelludo: reporte de un caso

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

Introducción: La cabeza y el cuello son sitios frecuentes de desarrollo de cáncer cutáneo y el carcinoma epidermoide de piel (CEC) es una de las neoplasias malignas sin melanoma más frecuentes en Chile (436 por 100.000 habitantes). Entre el 5% y el 10% del CCE cutáneo progresa de forma agresiva y genera metástasis en los ganglios linfáticos parótidos y cervicales. Reporte de Caso: Varón de 82 años, presenta lesión dolorosa de aumento de volumen en zona mandibular. Tiene antecedentes de hipertensión arterial crónica, insuficiencia renal aguda, CCE del cuero cabelludo, tuberculosis extrapulmonar, exposición crónica al sol y tabaquismo. El examen extraoral mostró una lesión de 4 cm en el tercio posterior de la rama mandibular, con bordes indefinidos, consistencia firme y dolorosa a la palpación. Intraoralmente se observa mucosa eritematosa, así como falta de lubricación, dolor a la palpación y expansión del hueso cortical. Se realiza biopsia incisional, se solicitan exámenes de imagen e histológicos. Los resultados indican la presencia de CCE y, por tanto, derivación a atención secundaria. Son muchos los factores de riesgo asociados al desarrollo de CEC, siendo la radiación ultravioleta la más relevante en este caso, favoreciendo su aparición en el cuero cabelludo. La probabilidad de metástasis es baja, pero cuando ocurre, la mayoría de los casos que comenzaron en el cuero cabelludo se diseminan a la región parotídea y cervical. Conclusión: El SCC tiene un buen pronóstico. Sin embargo, existen antecedentes, como tamaño y ubicación, que deben alertar al profesional para realizar el seguimiento, cribado precoz, control de ganglios metastásicos en zona maxilofacial.

Case for diagnosis. Dorsal nodule in a 10-year-old male

Abstract Granular cell tumors (GCTs) are rare soft-tissue neoplasms. GCT immunohistochemistry is positive for S-100, NSE, and CD68. This report describes the case of a 10-year-old male who presented with a dorsal nodule. A biopsy revealed aggregates and sheets of large epithelioid and spindle cells. The cells had abundant eosinophilic granular cytoplasm. Immunohistochemical analysis was positive for CD68, NKI/C3, and synaptophysin; weakly positive for NSE; and negative for S-100, SOX10, HMB45, Melan A, cytokeratin, SMA, EMA, and CD163. The Ki-67 index was less than 1%. A diagnosis of an S-100 negative, cutaneous, benign GCT was determined.

Ear melanoma: a four-case series

Abstract External ear melanoma is rare, and early diagnosis and treatment are paramount for the patient's survival. Four clinical cases are reported, emphasizing the importance of the routine clinical examination of the ears in the dermatological consultation. The study included male and female patients, aged 60 to 81 years old, with melanocytic lesions in the outer ear, evaluated with detailed physical and dermoscopic examination, leading to the identification of lesions suggestive of melanoma. The cases were treated surgically with excision of the lesion, and the diagnoses were confirmed by histopathological study. The therapeutic approach was instituted early as most cases were diagnosed at an early stage, which directly impacted global survival.

A case report and literature review of cutaneous intravascular large B-cell lymphoma presenting clinically as panniculitis: a difficult diagnosis, but a good prognosis,

Abstract Intravascular large B-cell lymphoma is a rare, non-mass-forming, extranodal large B-cell lymphoma subtype characterized by the presence of tumor cells in the lumens of vessels. It is divided into two major types: classical and Asian. Patients presenting only with skin involvement are mostly female, at a younger age than classical intravascular large B-cell lymphoma patients, and have a better prognosis. Since the diagnosis of cases with isolated skin involvement is difficult, keeping this entity in mind, performing a careful microscopic examination, and applying new, effective treatment regimens will make it possible to achieve better clinical outcomes in these cases.

Sítio Metastático Incomum - Metástases Peritoneais em Melanoma Maligno: Relato de Caso / Unusual Metastatic Site - Peritoneal Metastasis in Malignant Melanoma: Case Report / Sitio Metastásico Raro - Metástasis Peritoneales en Melanoma Maligno: Reporte de Caso

Introdução: O melanoma cutâneo é um tumor com grande capacidade de metastização. Um dos quadros possíveis, mas bastante raro, é quando a metástase se aloja em peritônio (carcinomatose peritoneal). Relato do caso: Paciente feminina, 61 anos, encaminhada por massa inguinal esquerda suspeita e lesão hipercrômica de 2 cm, com área de regressão em membro inferior esquerdo. A paciente foi submetida à linfadenectomia inguinal esquerda e ressecção da lesão de pele, que evidenciou melanoma maligno cutâneo extensivo superficial invasor, de espessura de Breslow 1,2 mm, e nível de Clark II, bem como metástase linfonodal. O tratamento adjuvante incluiu radioterapia e quimioterapia. Durante follow-up, oito meses depois, ultrassonografia e tomografia computadorizada de abdome evidenciaram imagem nodular sólida hipoecoica, heterogênea e bosselada, mal definida e mal delimitada em projeção para-aórtica à esquerda, com 12,7x6,7x4,8 cm. Em laparotomia exploradora, encontrou-se massa volumosa retroperitoneal em flanco esquerdo, com envolvimento do ângulo de Treitz e presença de carcinomatose peritoneal. O laudo anatomopatológico evidenciou neoplasia maligna pouco diferenciada epitelioide infiltrativa, compatível com história clínica de melanoma. A paciente evoluiu a óbito após consulta com oncologia clínica. Conclusão:Existem poucos casos de metástase peritoneal de melanoma relatados na literatura. Contudo, deve-se levar em consideração sua possibilidade de ocorrência e as opções terapêuticas disponíveis, além de também compreender seu impacto no prognóstico do paciente. Apesar de rara, a carcinomatose peritoneal deve ser considerada quando pacientes com histórico pessoal de melanoma apresentarem queixas abdominais inespecíficas, como a paciente do caso relatado.

Introduction: Cutaneous melanoma is a tumor with great capacity for metastasis. One of the possible but quite rare scenarios is when the metastasis is lodged in the peritoneum (peritoneal carcinomatosis). Case report:61-year-old female patient, referred by a suspected left inguinal mass and 2 cm hyperchromic lesion, with regression area in the left lower limb. The patient underwent left inguinal lymphadenectomy and resection of the skin lesion, which revealed invasive extensive superficial cutaneous malignant melanoma, Breslow depth 1.2 mm and Clark II level, as well as lymph node metastasis. Adjuvant treatment included radiotherapy and chemotherapy. During follow-up, 8 months later, abdominal ultrasound and computed tomography showed hypoechoic, heterogeneous, and beveled solid nodular image, poorly defined and delimited in left para-aortic projection, with 12.7x6.7x4.8 cm. In exploratory laparotomy, a large retroperitoneal mass was found on the left flank, involving the Treitz angle, and revealed the presence of peritoneal carcinomatosis. The anatomopathological report showed a poorly differentiated malignant infiltrative epithelioid neoplasm, compatible with the clinical history of melanoma. The patient died after consultation with clinical oncology. Conclusion: There are few cases of peritoneal metastasis of melanoma reported in the literature. However, its possibility of occurrence and the therapeutic options available must be taken into account, in addition to understanding its impact on the patient's prognosis. Although rare, peritoneal carcinomatosis should be considered when patients with a personal history of melanoma have non-specific abdominal complaints, such as the patient in the case reported.

Introducción: El melanoma cutáneo es un tumor con gran capacidad de metástasis. Una de las situaciones posibles, pero bastante rara, es cuando la metástasis se aloja en el peritoneo. Relato del caso: paciente femenina de 61 años, remitida por sospecha de masa inguinal izquierda y lesión hipercrómica de 2 cm, con área de regresión, en miembro inferior izquierdo. La paciente fue sometida a linfadenectomía inguinal izquierda y resección de la lesión cutánea, que demonstró melanoma maligno cutáneo superficial extenso invasivo, Breslow 1,2 mm y nivel de Clark II, así como metástasis ganglionares. El tratamiento adyuvante incluyó radioterapia y quimioterapia. Durante el seguimiento, 8 meses después, la ecografía y la tomografía computarizada de abdomen mostraron una imagen nodular sólida hipoecoica, heterogénea y biselada, mal definida y delimitada en proyección para-aórtica izquierda, con 12,7x6,7x4,8 cm. En la laparotomía exploradora se encontró una gran masa retroperitoneal en el flanco izquierdo, involucrando el ángulo de Treitz y presencia de carcinomatosis peritoneal. El informe anatomopatológico mostró una neoplasia epitelioide infiltrativa maligna mal diferenciada, compatible con la historia clínica de melanoma. El paciente falleció tras consulta con oncología clínica. Conclusión: Hay pocos casos de metástasis peritoneal de melanoma reportados en la literatura. Sin embargo, se debe tener en cuenta su posibilidad de ocurrencia y las opciones terapéuticas disponibles, además de comprender su impacto en el pronóstico del paciente. Aunque es poco común, la carcinomatosis peritoneal debe considerarse cuando los pacientes con antecedentes personales de melanoma tienen molestias abdominales inespecíficas, como la paciente del caso.

Dermatoscopía de nevos melanocíticos congénitos acrales: puesta al día / Dermoscopy of melanocytic nevi acral congenitals: update

Los nevos melanocíticos congénitos (NMC) son aquellos presentes al nacer o que se desarrollan durante los primeros dos años de vida. Hay muy pocos casos documentados de melanoma lentiginoso acral en asociación con nevos preexistentes en comparación a otros subtipos de melanoma. De éstos, la mayoría serían asociados a nevos melanocíticos adquiridos acrales (NMAA) y muy excepcionalmente asociados a nevos melanocíticos congénitos acrales (NMCA). Sin embargo, la extirpación de lesiones pigmentadas acrales congénitas es practicada con frecuencia y se desconocen los patrones dermatoscópicos más característicos, así como tampoco se disponen de algoritmos de seguimiento. A continuación, presentamos dos casos de NMCA con patrones dermatoscópicos característicos y realizamos una revisión de los patrones dermatoscópicos más comunes de NMCA descritos en la literatura.

Congenital melanocytic nevi (CMN) are those present at birth or that develop during the first two years of life. There are very few documented cases of acral lentiginous melanoma in association with pre-existing nevi compared to other subtypes of melanoma. Of these, the majority would be associated with acral acquired melanocytic nevi (NMAA) and very exceptionally associated with acral congenital melanocytic nevi (NMCA). However, the excision of congenital acral pigmented lesions is frequently practiced and the most characteristic dermoscopic patterns are unknown, nor are there any follow-up algorithms. In the following, we present two cases of NMCA with characteristic dermoscopic patterns and a review of the most common dermoscopic patterns of NMCA described in the literature

Nevus azul celular con satelitosis y velo azul blanquecino simulando un melanoma, a propósito de un caso / Cellular blue nevus with satellitosis and blue veil whitish simulating a melanoma, purpose of a case

Los nevi azules son proliferaciones melanocíticas dendríticas benignas a nivel dérmico, congénitos o adquiridos, debido a un defecto migratorio embrionario de melanocitos a partir de la cresta neural. Se manifiestan clásicamente como una pápula, nódulo o placa de color azul o azul-gris. Muchos subtipos histológicos se han descrito, siendo los más comunes el nevus azul común, nevus azul celular y nevus azul combinado. Las formas esporádicas incluyen al nevus azul lineal, eruptivo, agminado y con satelitosis. La dermatoscopía característica muestra un patrón de pigmentación homogéneo monocromático azul o azul-grisáceo, con ausencia de otras estructuras. Sin embargo, se han descrito también patrones de pigmentación dicromáticos y multicromáticos, además de estructuras tales como red de pigmento, puntos, glóbulos, proyecciones radiadas, pseudópodos, áreas cicatriciales blanquecinas, patrón vascular y rosetas. El diagnóstico diferencial de los nevi azules incluye lesiones melanocíticas y no melanocíticas, benignas y malignas, destacando entre ellas el melanoma. Se presenta el caso de un paciente de sexo masculino de 30 años, portador de un nevus azul celular con cambios de rápida evolución, con desarrollo de lesiones satélites y un aspecto dermatoscópico sugerente de malignidad, simulando un melanoma.

Blue nevi are benign, congenital, or acquired, dermal dendritic melanocytic proliferations due to an embryonic migratory defect of melanocytes starting from the neural crest. They classically manifest as a blue or blue-gray papule, nodule, or plaque. Many histological subtypes have been described, including common blue nevus, cellular blue nevus and combined blue nevus. Sporadic forms include linear blue nevus, eruptive, agminate and with satellitosis. Characteristic dermoscopy shows a homogeneous monochromatic blue or steel-blue pigmentation pattern, with the absence of other structures. However, dichromatic and multichromatic pigmentation patterns have also been described, in addition to structures such as pigment network, dots, globules, streaks, pseudopods, whitish scar areas, vascular pattern and rosettes. Differential diagnosis of blue nevi includes melanocytic and non-melanocytic, benign and malignant lesions, most notably melanoma. The case of a 30-year-old male patient is presented, with a cellular blue nevus with rapidly evolving changes, with development of satellite lesions and a dermoscopic appearance suggestive of malignancy, mimicking melanoma.

Solitary fibrofolliculoma: a retrospective case series review over 18 years / Fibrofoliculoma solitário: revisão de série retrospectiva de casos de 18 anos

ABSTRACT Purpose: The purpose of this study was to report a series of cases of solitary fibrofolliculoma, a lesion seldom observed in the lids. Demographics, as well as clinical and histological aspects of the lesion were evaluated. Methods: This was a retrospective case series spanning a period of 18 years. All the included patients were diagnosed with solitary fibrofolliculoma confirmed by histological examination. Data regarding patient demographics, signs, and symptoms, course of the disease, location of the lesion, clinical and histological diagnosis, and outcome were collected. Results: Eleven cases of solitary fibrofolliculoma were diagnosed in the study period. The median age of patients was 51 ± 16.3 years (range: 27-78 years). Most patients were females (7/11; 64%). Five of the patients (45%) were asymptomatic; four (36%) reported bleeding, one (9%) had referred itching, and one (9%) rubbing of the lesion. The lesion occurred in a wide range of locations; one of them was located in the lids. The diagnosis for all lesions was histological based on characteristic findings of a hair follicle occasionally dilated and containing keratin material surrounded by a moderately well-circumscribed thick mantle of fibrous tissue. The infundibular follicular epithelium extended out into this fibrous mantle forming epithelial strands or cords. There were no relapses after exeresis. Conclusion: Solitary fibrofolliculoma is a rare lesion, seldom affecting the eyelids. We reported 11 cases, and the third case reported thus far in the literature affecting the lids. Diagnosis may be easily missed due to the nonspecific symptoms and clinical appearance. Therefore, it is necessary to perform excisional biopsy and histological examination for the recognition of this lesion.

RESUMO Objetivo: o objetivo deste estudo foi relatar uma série de casos de fibrofoliculoma solitário, uma lesão raramente observada nas pálpebras. Demografia, bem como aspectos clínicos e histológicos da lesão foram avaliados. Métodos: Trata-se de uma série de casos retrospectivos, com um período de 18 anos. Todos os pacientes incluídos foram diagnosticados com fibrofoliculoma solitário confirmado por exame histológico. Foram coletados dados referentes à demografia, sinais e sintomas dos pacientes, evolução da doença, localização da lesão, diagnóstico clínico e histológico e desfecho. Resultados: Onze casos de fibrofoliculoma solitário foram diagnosticados no período do estudo. A média de idade dos pacientes de 51 ± 16,3 anos (variação: 27-78 anos). A maioria dos pacientes era do sexo feminino (7/11, 64%). Cinco dos pacientes (45%) eram assintomáticos; quatro (36%) relataram sangramento, um (9%) referiu coceira e um (9%) fricção da lesão. A lesão ocorreu em luma ampla variedade de locais; um deles sendo nas pálpebras. O diagnóstico de todas as lesões foi histológico com base nos achados característicos de um folículo piloso ocasionalmente dilatado e contendo material de queratina, cercado por um manto espesso de tecido fibroso moderadamente bem circunscrito. O epitélio infundibular folicular se estendeu até esse manto fibroso, formando cordões ou cordões epiteliais. Não houve recaídas após exérese. Conclusão: Fibrofoliculoma solitário é uma lesão rara, mais ainda quando afeta as pálpebras. Relatamos 11 casos, e o terceiro relatado até o momento na literatura que afeta as pálpebras. O diagnóstico pode ser facilmente esquecido devido a sintomas inespecíficos e aparência clínica. Portanto, é necessário realizar biópsia excisional e exame histológico para o reconhecimento dessa lesão.