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Arq. neuropsiquiatr ; 80(2): 153-160, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364374


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.

Humans , Female , Infant, Newborn , Adult , Melanosis/complications , Melanosis/pathology , Nevus, Pigmented/complications , Nevus, Pigmented/pathology , Skin Neoplasms , Central Nervous System/pathology , Retrospective Studies
An. bras. dermatol ; 94(3): 361-362, May-June 2019. graf
Article in English | LILACS | ID: biblio-1011102


Abstract: Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.

Humans , Male , Child , Melanoma/diagnosis , Skin Diseases/diagnosis , Skin Diseases/etiology , Skin Diseases/drug therapy , Hyperpigmentation/complications , Dermoscopy , Diagnosis, Differential , Ethanol/therapeutic use , Anti-Infective Agents, Local/therapeutic use , Nevus, Pigmented/complications
An. bras. dermatol ; 92(2): 200-205, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838037


Abstract: Background: Large congenital melanocytic nevus (LCMN) is considered a risk factor for melanoma, although the magnitude of this risk is controversial. Objective: To evaluate the risk of melanoma development in patients with LCMN seen at a dermatology referral center in Brazil during a twelve-year period. To the best of our knowledge, there are no published similar studies on large congenital melanocytic nevus in South America. Methods: Our prospective cohort included only patients with congenital nevi ≥20cm. The cumulative risk of developing melanoma and the standardized morbidity ratio were calculated for patients followed up prospectively for at least 1 month. Results: Sixty-three patients were enrolled in this study. One patient who developed melanoma prior to enrollment was excluded, and five were eliminated because of insufficient follow-up time. Mean follow-up for the remaining 57 patients was 5.5 years (median 5.2 years). Median age of entry into the study was 2.6 years. Most patients (75.4%) underwent only clinical observation. Melanomas occurred in 2 (3.5%) patients. Five-year cumulative risk for melanoma was 4.8% (95% CI: 1.9-11.5%). Standardized morbidity ratio was 1584 (95% CI: 266-5232, p<0.001). Study limitations: The small sample size reduces the accuracy of risk estimates. Conclusions: This study analyzed prospectively for the first time data from South America demonstrating that patients with LCMN have a higher risk of developing melanoma than the general population (p<0.001).

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Skin Neoplasms/etiology , Melanoma/etiology , Nevus, Pigmented/complications , Referral and Consultation , Prospective Studies , Risk Factors , Follow-Up Studies , Nevus, Pigmented/congenital
An. bras. dermatol ; 92(2): 256-259, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-838054


Abstract: Although giant congenital melanocytic nevus is a rare lesion, it causes significant deformity and carries a risk of malignant degeneration. Different surgical techniques for the lesion removal are described, including serial resection, resection with skin grafting, and resection and coverage with expanded skin flap (skin expanders). The aim of this study is to report the author's 40 years of experience with cases requiring at least 4 serial excisions to complete the treatment. Serial resection is an effective, safe, and simple technique that requires a lot of patience. Treatment often results in a single linear scar, requires no donor sites, nor large flaps. It is not subject to potencial complications of expanders and avoid aesthetic deformities depending on the location.

Humans , Skin Neoplasms/surgery , Surgical Flaps/surgery , Dermatologic Surgical Procedures/methods , Nevus, Pigmented/surgery , Skin Neoplasms/complications , Skin Neoplasms/congenital , Time Factors , Tissue Expansion Devices , Nevus, Pigmented/complications , Nevus, Pigmented/congenital
Rev. bras. oftalmol ; 73(3): 178-181, May-Jun/2014. graf
Article in Portuguese | LILACS | ID: lil-727181


O melanoma conjuntival multifocal recidivado originado de nevus preexistente é extremamente raro, ocorrendo em uma pessoa para cinco milhões de habitantes. Seu estudo é de extrema relevância, devido sua potencial letalidade. Este estudo objetiva descrever um caso de melanoma conjuntival multifocal recidivado proveniente de nevus pigmentado preexistente ocorrido em Patos de Minas, MG. Este é um estudo de caso com revisão de literatura. O diagnóstico histopatológico e o estadiamento precoce da lesão conjuntival é de fundamental importância para designar a conduta frente ao paciente. O procedimento terapêutico mais utilizado nos dias atuais é a excisão cirúrgica com crioterapia adjuvante associada à mitomicina C. O prognóstico do melanoma conjuntival multifocal recidivado originado de nevus preexistente é o pior dentre todos os melanomas oculares, apresentando alta taxa de mortalidade, 12% a 20% em 5 anos e 30% em 10 anos de desenvolvimento patológico.

Recurrent multifocal conjunctival melanoma originated from preexisting nevus is extremely rare: it occurs in one out of five million individuals. The investigation of this disease is extremely important due to its potential lethality. Thus, this study aims to describe a case of recurrent multifocal conjunctival melanoma originated from preexisting pigmented nevus, which occurred in the city of Patos de Minas, state of Minas Gerais. This is a case study and literature review. Histopathological diagnosis and early staging of the conjunctival lesion is a key element on how to approach the patient. The treatment procedure most commonly used today is surgical excision with adjuvant cryotherapy and mitomycin C. The prognosis of recurrent multifocal conjunctival melanoma originated from preexisting nevus is the worst of all ocular melanomas, with high mortality rate: 12% to 20% within 5 years and 30% within 10 years of pathological development.

Humans , Male , Adult , Recurrence , Conjunctival Neoplasms/pathology , Melanoma/pathology , Nevus, Pigmented/pathology , Ophthalmologic Surgical Procedures , Biological Dressings , Biopsy , Conjunctival Neoplasms/surgery , Conjunctival Neoplasms/diagnosis , Amnion/transplantation , Melanoma/surgery , Melanoma/diagnosis , Nevus, Pigmented/complications
An. bras. dermatol ; 87(2): 288-291, Mar.-Apr. 2012. ilus
Article in English | LILACS | ID: lil-622429


A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patient's age and the absence of malignant degeneration to date.

Nevo melanocitico congênito gigante constitui uma condição rara. O fenômeno halo pode ser observado em nevos melanocíticos congênitos ou adquiridos. Na literatura a associação nevo halo e nevo melanocítico congênito gigante é rara e a associação de ambos com vitiligo ainda mais rara. Mulher de 75 anos que à primeira consulta apresentava mácula hipercrômica castanho-azulada pilosa na região lombar, nádegas e coxas desde o nascimento e halo acrômico de aparecimento há 3 anos. Os histológicos foram compatíveis com nevo melanocítico congênito e nevo halo respectivamente. Após dois anos evoluiu com áreas de acromia à distância, com histológico de vitiligo. Os autores ressaltam a raridade desta tripla associação; a idade da paciente e a ausência de degeneração maligna até o presente momento.

Aged , Female , Humans , Nevus, Halo/complications , Nevus, Pigmented/complications , Skin Neoplasms/complications , Vitiligo/complications , Nevus, Halo/pathology , Nevus, Pigmented/congenital , Nevus, Pigmented/pathology , Skin Neoplasms/congenital , Skin Neoplasms/pathology , Vitiligo/pathology
Rev. bras. cir. plást ; 26(3): 407-410, July-Sept. 2011. ilus, tab
Article in English | LILACS | ID: lil-608197


BACKGROUND: The shortage of tissue for large defect reconstruction is a challenge for the plastic surgeon. Tissue expansion emerged in this context, and in the last 30 years has become one of the most widely used modalities in reconstructive surgery. Tissue expansion is a very versatile technique that can be performed in patients of all ages for the correction of different pathologies. The most common indications are burn sequelae and giant congenital nevus. The present study describes the indications and use of tissue expanders at the Hospital de Clínicas of Universidade Federal do Paraná. METHODS: Patients who underwent tissue expansion for reconstructive surgery between January 2005 and December 2009 were retrospectively reviewed. RESULTS: A total of 24 patients (70.8 percent female and 29.2 percent male) were analyzed. Ages ranged from 3 to 46 years old (average, 17.1 years). The most common indication for tissue expansion was the treatment of burn sequelae (62.5 percent), mainly in the head and neck. Alopecia was the second most prevalent indication (29.2 percent), followed by scar retraction in the neck (20.8 percent). Other indications were giant congenital melanocytic nevus (16.7 percent), Poland's syndrome (8.3 percent), abdominal scar (8.3 percent), and amastia (4.2 percent). Complications developed in 11 patients, and the highest incidence of complications, reported in 8 (72.7 percent) patients, was among those with burn sequelae as the primary pathology. The complications were infection, rupture, extrusion, wound dehiscence, and displacement of the expander. CONCLUSIONS: Tissue expansion is indicated for the treatment of several diseases among which burn sequelae is one of the most common indications.

INTRODUÇÃO: A escassez de tecidos para reconstrução de grandes defeitos é um desafio ao cirurgião plástico. Nesse contexto, surgiu a expansão tecidual, que, nos últimos 30 anos, se tornou uma das modalidades mais utilizadas na cirurgia reparadora. A expansão é uma técnica muito versátil, que pode ser realizada em todas as idades e para correção de diferentes afecções. As principais indicações são sequelas de queimadura e nevo congênito gigante. Este estudo teve como objetivo demonstrar as indicações na utilização dos expansores tissulares e sua evolução em pacientes do Hospital de Clínicas da Universidade Federal do Paraná. MÉTODO: Estudo retrospectivo, incluindo pacientes submetidos a expansão tecidual para cirurgia reconstrutora, no período de janeiro 2005 a dezembro 2009. RESULTADOS: Foram analisados 24 pacientes, sendo 70,8 por cento do sexo feminino e 29,2 por cento do sexo masculino. A idade variou entre 3 anos e 46 anos (média de 17,1 anos). A principal indicação de expansão tecidual foi o tratamento de sequelas de queimaduras (62,5 por cento), principalmente na região da cabeça e do pescoço. Alopecia foi a indicação mais prevalente (29,2 por cento), seguida por retração cicatricial em região cervical (20,8 por cento). Outras indicações foram nevo melanocítico congênito gigante (16,7 por cento), síndrome de Poland (8,3 por cento), cicatriz abdominal (8,3 por cento) e amastia (4,2 por cento). Entre os pacientes avaliados, 11 evoluíram com alguma complicação, 8 (72,7 por cento) dos quais tinham como doença primária sequela de queimaduras, demonstrando maior incidência de complicações em relação às outras indicações. As complicações encontradas foram: infecção, ruptura, extrusão, deiscência de sutura e deslocamento do expansor. CONCLUSÕES: A expansão tissular é indicada no tratamento de múltiplas doenças e uma das principais indicações continua sendo o tratamento de sequelas de queimaduras.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , History, 21st Century , Postoperative Complications , Retrospective Studies , Evaluation Study , Postoperative Complications/surgery , Burns , Burns/surgery , Burns/therapy , Tissue Expansion Devices , Tissue Expansion Devices/adverse effects , Tissue Expansion , Tissue Expansion/adverse effects , Tissue Expansion/methods , Reconstructive Surgical Procedures , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Alopecia , Alopecia/surgery , Nevus, Pigmented , Nevus, Pigmented/surgery , Nevus, Pigmented/complications , Nevus, Pigmented/congenital , Nevus, Pigmented/therapy
An. bras. dermatol ; 86(4): 767-771, jul.-ago. 2011. ilus
Article in Portuguese | LILACS | ID: lil-600623


Lesões melanocíticas adquiridas assemelhando-se à melanoma têm sido descritas nos principais grupos da Epidermólise bolhosa, e referidas como "Nevos da Epidermólise bolhosa''. Induzem facilmente ao erro diagnóstico, apesar de nenhuma transformação maligna ter sido descrita. Relatamos o desenvolvimento de um nevo melanocítico adquirido grande no local de bolhas recorrentes em uma criança de 5 anos portadora de Epidermólise bolhosa simples. O padrão dermatoscópico global foi sugestivo de benignidade, e os achados histopatológicos foram compatíveis com um nevo melanocítico composto. Este é o primeiro caso de um Nevo da Epidermólise bolhosa publicado na literatura brasileira.

Acquired melanocytic lesions resembling malignant melanoma have been described in all major categories of Epidermolysis bullosa and referred to as "Epidermolysis bullosa nevi''. They easily induce to diagnostic error, although no malignant transformation has been reported. We report the development of a large acquired melanocytic nevus at a site of recurrent blisters in a 5-year-old child with Epidermolysis bullosa simplex. The global dermoscopic pattern was suggestive of benignity, and the histopathological findings were compatible with a compound melanocytic nevus. This is the first published case of Epidermolysis bullosa nevi in Brazilian literature. Despite their benign behavior, we emphasize the importance of regular clinical and dermoscopic monitoring, since a malignant course still cannot be totally excluded.

Child, Preschool , Female , Humans , Epidermolysis Bullosa Simplex/complications , Nevus, Pigmented/complications , Skin Neoplasms/complications , Nevus, Pigmented/diagnosis , Skin Neoplasms/diagnosis
Rev. chil. dermatol ; 21(4): 297-300, 2005.
Article in Spanish | LILACS | ID: lil-433891


El melanoma es el principal responsable de las muertes por cáncer de piel en el mundo y su incidencia se ha duplicado en los últimos 25 años. Del total de los melanomas en piel, un 0,5 por ciento a un 4 por ciento ocurre en niños, lo que constituye entre el 1 por ciento a 3 por ciento del total de las enfermedades malignas de la infancia. Sólo un 0,3 por ciento-0,9 por ciento de los melanomas aparecen antes de la pubertad, pero cada vez son más frecuentes. No hay diferencias por sexo. Tanto la ubicación (tronco), el tipo histológico (extensivo superficial), tratamiento y sobrevida relativa son similares a los de los adultos. Hasta un 47 por ciento puede ser asociada a nevos (15 por ciento-22 por ciento a nevos melanocíticos congénitos y entre un 3 por ciento-25 por ciento, a nevos melanocíticos adquiridos). El riesgo de malignización de un nevo melanocítico congénito gigante es mayor y mejor documentado y va desde un 1 por ciento-31 por ciento promedio 8,5 por ciento. Para los nevos melanocíticos pequeños y medianos es cercano a un 3 por ciento y la aparición es sobre la tercera década. La malignización ocurre tanto en el componente de unión como en el dérmico del nevo congénito gigante y no en satelitosis acrales. Hay controversias sobre el manejo de nevos melanocíticos congénitos. Otros factores de riesgo son estados de inmunosupresión, como xeroderma pigmentoso o linfoma con hasta un 9,4 por ciento de asociación. El melanoma puede clasificarse en congénito, infantil (ambos muy raros y de mal pronóstico) y de la niñez.

Humans , Child , Melanoma/congenital , Melanoma/pathology , Skin Neoplasms/pathology , Nevus, Pigmented/complications , Nevus, Pigmented/congenital , Melanoma/therapy , Nevus, Pigmented/therapy
J Indian Med Assoc ; 2004 Jun; 102(6): 327-8
Article in English | IMSEAR | ID: sea-96469


A 15-year-old male presented with history of progressive instability of gait for last 6 months. General examination revealed multiple subcutaneous nodules all over the body. There was a large pigmented naevus over the lower back area along with a subcutaneous bosselated swelling over right arm. Neurological examination revealed features of gait ataxia. Plantar reflexes were extensor on both sides. Skin biopsy from the pigmented naevus showed features of melanocytic naevus. Electrophysiological studies of both common peroneal and sural nerves revealed features of axonal neuropathy. With the above clinical and laboratory findings a diagnosis of neurofibromatosis type 1 accociated with bathing trunk naevus and Friedrich's ataxia was entertained.

Adolescent , Arm/pathology , Back/pathology , Friedreich Ataxia/complications , Humans , Male , Neurofibromatosis 1/complications , Nevus, Pigmented/complications , Skin Neoplasms/complications
Pediatr. día ; 18(2): 13-17, mayo-jun. 2002. ilus
Article in Spanish | LILACS | ID: lil-390379


Los nevos melanocítos congénitos (NMC) constituyen un importante grupo de lesiones pigmentarias en los niños por su elevada prevalencia y por el compromiso funcional y estético que producen. Según su tamaño, pueden clasificarse en pequeños, medianos y gigantes. Éstos últimos, los menos frecuentes, en un alto porcentaje se asocian a melanosis neurocutánea, cuadro de mal pronóstico neurológico y vital.Los NMC gigantes, y recientemente los pequeños, se consideran lesiones precursoras de melanoma maligno cutáneo, por lo tanto, el tratamiento de elección es la resección completa. El riesgo de transformación maligna de los NMC medianos aún se desconoce.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Nevus, Pigmented/complications , Nevus, Pigmented/congenital , Nevus, Pigmented/diagnosis , Nevus, Pigmented/epidemiology , Nevus, Pigmented/pathology , Nevus, Pigmented/therapy , Skin Neoplasms
Arch. argent. dermatol ; 46(3): 137-40, mayo-jun. 1996. ilus
Article in Spanish | LILACS | ID: lil-177417


El nevo dividido palpebral (NDP) es una forma particular de nevo melanocítico congénito (NMC), que constituye un marcador biológico del período fetal en el cual se forman estos nevos. Nos induce a pensar que tiene que originarse durante o después de la fusión palpebral y antes de su aperura definitiva. En los fetos humanos, los párpados se forman entre la 5a. y 6a. semana, y comienzan a fusionarse entre la 8a. y 9a. semanas, para reabrirse durante el 6º mes de vida intrauterina. Por lo tanto, es posible que éste sea el período en el cual se forman los NMC (entre la 10a. semana y el 6º mes). Hemos tenido la oportunidad de estudiar 3 pacientes con NDP y dada la importancia biológica de los mismos y su escasa observación, nos parece de interés comunicarlos

Humans , Male , Female , Child, Preschool , Adult , Eyelid Diseases/congenital , Nevus, Pigmented/congenital , Diagnosis, Differential , Eyelid Diseases/complications , Melanoma/complications , Nevus, Pigmented/complications , Nevus, Pigmented/pathology , Eyelids/anatomy & histology
Rev. chil. dermatol ; 12(3): 139-41, 1996. ilus
Article in Spanish | LILACS | ID: lil-207002


El nevus spilus es una mácula de color café claro moteada con elementos maculares o papulares de color café oscuro, cuyo examen histológico revela la presencia de células névicas asociadas a una hiperpigmentación basal y elongación de la red de crestas. Tiene el mismo potencial neoplásico que cualquier otro nevo pigmentario. Se ha descrito la asociación con nevo de Spitz, nevo azul y melanoma maligno, pero son muy poco frecuentes. Describimos el caso de un paciente que desarrolló un melanoma maligno extensivo superficial sobre un nevus spilus de la región dorsal y se hace una revisión de la literatura respecto al tema

Humans , Male , Adult , Melanoma/pathology , Nevus, Pigmented/pathology , Melanoma/complications , Nevus, Pigmented/complications