Melanoma infantil: diagnóstico precoce pelo mapeamento corporal total em síndrome do nevo displásico / Infantile melanoma: early diagnosis by total body mapping in dysplastic nevus syndrome total em síndrome do nevo displásico

O melanoma é uma neoplasia rara na população pediátrica, sendo ainda mais rara em crianças menores de 10 anos. O mapeamento corporal total constitui método não invasivo e de baixo custo, capaz de aumentar a acurácia diagnóstica na avaliação de lesões pigmentadas, principalmente em pacientes de alto risco. Relatamos um paciente de nove anos de idade com síndrome do nevo displásico, no qual uma lesão apresentou mudança sutil (assimetria de estruturas) no seguimento de seis meses. A exérese da lesão resultou em melanoma com Breslow 1mm e linfonodo-sentinela negativo. O mapeamento corporal total reduz o número de exéreses desnecessárias e permite o diagnóstico de melanomas em estágios iniciais e potencialmente curáveis, especialmente em crianças e pacientes com fatores de risco como síndrome do nevo displásico. O caso foi reportado devido à raridade da neoplasia na faixa etária e para demonstrar a importância da dermatoscopia digital seriada no diagnóstico precoce de melanoma nessa população.

Melanoma is a rare neoplasm in the pediatric population, and it is even rarer in children under 10 years of age. Total body mapping constitutes a low-cost and non-invasive method that increases diagnostic accuracy in evaluating pigmented lesions, especially in high-risk patients. We reported the case of a 9-year boy with dysplastic nevus syndrome, in which one lesion presented a subtle change (asymmetry of structures) within a 6-months follow-up. Its excision resulted in melanoma with a Breslow thickness of 1 mm and a negative sentinel lymph node. Total body mapping reduces the number of unnecessary excisions. It allows diagnosis of melanomas in early and potentially curable stages, especially in children and patients with risk factors such as dysplastic nevus syndrome. We report this case due to the rarity of the neoplasia in this age group and also to demonstrate the importance of sequential digital dermoscopy in early diagnosis of melanoma in this population.

Agminated atypical melanocytic nevus associated with Langerhans cell histiocytosis

Abstract: Agminated nevus refers to the presence of multiple nevi grouped in a circumscribed skin area; it is rarely reported in the literature. This report presents the case of a 10-year-old female patient with a history of Langerhans cell histiocytosis, who presents multiple nevi in the lumbar and inguinal region. In the histopathological study, an atypical melanocytic nevus was reported. Wood's lamp examination discarded the presence of nevus spilus, and the diagnosis of agminated nevus was reached. The association of this type of nevus with Langerhans cell histiocytosis is rare, and only four cases were found reported in the indexed literature. The reason for this association is unknown, thus a new theory about its origin is presented here.

A case of malignant melanoma after repeated recurrent dysplastic nevi

Dysplastic nevus is common and affects about 10% of the northern European-descendent population. Studies over the past several decades have identified dysplastic nevi as a risk factor for malignant melanoma. Furthermore, in rare cases, they confirmed that dysplastic nevi have progressed to melanoma. Cases in which dysplastic nevi progressed to malignant melanoma in multiple studies are not uncommon. A 35-year-old woman presented with the major symptom of multiple itchy brown nodules (2.0 cm× 1.3 cm) in the left cheek that had first appeared 20 years earlier. Complete excision was performed at the first visit; subsequent biopsy confirmed that they were dysplastic nevi. They recurred three times over 3 years at the same site, all of which were histologically diagnosed as dysplastic nevi. Five years after the final excision, a brownish nodule developed in the left cheek, with others at the left temporal region, right retroauricular region, and left shoulder at the same time. These lesions were histologically diagnosed as malignant melanoma. We experienced a case of malignant melanoma that occurred at the same site after three recurrences of dysplastic nevi. Although rare, the possibility of malignant melanoma should be considered in follow-ups in cases involving repeatedly recurrent dysplastic nevi.

Histogenetic categorization of atypical melanocytic tumor of uncertain biological malignant potential

Abstract: Several reports have demonstrated difficulties and lack of agreement in the histopathological diagnosis of particular melanocytic lesions, with problems in their management. A histogenetic approach to the study of these lesions originated the following classification: 1. superficial atypical proliferation significance; 2. melanocytic tumor of uncertain potential; 3. pigmented epithelioid melanocitoma of uncertain potential; 4. microinvasive radial growth phase of uncertain potential. The terminology remains controversial, reflecting the uncertainty of the diagnosis and the biological potential of these atypical melanocytic lesions.

Lack of compliance: a challenge for digital dermoscopy follow-up

BACKGROUND: Digital dermoscopy is the gold standard follow-up method for patients with high risk for developing cutaneous malignant melanoma. By comparing the same lesion at different moments, it allows early detection of subtle changes that could suggest the diagnosis of melanoma. Thus, it is clear that the test must be repeated after a period of time, according to time intervals determined by the evaluator. OBJECTIVES: To evaluate adherence of patients to follow-up examinations using digital dermoscopy. METHOD: Retrospective analysis of 36 patients who underwent digital dermoscopic examination and total-body photography in a private medical center between September 2010 and January 2013. Results: Only 25% of the patients returned for followup evaluations. CONCLUSIONS: Low adherence to digital dermoscopy follow-up could compromise the efficacy of this valuable method. This lack of adherence represents a challenge for the evaluator. .

Analysis of interobserver reproducibility in grading histological patterns of dysplastic nevi* / Avaliação da reprodutibilidade interobservador da graduação de padrões histológicos dos nevos displásicos

Dysplastic nevi are among the most important cutaneous melanoma simulators. They are important risk markers for this neoplasia and can be its potential precursors. Some authors found a statistically significant relationship between the degree of dysplasia and the risk for developing melanoma. However, reproducibility of grading criteria ranged from poor to fair in the researched articles. To test the reproducibility of the grading criteria proposed by Sagebiel et al. regarding dysplastic nevi. Histological specimens of 75 dysplastic nevi were graded, independently and in a blinded fashion, according to preestablished criteria, by a panel of 10 pathologists with different levels of experience. Diagnostic agreement was calculated using weighted kappa and intraclass correlation coefficients. The average of weighted kappa values was 0.13 for all observers, 0.12 for dermatopathologists, 0.18 for general pathologists and 0.05 for residents. Intraclass correlation coefficient values were 0.2 for all observers, 0.18 for dermatopathologists, 0.33 for general pathologists and 0.15 for residents. Histopathological grading for dysplastic nevi was not reproducible in this Brazilian series, so the criteria used are not a helpful histopathological parameter for clinicopathological correlation. .

Nevos displásicos estão entre os mais importantes simuladores de melanoma. São marcadores de risco para o desenvolvimento dessa neoplasia e podem ser seus precursores. Alguns autores observaram uma relação estatisticamente significativa entre o grau de displasia e o risco de desenvolvimento de melanoma. No entanto, a reprodutibilidade dos critérios para graduação variou de ruim a razoável nos artigos consultados. Testar a reprodutibilidade da graduação proposta por Sagebiel et al. para os nevos displásicos. Seções histológicas de setenta e cinco nevos displásicos foram graduadas, de forma independente e anônima, segundo critérios pré-estabelecidos, por um painel de 10 patologistas com diferentes níveis de experiência. A concordância diagnóstica foi calculada usando os coeficientes de kappa ponderado e de correlação intraclasse. A média dos valores de kappa ponderado foi de 0,13 para todos os observadores, de 0,12 para os dermatopatologistas, de 0,18 para os patologistas gerais e de 0,05 para os residentes. Os valores dos coeficientes de correlação intraclasse foram 0,2 para todos os observadores, 0,18 para os dermatopatologistas, 0,33 para os patologistas gerais e 0,15 para os residentes. A graduação histopatológica dos nevos displásicos não foi reprodutível nesta ...

Contribuição do mapeamento corporal total e dermatoscopia digital para o diagnóstico precoce do melanoma / The contribution of total body mapping and digital dermoscopy for the early diagnosis of melanoma

O prognóstico do melanoma cutâneo depende principalmente de sua espessura, sendo a detecção precoce do melanoma extremamente importante para a maior sobrevida dos pacientes. Com a utilização do exame dermatoscópico, pode-se alcançar acurácia de aproximadamente 90%. Melanomas iniciais podem não apresentar características dermatoscópicas específicas, sendo apenas diagnósticados pela mudança ao longo do tempo, observada pelo mapeamento corporal total e dermatoscopia digital seriados. Os grupos que apresentam maior sensibilidade para detecção do melanoma com esse exame são os de portadores de síndrome do nevo atípico e melanoma múltiplo familial.

The prognosis of cutaneous melanomas depends mainly on the lesions' thickness; early detection is of paramount importance for patient longer survival rates. An accuracy of approximately 90% can be achieved using dermoscopic assessment. Since early melanomas might not present specific dermoscopic features, they can only be diagnosed by observing alterations over time through total body mapping and serial digital dermoscopy. Patients with atypical nevus syndrome and multiple familial melanoma presented a higher sensitivity for the detection of melanoma using that technique.

Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma: review article

Atypical Mole Syndrome is the most important phenotypic risk factor for developing cutaneous melanoma, a malignancy that accounts for about 80 percent of deaths from skin cancer. Because the diagnosis of melanoma at an early stage is of great prognostic relevance, the identification of Atypical Mole Syndrome carriers is essential, as well as the creation of recommended preventative measures that must be taken by these patients.

Expression of insulin-like growth factor-Ⅱ (IGF-Ⅱ) mRNA-binding protein-3 in malignant melanoma and benign nevi / 中华皮肤科杂志

Objective To investigate the expression of insulin-like growth factor-Ⅱ(IGF-Ⅱ) mRNAbinding protein-3 (IMP3) in tissue of benign nevi and malignant melanoma,and to evaluate the role of IMP3 in the development and diagnosis of malignant melanoma.Methods Immunohistochemistry was performed to measure the expression of IMP3 in tissue samples from 28 cases of malignant melanoma,8 Spitz nevi,6 dysplastic nevi and 25 benign nevi.Results Immunohistochemically,IMP3 was observed in 23 of 28 melanoma samples,4 of 8 Spitz nevus samples and 2 of 6 dysplastic nevus samples,but not in benign nevus samples.The expression level of IMP3 wag significantly higher in tissue of melanoma than in that of Spitz nevi and dysplastic nevi (both P<0.05),also higher in tissue of aggressive melanoma than that of melanoma in situ(P<0.01).Conclusions IMP3 seems to be a biomarker for the progression of benign nevi to malignant melanoma,and may be utilized to distinguish melanoma from benign nevi.

Development of Multiple Pigmented Nevi Within Segmental Nevus Depigmentosus

Nevus depigmentosus is a stable and well-circumscribed congenital hypomelanosis that may be in an isolated, dermatomal or systemic form. An 18-yr-old Korean man with segmental nevus depigmentosus developed multiple pigmented nevi which were present only within the confines of the leukoderma. Histologic and electron microscopic studies rendered a diagnosis of nevus depigmentosus with dysplastic nevus to the patient. The genetic alteration of melanocytes in the hypopigmented lesion is assumed to have resulted in the development of multiple pigmented nevi.