Frequency of congenital nevi, nevi spili and café-au-lait spots and their relation to nevus count and skin complexion in 939 children

To determine the prevalence of congenital melanoevocytic nevi (CMN), of so-called congenital nevus-like nevi (CNLN), nevi spili (NS) and café-au-lait spots (CLS) in childhood, a series of 939 children aged 8-16 years had total skin examination. CMN/CNLN were observed in a frequency of 5.9%, NS in 2.1% and CLS even in 32.7%. Except CLS (which occurred more frequently in boys), all of these lesions were equally represented in both sexes. According to the classification of Kopf and coworkers, 44/55 CNM/CNLN were small and 11/55 medium-sized. CMN/CNLN affected preferentially trunk and upper limbs while head and neck were spared. Such nevi occurred more frequently in dark types of skin complexion and showed a tendency to be more frequent in groups of patients with increased average number of acquired melanonevocytic nevi. Remarkably, CLS were also found in 23/55 (41.7%) children with CMN/CNLN and in 12/20 (60%) children with NS (in a higher frequency than such combinations have to be expected). Compared with the data from other studies, both CMN/CNLN and CLS in our patients were observed in highest prevalence in the literature. Since the frequency of CLS in adults is much lower, it cannot be ruled out that some of the CLS disappear in adolescence.

Clinical considerations in Buschke-Ollendorff syndrome

This brief report describes a mother and two daughters with the rare Buschke-Ollendorff syndrome. That the typical dermal connective tissue naevi lesions may become less obvious with time and that the condition is not always so "benign" are important clinical features not well recognised. Incorrect diagnosis may lead to embarkation upon hazardous management.

[Jadassohn's sebaceous nevus]

We report the case of a child's Jadassohn sebaceous noevus, localised on the vertex cranii, the trunk and the limb, associated with the presence of ophthalmological and neurological abnormalities. The diagnosis of this syndrome has been difficult because all the signs were not present at birth. The surgical treatment of the vertex cranii lesions will be realised after expansion with sub cutaneous prothesis, allowing a large exeresis and an adequate reconstruction. Only the anatomo-pathological examination allows any malignant degeneration of the lesion.

Nevus comedonicus associated with epidermal nevus

A 21-year-old man had a zosteriform nevus comedonicus associated with a surrounding hyperpigmented maculopapular eruption, which had the histologic appearance of epidermal nevus. Scanning electron microscopic examinations of the comedones and the surrounding epidermal nevus showed a common feature, that is, chrysanthemum-like keratotic plugs. The association of a nevus comedonicus with an epidermal nevus and the common scanning electron microscopic findings of both suggest that a nevus comedonicus probably is an uncommon form of epidermal nevus.

What to do about moles

Nearly everyone has a mole or two, and with the increasing publicity about the sun and skin cancer, people are looking at their moles with new concern. Dr Parkinson summarizes the main controversies over moles: Which ones are most likely to degenerate into skin cancer, and what should be done about them? Included in the discussion are a description of moles that should be removed and the choice of removal methods available.

Hemimegalencephaly and intractable epilepsy: benefits of hemispherectomy

We observed 4 children with hemimegalencephaly, (3 boys, 1 girl aged 3-7 years). One child had a linear sebaceous nevus. All patients had a similar clinical, EEG, and neuroradiologic pattern. All patients had macrocrania, hemiparesis, hemianopsia, and psychomotor retardation of variable degree. All cases had an epileptic syndrome with onset during the first days or the first months of life. The seizures were consistently similar: partial motor seizures, generally hemiclonic and asymmetric brief tonic seizures, in series, involving predominantly one side of the body, contralateral to the cerebral damage. The EEG was initially characterized by a hemihypsarrhythmia and afterward, over the malformed hemisphere, by a rather high-frequency background activity associated with almost continuous transients of spikes, sharp waves, and spike and waves that progressively involved the contralateral hemisphere. Hemispherectomy was performed in two children with sudden and complete recovery from seizures and improvement in psychomotor development. Macroscopic examination was consistent with the computed tomography (CT) scan and magnetic resonance imaging (MRI) showing pachygyria and poorly represented white matter. Histologic examination showed the characteristic absence of cortical neuronal layering, and the presence of giant neurons, neuronal heterotopias, and gliosis. For hemispherectomy to be successful, we believe prolonged EEG monitoring is needed to verify that no seizures are originating in the normal hemisphere.

Birthmarks of the eye and eyelids as indicators of ocular or systemic tumors

1. Some birthmarks and acquired ocular-facial lesions indicate the presence of or potential to develop intraocular and/or systemic tumors. 2. Facial nevus flammeus is commonly associated with an ipsilateral diffuse choroidal hemangioma. 3. Ocular and oculodermal melanocytosis appear to be associated with an increased risk of ipsilateral primary intraocular malignant melanoma of the uveal tract. 4. Aniridia is occasionally associated with Wilms' tumor, a potentially fatal primary abdominal malignancy of children. If detected early, Wilms' tumor can offer be cured.

[Proteiform syndrome (Proteus syndrome). Skin manifestations in a recently observed case]

The case of a 4-year-old female affected by partial gigantism of the feet, syndactyly and polydactyly, partial right hemihypertrophy of buttock and lower limb, warty hyperpigmented nevus and vulvar lipoma is described. The Authors discuss about the Proteus syndrome, pointing out its rarity, the polymorphism and the problems of differential diagnosis with the Klippel-Trenaunay-Weber syndrome and with other congenital hamartomatous disorders.

Naevoid psoriasis

A six-year-old boy presented with an eruption comprising multiple psoriasiform plaques, arranged in linear bands distributed along the lines of Blaschko and confined to the left side of the body. We believe that the eruption is true psoriasis, occurring in an unusual naevoid distribution. The existence of a genuinely naevoid form of psoriasis has frequently been debated, and has tended to be discounted. We believe that we have encountered a child who has this condition.

Nevus of ota with nevus of Ito--report of a case with cataract

A 53-year-old Japanese male patient with both nevus of Ota and nevus of Ito developed cataract of the eye ipsilateral to the side of the nevi. In this patient, cataract might have appeared in a close pathogenetic relationship with nevus of Ota.

The treatment of serous macular detachment secondary to choroidal melanomas and nevi

The authors successfully treated with laser photocoagulation five patients who had a serous macular detachment secondary to leakage from a pigmented choroidal tumor. Three patients had dye leakage on fluorescein angiography from a choroidal neovascular membrane. The subretinal fluid resolved in all three patients after the neovascular membrane was obliterated by either krypton red (2 patients) or argon green (1 patient) laser photocoagulation. The other two patients had prominent leakage from a localized choroidal neovascular membrane as well as mild diffuse leakage over the entire tumor. Focal argon laser treatment to the neovascular membrane alone did not cause permanent resolution of the subretinal fluid. The fluid did resolve, however, after the entire area of diffuse leakage was retreated with photocoagulation. In one of the patients who received both focal and confluent laser treatment, the choroidal tumor grew in a collar-button fashion through Bruch's membrane at the original site of focal treatment. This eye was enucleated, and results of histopathologic examination showed a choroidal melanoma.

[Linear psoriasis (linear psoriatic epidermal nevus) in a patient with HIV infection]

The Authors report a 24 year-old female who presented a linear localized epidermal nevus, from birth. Few months after a diagnosis of HIV infection (ARC WR 4) they observed the flaring-up of psoriasis both on the typical cutaneous sites, and on nevus, which looked like linear psoriasis.

Residual dysplastic and other nevi in superficial spreading melanoma. Clinical correlations and association with sun damage

Excision biopsies of 500 invasive superficial spreading melanomas were examined for evidence of residual melanocytic dysplasia (remnants of dysplastic nevi). Melanocytic dysplasia was identified in 32.4% of tumors. Remnants of nevi without melanocytic dysplasia were found in 9.8%. Sun damage as evidenced by solar elastosis was histologically estimated in contiguous skin. Patients' age at diagnosis, tumor site, pathologic stage, evidence of tumor regression, and coexisting sun damage were correlated with the presence or absence of melanocytic dysplasia. Patients whose tumors displayed residual dysplasia were younger and demonstrated a more favorable tumor stage and less evidence of sun damage. Melanomas on the trunk were more likely to be associated with melanocytic dysplasia than those from other areas. The findings support the belief that dysplastic nevi have an important role in the genesis of superficial spreading melanoma. The influence of ultraviolet radiation in the development of dysplastic nevi and in their potential malignant progression is discussed.

Identifying people at high risk of cutaneous malignant melanoma: results from a case-control study in Western Australia

To assess whether screening people at high risk of malignant melanoma would be effective in reducing the mortality from the disease data from 400 case-control pairs in a study of cutaneous malignant melanoma conducted in Western Australia during 1980-1 were used to predict the risk of melanoma in the remaining 111 pairs. All variables previously shown to be associated with a decrease or increase in the incidence of melanoma were considered for inclusion in a single conditional logistic regression model of the incidence of melanoma in the randomly chosen subset of 400 case-control pairs. Five of these variables--number of raised naevi on the arms, arrival in Australia before 10 years of age, history of non-melanocytic skin cancer, time spent outdoors in summer from the age of 10 to 24, and family history of melanoma--provided good discrimination between patients and controls in this sample and the 111 other case-control pairs. Among the 222 subjects in these other case-control pairs a group defined as being at high risk of melanoma by a risk score derived from these five variables contained 60 (54%) of the patients with melanoma but only 18 (16%) of the controls. These data suggest that in Western Australia more than half of all new patients with melanoma arise in an identifiable subpopulation constituting less than one fifth of the whole population. Identifying this subpopulation and screening it regularly for cutaneous malignant melanoma could be cost effective in reducing mortality from this disease.

Angiosarcoma arising in an angiomatous naevus following irradiation in childhood

We describe a patient who developed an angiosarcoma on her face at the age of 24. The tumour arose from an angiomatous naevus that had been treated with radiotherapy when the patient was 7 months old.

Nevus comedonicus with epidermolytic hyperkeratosis

A 7-year-old girl had a linear nevus comedonicus affecting the right upper limb. Histologic examination of two biopsies specimens showed both the common changes of nevus comedonicus and the presence of epidermolytic hyperkeratosis. Therefore, nevus comedonicus should be included in the list of dermatoses having the distinctive histologic pattern of epidermolytic hyperkeratosis.

Nevus comedonicus in association with widespread, well-differentiated follicular tumors

Multiple different tumors of follicular origin within the same patient are an infrequently reported phenomenon. We present a patient with nevus comedonicus associated with widespread, well-differentiated cutaneous tumors of follicular origin that have histologic features of trichofolliculoma, Winer's pore, and pilar sheath acanthoma.

Central nervous system involvement in blue-rubber-bleb-nevus syndrome

The blue-rubber-bleb-nevus syndrome is an uncommon neurocutaneous disorder where scattered, bluish, rubbery nevi occur on the body surface. These nevi are frequently noticeable at birth. In addition to the skin lesions, vascular malformations of internal organs, which tend to bleed, are frequently present. However, well-documented central nervous system angiomata are rarely encountered. We present herein the case of a young adult with central nervous system involvement. Patient presented with a slowly progressive ataxia and brain stem signs. A large posterior fossa, and multiple smaller hemispheric angiomata were noted. Only a very few well-described symptomatic cases have been reported in the literature; we have reviewed them here. Unlike these cases, our patient with extensive nervous system involvement had a chronic, slowly progressive and nonfatal course.