Malignant melanoma arising intradermally in a small congenital nevus of an adult

The occurrence of a malignant melanoma in a small congenital nevus is a rare event. A malignant melanoma arising intradermally in a small congenital nevus in an adult has not been previously reported. The clinical implications and known information about the prognosis of intradermal malignant melanomas are discussed.

Cutaneous lentiginosis with atrial myxomas

This report describes a 25-year-old white woman with lentigines, cutaneous myxomas, bilateral atrial myxomas, and cerebral artery aneurysms. We believe this case to be the fifth reported case of this unusual association in the medical literature, with the additional finding of a central nervous system aneurysm. In the past this association has been described under the mnemonics NAME syndrome and LAMB syndrome. We propose that these mnemonics be dropped because the particular features encompassed within this syndrome are unclear. We suggest that "cutaneous lentiginosis with atrial myxomas" is an adequate description of this syndrome.

The involvement of 6p in melanoma

Karyotype analysis of first passage cells from a melanoma, occurring in a patient with a giant congenital nevus, revealed monosomy of chromosomes #6 and #11, and trisomy of chromosomes #8 and #22. Five marker chromosomes were present, including two ring chromosomes. The origin of three of the marker chromosomes was determined, and all were found to contain the region 6p21.1-6p23. The ring chromosomes were also thought to contain this region, to which the major histocompatibility locus has been mapped. The significance of these findings is discussed in the light of recent reports of chromosome studies of melanoma cells.

Hereditary dysplastic nevus syndrome: lymphoid cell ultraviolet hypermutability in association with increased melanoma susceptibility

The hereditary dysplastic nevus syndrome (DNS) is a well-characterized disorder in which affected individuals have increased numbers of premalignant (dysplastic) nevi and a markedly increased risk of developing cutaneous melanoma. Seeking evidence of a systemic disorder in DNS, we examined the effect of ultraviolet radiation on cultured lymphoid cells. Epstein-Barr virus-transformed lymphoblastoid cell lines from patients with hereditary DNS had similar survival values following treatment with 2.3 to 9.0 J of 254-nm ultraviolet radiation per m2 as did lines from control individuals. Mutagenesis at the hypoxanthineguanine phosphoribosyltransferase locus was assessed by measuring the induction of resistance to thioguanine using a microtiter well assay. Three lymphoblastoid cell lines from patients with hereditary DNS and melanoma had a 2- to 3-fold greater frequency of induced mutants per clonable cell than three normal lines following exposure to 4.5 to 9.0 J of ultraviolet radiation per m2. Expanded clones of mutated DNS lymphoblastoid cell lines had less than 6% of normal hypoxanthine-guanine phosphoribosyltransferase activity. Inhibition and recovery of DNA synthesis following ultraviolet exposure were similar in 2 DNS and 2 normal lines. Repair by DNS lines of ultraviolet-induced DNA damage was in the normal range as measured by alkaline elution. Thus, hereditary DNS exhibits in vitro hypermutability which may reflect increased susceptibility to ultraviolet-induced somatic mutations in vivo. This abnormality may be related to the increased melanoma susceptibility of patients with hereditary DNS.

The classification of malignant melanoma, its histological reporting and registration: a revision of the 1972 Sydney classification

A group of pathologists with an interest in malignant melanoma met in Sydney in 1982 to update the classification of melanoma formulated in Sydney in 1972. The group recommended that malignant melanoma be classified as follows: malignant melanoma with an adjacent component of superficial spreading type, malignant melanoma with an adjacent component of lentigo maligna type, malignant melanoma with an adjacent component of acral lentiginous type, malignant melanoma with an adjacent component of mucosal lentiginous type, malignant melanoma with no adjacent component, malignant melanoma of unclassifiable histogenetic type. The data recorded in the surgical pathology report should include: diagnosis of primary malignant melanoma, histogenetic classification, presence/absence of ulceration, micrometer-measured thickness, microanatomical level, mitotic rate/mm2, presence/absence of vascular invasion, presence/absence of regression, completeness of resection. The recommendations for the examination of specimens and the recording of data for research purposes and for tumour registries are described.

Nevus sebaceus, syringocystadenoma papilliferum, and basal cell epithelioma

This case report illustrates the pluripotential nature of the hair matrix cells in nevus sebaceus. Syringocystadenoma papilliferum and basal cell epithelioma both developed in the same scalp lesion. The staged surgical excision is illustrated.

Port wine nevus associated with ipsilateral saccular aneurysms: treatment by intraarterial balloon trapping

A 21-year-old woman with a port wine nevus presented with ipsilateral monocular visual loss. A computed tomography scan of the brain revealed a round suprasellar mass. Angiography demonstrated aneurysm of the right external carotid artery, and petrous, cavernous, and giant ophthalmic internal carotid aneurysms. Four detachable balloons were deployed with arteriographic guidance, resulting in occlusion of the right carotid artery. The association of aneurysms and phakomatoses is discussed. The use of detachable balloons in the treatment of nonresectable aneurysms represents a safe and advantageous option. The use of detachable balloons for carotid occlusion has proven to be an effective modality in the treatment of giant supraclinoid and carotid-cavernous aneurysms. Giant intracranial aneurysms have been surgically treated with carotid ligation proximal to the aneurysm and by direct approach using microsurgical technique. In cases in which direct ligation is not possible balloon occlusion represents an effective alternative. This case illustrates treatment by carotid trapping performed entirely with intraarterial balloons. In addition the association of saccular aneurysms in a patient with a port wine facial nevus is reported.

Choroidal (subretinal) neovascularization secondary to choroidal nevus and successful treatment with argon laser photocoagulation. Case reports and review of literature

Retinal detachment secondary to choroidal nevus may be caused by subretinal fluid accumulation or neovascularization. Foveal subretinal fluid or leakage of choroidal neovascularization may impair visual acuity. 10 cases of nevus with serous sensory retinal detachment successfully treated with laser photocoagulation are reviewed. 2 additional cases of successful laser therapy for retinal detachment secondary to choroidal neovascularization with nevus of the choroid are presented.

Basal cell epithelioma occurring in an epidermal nevus

An unusual case is presented of a thirty-year-old woman in whom basal cell epithelioma developed from a preexisting localized epidermal nevus in the scalp. The epidermal nevus was not associated with any abnormal pilosebaceous complexes.

Pigmentary traits, ethnic origin, benign nevi, and family history as risk factors for cutaneous malignant melanoma

The roles of constitutional factors and benign nevi in causation of malignant melanoma were examined in a case-control study of 511 patients and 511 matched controls in Western Australia. The strongest risk factor was the number of palpable benign nevi on a subject's arms. Compared to the risk of melanomas for persons having no palpable nevi on the arms, the relative risk of melanoma was 2.0 for persons with 1-4 nevi, 4.0 for persons with 5-9 nevi, and 11.3 for persons with 10 or more nevi (P less than .0001). Of the several pigmentary traits known to have associations with melanoma, inability to tan was the most important. Susceptibility to sunburn and hair color also had significant effects that were independent of tanning ability; however, after these traits were controlled, measured skin color and eye color had no additional effects. A reduced risk of melanoma was observed in persons having two or more Southern European grandparents [odds ratio (OR) = 0.39; P = .025]. Persons of Celtic origin did not have a significantly increased risk (OR = 1.18). Possession of one or more affected blood relatives was related to an increased risk of melanoma (OR = 2.69; P less than .0001). The effects of pigmentary traits, benign nevi, ethnic origin, and family history as risk factors were largely independent of one another.

[Connective tissue nevus in disseminated tumors (of Graciansky and Leclercq)]

We describe three cases of Connective tissue nevi in disseminated tumors, similar to those referred by de Graciansky and Leclercq . Although clinically similar, their different dermopathological pictures stand out, as does the fact that one showed osteopoikilid . We review the clinical and dermopathological features, nosology, associations, differential diagnosis and therapeutic procedures.

Cutaneous factors related to the risk of malignant melanoma

In a case-control study, 287 women with malignant melanoma were compared with 574 age-matched controls. Red hair colour at age 5 years was associated with a tripling of risk [relative risk (RR) = 3.0], blonde hair with a 60% increase (RR = 1.6) and fair skin with a doubling (RR = 2.1). Women with melanoma also reported that they tended to burn (RR = 1.4) and to freckle (RR = 1.9) after exposure to sunlight. Since fair skin, red hair, and the tendency to burn or freckle after exposure to sunlight all cluster in the same individuals, the extent to which each of these factors had an independent influence on susceptibility to melanoma was investigated. Hair colour, especially red hair, proved to be the major determinant, followed by skin colour. The reporting of above average numbers of naevi on the body was as strong a predictor of melanoma as was red hair colour (RR = 3.4). A history of psoriasis was also more common in cases than controls (RR = 3.0) as was a history of vitiligo (RR = 1.8). A history of acne appeared to be protective (RR = 0.4) as did a history suggestive of chloasma (RR = 0.6) and premature greying of the hair (RR = 0.6). These relationships were irrespective of hair and skin colour.

Nevus of Ota associated with meningeal melanosis and intracranial melanoma. Case report

A case is reported of a patient in whom an intracranial extracerebral melanoma developed in association with a life-long nevus of Ota. Melanotic pigmentation of the skull, periosteum, and meninges beneath the nevus was found at operation.

[A patient with Ito's hypomelanosis, also called incontinentia pigmenti achromians]

A 2 1/2 year old mentally retarded Dutch boy, suffering from epilepsy, hydrocefalus, generalised hypotonia, degenerative signs of the eyes and teeth and characteristic pigment disturbances of the skin is described. The complete picture fits in the syndrome of Ito's hypomelanosis, also called incontinentia pigmenti achromians. This is a neurocutaneous syndrome or an ectodermal dysplasia.

Buschke-ollendorff syndrome

Buschke-Ollendorff syndrome or dermatofibrosis lenticularis disseminata with osteopoikilosis is a rare autosomal dominant condition characterized by focal sclerotic bone dysplasia and associated connective tissue nevi. The following case report not only illustrates classic findings in this disease but also demonstrates previously reported, but little known features.

Verruciform xanthoma in an epithelial nevus

Verruciform xanthoma is an unusual lesion that was initially reported in 1971. Clinically, it is a verrucous, vascular, epithelial plaque or papillomatous growth commonly found on oral or mucosal tissues. Histologically, it is characterized by a verruciform epithelium with abundant parakeratosis and by foam cells occupying the vascularized dermal papillae. This is the second extramucosal verruciform xanthoma reported. Our patient had several unique features. She is the youngest patient described to date, her lesion is the largest reported, and the lesion occurred in an epithelial nevus-type eruption of a phocomelic extremity. Light and electron microscopic studies disclosed abnormal keratinization, mast cell proliferation, and the previously described foam cells. We believe that the verruciform xanthoma in our patient represents part of a reaction to the epithelial nevus occurring in association with a developmental anomaly.