Treatment of unsightly oral pigmentation: a case report

Discoloration of the oral mucosa may cause embarrassment to sufferers. In this case report, the author describes a simple, versatile and relatively non-invasive technique for treating unsightly racial pigmentation of the oral mucosa.

[Prostatic melanosis]

We report a case of prostatic melanosis in a 68-year-old patient. Although uncommon, some authors have reported an incidence of 4-10% for benign pigmented lesions of the prostate. It is important to distinguish this from the blue nevus where melanin deposits only involve the prostatic stroma. We discuss the theories explaining the origin of melanin in the prostate and its presence in the epithelium. The gross and microscopic findings of these conditions are described.

Diffuse leptomeningeal melanomatosis of the spinal cord: a case report

A rare case of diffuse leptomeningeal melanosis presenting with symptoms of spinal cord compression due to the presence of anterolateral arachnoid cyst and treated with Spetzler's drainage system is reported. The diagnosis of diffuse melanosis of the leptomeninges is rarely possible during life. In the present case MRI was of great help in the definition of the limits of the pathological process and the presence of the anterior compressing cyst. After laminectomy and a biopsy of the pathological tissue which achieved the histological diagnosis, an external drainage was inserted to reduce the cyst extension and to exclude the presence of melanocytes in the cystic fluid before a peritoneal shunt was placed. At 8th month of follow-up the patient is doing well with a dramatic reduction of symptoms and a significant reduction of spinal cord compression. The diagnostic role of MRI and the relationship between leptomeningeal melanosis and arachnoid cyst are discussed.

Scleral melt after cryotherapy for conjunctival melanoma

BACKGROUND

The authors report a patient with a cryotherapy-induced scleral melt after combined excision and cryotherapy of a conjunctival melanoma arising within primary acquired melanosis with atypia.

FINDINGS

In a 65-year-old white man, a severe scleral melt developed within 1 month of complete excision of a superficial conjunctival melanoma combined with double-freeze-thaw nitrous oxide cryotherapy to the scleral bed and surrounding conjunctival margins. Ultrasound biomicroscopy showed the degree of scleral thinning.

CONCLUSIONS

Although many complications associated with cryotherapy have been described in the literature, there are no reports of a scleral melt. Scleral melt is a potential complication of cryotherapy that can occur despite taking precautions and should be monitored in the first few weeks after cryotherapy to the scleral bed of excised conjunctival tumors.

Excimer laser ablation of conjunctival epithelial melanosis

Two patients with conjunctival epithelial melanosis received a 193 nm argon fluoride excimer laser treatment. In both patients the melanosis was easily removed with a smoothing technique using the excimer laser. The ablated area showed normal appearing conjunctiva. The lesion did not recur during the eight-month follow-up. Therapeutically, the excimer laser can be used to treat benign conjunctival lesions as well as superficial corneal diseases.

[Clinical observation of face peeling treatment for ephelides and phenol excretion in urine]

Since 1986, 710 patients with freckles were hospitalized, and the effects of face peeling were studied. Before treatment, blood and urine routines and hepatic and renal function tests were performed in every patient. Comparisons have been made between the hepatic and renal functions before and after treatment in 100 patients. ECG was performed in all the patients before treatment, and 20 of them have been monitored continuously with ECG after treatment. Comparison of 24h urinary phenol excretion before and after treatment were made in 27 patients. In 5 patients it was showed that the amount of urine phenol declined rapidly with the time. The treatment was effective in 100% of the patients. The cure rate was 84.2%. We concluded that the treatment is an effective and safe method for ephelides in healthy persons.

Longitudinal melanonychia (melanonychia striata): diagnosis and management

Longitudinal melanonychia presents a difficult clinical challenge because subungual melanoma must always be included in the differential diagnosis and because the cause of longitudinal melanonychia is usually not apparent. Accordingly, biopsy is often necessary to establish the cause. This review attempts to expedite management by providing suggestions for the examination of patients with this disorder. The causes of longitudinal melanonychia are enumerated and clues to arrive at the various causes are discussed. Similarities between longitudinal melanonychia and subungual melanoma are discussed in an effort to clarify their differences and similarities; clues to the diagnosis of subungual melanoma are also discussed. Various biopsy techniques applicable to longitudinal melanonychia are considered and the indications for different surgical approaches are emphasized. The importance of the pathologist in interpreting nail biopsy specimens is emphasized.

Maturation of cerebellar neuroblastoma into ganglioneuroma with melanosis. A histologic, immunocytochemical, and ultrastructural study

A ganglioneuroma with areas of melanosis was resected from the cerebellum of a 6.5-year-old girl. At 2.5 years of age, she was diagnosed to have cerebellar neuroblastoma, which was incompletely resected and then radiated. Histologic, ultrastructural, and immunocytochemical studies undertaken on tissue from both stages of the tumor demonstrated a neuroblastic origin and differentiation into a predominantly neuronal tumor with limited astroglial participation. In addition, widespread deposition of basal lamina material, perineuronal distribution of S-100 protein-bearing cells and melanosis were found. The various features and unusual biology of the tumor are discussed in the light of a review of the literature.

[Treatment of primary acquired melanosis of the conjunctiva]

The progression to malignancy of primary acquired melanosis of the conjunctiva with cytologic atypia is often insidious and may not be recognized clinically. Because of the bad prognosis of such melanomas, destruction of the intraepithelial lesion has been recommended. We have been freezing proliferative melanosis with the aid of a cryoprobe. A double freeze-thaw cycle at -70 degrees to -80 degrees was sufficient to destroy the epithelium and eradicate atypical melanocytes without serious complications. Focal nodules, arising in acquired melanosis representing invasive melanomas, however, should be excised initially. Cryotherapy may then be applied to the base and surroundings of the tumor.

Primary acquired melanosis of the conjunctiva

Forty-one cases of conjunctival primary acquired melanosis (PAM) were studied to determine the frequency of progression to malignant melanoma and to establish prognostic parameters for progression to melanoma. Two subdivisions were identified: lesions with cytologically atypical melanocytes (PAM with atypia, 28 lesions, 68.3 per cent) and those lacking cytologically atypical melanocytes (PAM without atypia, 13 lesions, 31.7 per cent). None of the lesions of PAM without atypia progressed to melanoma. Thirteen of the 28 lesions of PAM with atypia (46.4 per cent) progressed to melanoma. Progression to melanoma was more frequent in the lesions of PAM with atypia if basilar hyperplasia was not the dominant histologic pattern (90 per cent progression, P = 0.02) or if any epithelioid cells were present (75 per cent progression, P = 0.02). It was not possible to determine which lesions were atypical on the basis of clinical appearance. Lesions at risk for the development of melanoma should be totally extirpated.

Neurocutaneous melanosis with hydrocephalus and syringomyelia. Case report

The authors report the investigation, treatment, and progress of a unique case of neurocutaneous melanosis with syringomyelia. The suspected etiology, the pathology, and the variable clinical manifestations of this rare phakomatosis are recounted. The potential for malignant change and the possible mechanisms of syrinx development in this syndrome are discussed.

Melanotic schwannoma of the spinal cord

The eighth case of axial melanotic nerve sheath tumor involving the thoracic spinal cord is reported. The literature is reviewed, and proposed theories on the origin of these tumors are discussed. The present study further supports the melanogenic capacity of neoplastic Schwann cells.

Idiopathic acquired melanosis

Acquired melanosis is the clinical term used to describe a slowly enlarging, diffusely pigmented lesion of the conjunctiva which may also involve the lids, caruncle or cornea. The controversial histologic classifications are reviewed and suggestions made regarding useful and accurate terminology. In acquired melanosis, development of malignant melanoma may occur. Previous work indicates that the prognosis of the resulting melanoma may be assessed by histopathologic staging as is done in cutaneous melanoma. The suggested management of acquired melanosis is close observation with excisional biopsies of areas clinically suggestive of invasive melanomas. Examination of the entire biopsy by serial or staged sections is essential for accurate histopathologic diagnosis. Invasive melanomas have been conventionally treated by local excision or exenteration. Radiation therapy may be a beneficial adjunct.

Benign melanosis and malignant melanoma of penis and male urethra

Malignant melanoma of the penis and male uretha are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.