Giant congenital nevus with progressive sclerodermoid reaction in a newborn

"Sky Full of Stars" Pattern: Dermoscopic Findings in a Desmoplastic Giant Congenital Melanocytic Nevus

Desmoplastic giant congenital melanocytic nevus (DGCN) is an uncommon variant of congenital nevus, presenting as a progressive induration and hypopigmentation of the lesion that occasionally causes hair loss and even total or partial disappearance of the nevus. A 6-month-old girl with a giant congenital melanocytic nevus that involved the entire posterior side of the right thigh was seen in our department. Nine months later, the peripheral area of the nevus presented as a marked induration with hypopigmentation. Dermoscopy demonstrated a reticular pattern exclusively located in the perifollicular areas, with a radial distribution from the follicular ostium that mimicked a "sky full of stars." We report a case of DGCN, including a dermoscopic description of the findings noted in the indurated and hypopigmented areas that appear as a "sky full of stars" image.

Sclerotic Regressing Large Congenital Nevus

Regression of congenital nevi is usually associated with loss of pigment or halo formation. In rare cases, regression is characterized by sclerosis and hair loss. We describe a rare case of a sclerotic hypopigmented large congenital melanocytic nevus in which a localized scleroderma-like reaction process of regression seemed to have started in utero and progressed throughout early childhood.

Spontaneous Regression of a Congenital Melanocytic Nevus by Sclerosis

Congenital melanocytic nevi (CMNs) naturally evolve throughout life, growing proportionately with the child, darkening, and exhibiting textural or surface changes (e.g., papillomatous, verrucous, cerebriform), hypertrichosis, and, later in life, lightening of pigmentation. We report the case of a 5-year-old child with complete resolution of a medium-sized CMN involving the distal left leg and foot via sclerosis and in the absence of any halo phenomenon. Spontaneous regression of CMN via sclerosis is rare, and it is thought that an immunologic mechanism different from the mechanism that the halo phenomenon induces mediates this regression. We reviewed the literature on this phenomenon and discuss how it might lead to regression of the nevus.

Desmoplastic hypopigmented hairless nevus: a variant with progressive depigmentation, induration, and overgrowth

Large congenital melanocytic nevus rarely presents itself without hairs, with hardened skin and progressive depigmentation. We report a girl who presented with a large congenital melanocytic nevus in the left cheek. Over the years, the nevus became pruriginous, light brown, bumpy, and hard. Histology revealed nevus cells interspersed with dense fibrosclerotic collagen bundles. There are few reported cases of large congenital melanocytic nevus with this evolution, so-called desmoplastic hypopigmented hairless nevus.

Congenital melanocytic nevi

The relative risk for melanoma arising within a congenital nevus is related to the size of the lesion. The timing of and clinical presentation of development of melanoma is also related to the size of the lesion. Medical decisions are individualized taking into account the perceived risk of malignancy, psychosocial impact, and anticipated treatment outcome. In this article, the common features of congenital nevi are discussed as well as the potential individual variations and their impact on treatment recommendations.

Desmoplasia: not always a bad thing

Desmoplasia describes a histological pattern characterized by a hyalinized stroma and a minimal cellular infiltrate. In non-cutaneous neoplasms, this pattern of stromal response is classically associated with malignancy, whereas in cutaneous pathology, desmoplasia is observed in malignant as well as benign neoplasms. Given this, the obvious question is whether desmoplasia associated with a benign neoplasm is any different from that associated with malignant tumours. Is the stromal response a mere epiphenomenon, or does it actually contribute to the biological behaviour of the neoplasm? What happens at the tumour-host interface? Which molecules are involved in mediating the desmoplastic reaction pattern? This review is an attempt to answer these questions. Examples of benign and malignant cutaneous neoplasms associated with the desmoplastic reaction pattern will be included.

Giant ceribriform intradermal nevus on the back of a newborn

A male newborn had a large cerebriform tumor covering his shoulders and almost the entire surface of his back. After exclusion of further abnormalities, the diagnosis of cerebriform intradermal nevus was made. This particular variant of giant melanocytic nevus should always be differentiated from cutis verticis gyrata, if located on the vertex. The clinical manifestation of cerebriform intradermal nevi as giant melanocytic nevi on the back is extremely rare, with only one instance reported to date. Such nevi are a therapeutic challenge, particularly if the skin lesion covers a large surface of the body, as in the patient presented here.

Ulcerated sclerotic giant congenital melanocytic naevus: case report and review of the literature

We report a case of a white girl with an ulcerated giant congenital melanocytic naevus that initially had a hard, stony consistency but in which the pigmentation and the induration are progressively vanishing. Very few cases of this variant of GCMN, known as sclerodermoid GCMN or desmoplastic hypopigmented hairless naevus, have been reported to date, and clinical evolution seems to be heterogeneous. We review the published cases and propose the term 'sclerotic hypopigmented GCMN as a common descriptor of this type of congenital melanocytic naevus.

Desmoplastic giant congenital nevus with progressive depigmentation

Desmoplastic hairless hypopigmented nevus is an extremely rare sclerotic, alopecic, and progressively hypopigmented giant congenital melanocytic nevus, which is histologically characterized by an intense desmoplasia. A significant trend toward spontaneous involution has been described. We report a case of desmoplastic hairless hypopigmented nevus that underwent a progressive depigmentation associated with loss of its woody consistency. The loss of induration appears to be the main marker for the complete regression of these nevi.

Clinical resolution of a neonatally eroded giant congenital melanocytic nevus

We report an unusual occurrence of spontaneous pigmentary regression with a desmoplastic reaction in a neonatally eroded giant congenital melanocytic nevus. This process has been documented with photographs and skin biopsy specimens. Neonatal histology demonstrated connective tissue proliferation. Histology at age 5 years also demonstrated a very high proportion of amelanotic dermal nevus cells. Regression of pigmentation in our patient may be due to a decrease in melanin production by dermal nevus cells rather than a decrease in their number.

Congenital localized scleroderma

OBJECTIVES

Juvenile localized scleroderma (JLS) usually has its onset during later childhood. This report describes the clinical and serologic features of six children with congenital localized scleroderma (CLS).

STUDY DESIGN

A large, multinational study was conducted among pediatric rheumatology and dermatology centers by collecting information on demographics, family history, triggering environmental factors, clinical features, laboratory reports, and treatment of patients with JLS. Patients with onset at birth were carefully examined.

RESULTS

Among 750 patients with JLS, 6 patients (0.8%) had scleroderma-related lesions at birth. Female-to-male ratio was 2:1. All patients had linear scleroderma, in four involving the face with en coup de sabre appearance. Two patients were misdiagnosed as having skin infection, one nevus, one salmon patch, and two undefined skin lesions. The mean diagnostic delay was 3.9 years. In comparison with the group of 733 patients with late-onset JLS, CLS presented a significantly more prolonged disease duration at diagnosis and a higher frequency of en coup de sabre subtypes.

CONCLUSIONS

Congenital localized scleroderma is a rare and probably underestimated condition in neonates. The linear subtype was the exclusive manifestation of the disease. CLS should be included in the differential diagnosis of infants with cutaneous erythematous fibrotic lesions to avoid functional and aesthetic sequelae and to allow prompt therapy.