Speckled lentiginous naevus: which of the two disorders do you mean?

Treatment of Nevus Spilus with dual-wavelength copper vapor laser

Introduction. Speckled lentiginous nevus or Nevus Spilus (NS) is a congenital or acquired melanocytic nevus. NS appears as dark hyperpigmented macules or papules interspersed in the lentigo-like hyperpigmentation patch. Surgical methods for removing NS, primarily on the skin with a thin dermis, are associated with the risk of disruption of its structure or scarring. The use of single wavelength laser irradiation allowed achieving pronounced bleaching of the NS area with such side effects as scars, post-inflammatory hyperpigmentation, and relapses in some cases. Side effects could occur due to the lack of complete blood flow in the microvascular bed near the NS. The study aimed to evaluate the efficacy of NS treatment with a dual-wavelength copper vapor laser (CVL). Description of patients and the method of the treatment. Two fair-skinned adult female patients with NS, of medium size and different location, asked to restore the natural colour of the skin in order to get rid of cosmetic defects. NS treatment was carried out using CVL (Yakhroma-Med model, P.N.Lebedev Physical Institute of the Russian Academy of Sciences) during six procedures, an interval of 46weeks. For treatment, we used two-wavelength CVL radiation with average power in the range of 0.60.8W with a power ratio of 3:2 at wavelengths of 511 nm and 578 nm; exposure time: 0.20.3 s. The diameter of the light spot on the skin accounted for 1 mm. Both patients were satisfied with the result of the treatment due to the noticeable blanching of the pigmented skin area after the NS removal. During the following two years, no dark spots or scarring was observed at the NS removal site. Conclusion. Treatment of medium-sized NS using two-wavelength CVL radiation made it possible toeliminate the cosmetic defect without side effects.

Partial unilateral lentiginosis: a clinicopathological analysis of 32 cases on the head and neck area in Korea

BACKGROUND

Partial unilateral lentiginosis (PUL) is a rare acquired circumscribed hyperpigmentation characterized by multiple simple lentigines involving half of the body. Since the previous studies of PUL were mostly based on case reports and the current literature lacks well-designed retrospective studies that involve a large number of cases, PUL is not a well-defined entity, and differential diagnosis with nevus spilus is still difficult. This study aims to evaluate clinical and histopathological characteristics and treatment outcomes of PUL on head and neck area of Koreans.

METHODS

Thirty-two patients with PUL on head and neck area were diagnosed clinicohistopathologically at the Asan Medical Center from 2004 to 2017. Their medical records, photographs, and biopsy specimens were reviewed, and immunohistochemical staining for protein kinase C (PKC)-βΙΙ was evaluated for melanogenic activity.

RESULTS

Four patients (12.5%) of PUL had congenital lesions, and 24 (75.0%) had age of onset younger than 10 years. Confluency of lentiginous lesions (100%) and mild to moderate background interlesional hyperpigmentation (90.6%) were observed. The lentiginous lesions showed increased melanocytes, melanophages, basal melanins, lentiginous hyperplasia, and perivascular inflammatory cells compared with background interlesional hyperpigmentation, and PKC-βΙΙ was focally positive in 7 of 12 stained PUL lesions. Among the 16 patients who received laser treatments, 10 (62.5%) showed more than 50% of improvement.

CONCLUSIONS

The findings of this study will allow for improved diagnosis of PUL and understanding of its features, which may facilitate proper management in the future.

Speckled lentiginous nevus: A rare presentation associated with motor neuropathy and muscular atrophy in a child

Speckled lentiginous nevus syndrome has been described in individuals with a speckled lentiginous nevus with rare associated neurologic deficits. Because speckled lentiginous nevus syndrome almost always affects adults, it is not typically considered when evaluating children. We present the first reported case of speckled lentiginous nevus syndrome presenting in a young child with muscle atrophy and motor deficits affecting muscles along the same distribution as the speckled lentiginous nevus.

Genomic analysis of a case of agminated Spitz nevi and congenital-pattern nevi arising in extensive nevus spilus

Nevus spilus is a melanocytic neoplasm characterized by a tan macular background punctuated by multiple hyperpigmented macules or papules that represent various types of nevi. These include junctional and compound nevi, Spitz nevi, and rarely blue nevi. We report a unique case of widespread, multiple nevi spili giving rise to agminated Spitz nevi and congenital-pattern compound nevi. We performed genetic analysis to further characterize the mutational profile of this rare entity.

At first sight or second glance: clinical presentation of mosaic manifestations of autosomal dominant skin disorders - a case series

BACKGROUND

Several autosomal dominant disorders may manifest in mosaic patterns with cutaneous involvement. Genomic mosaicism results from postzygotic autosomal mutations, giving rise to clonal proliferation of two genetically distinct cell groups, which clinically present as lesions following the lines of Blaschko.

OBJECTIVE

To increase the awareness of the clinical variability of mosaic manifestations in autosomal dominant skin disorders in order to avoid delayed diagnosis.

METHODS

Clinicopathologic correlation in a case series including three patients with mosaic manifestations of different autosomal dominant skin diseases.

RESULTS

Here, we describe a patient with type 1 segmental mosaicism of epidermolytic ichthyosis (case 1) and two patients with either type 1 (case 2) or type 2 (case 3) segmental neurofibromatosis 1 (NF1).

CONCLUSION

Dermatologists should be familiar with mosaic manifestations of autosomal dominant skin diseases to ensure appropriate guidance of the affected patient. Genetic counselling is mandatory as even limited forms of mosaicism may involve the patient's germline with a moderately increased risk to transmit the mutation to their offspring, resulting in a more severe, generalized form of the respective disease.

Large congenital nevus spilus-improved follow-up through the use of in vivo reflectance confocal microscopy

BACKGROUND

Nevus spilus (NS) is a potential precursor of melanoma; the vast majority of cases reported in the literature were histologically classified as superficial spreading melanoma.

OBJECTIVE

To demonstrate the diagnostic value of reflectance confocal microscopy (RCM) in this subtype of congenital nevi.

METHODS

We report a case of a large congenital NS with equivocal clinical and dermoscopic findings in which RCM was applied for diagnosis and follow-up.

RESULTS

There was a good correlation of RCM with histopathology and a lack of dynamic changes during follow-up.

CONCLUSION

Our observations indicate that RCM, as a non-invasive tool, can be useful for diagnosis and follow-up of clinically and dermoscopically equivocal NS.

Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions

Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision-making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma-specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma-specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue-white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma-specific structure, the most common being atypical vascular structures and crystalline structures.

Spitz nevi arising in speckled lentiginous nevus: clinical, histologic, and molecular evaluation of two cases

Spitz nevi are small dome-shaped nodules that sometimes arise in areas of preexisting hyperpigmentation, such as a speckled lentiginous nevus (nevus spilus), where they present a diagnostic dilemma. We report clinical, histopathological, and molecular findings of two cases of multiple Spitz nevi arising in a speckled lentiginous nevus. We used immunohistochemistry to assess expression of Ki-67, epidermal growth factor receptor, vascular endothelial growth factor, and RelA in two cases of Spitz nevi arising in a speckled lentiginous nevus. We observed rare staining for the proliferative marker Ki-67, but positive staining for the growth and antiapoptotic factors epidermal growth factor receptor, vascular endothelial growth factor, and RelA. Characterization of the molecular phenotype of Spitz nevi arising in speckled lentiginous nevi may provide a useful adjunct to long-term monitoring in this rare but difficult clinical presentation.

Widespread nevus spilus associated with torsion dystonia: a case report

Usually speckled lentiginous nevus or nevus spilus is a small solitary lesion consisting of a light tan patch with numerous dark brown macules or papules (or both) within it. It is occasionally associated with complex birth defects such as phacomatosis pigmentovascularis, phacomatosis pigmentokeratotica, or speckled lentiginous nevus syndrome. Uncommon presentations include large segmental lesions that may or may not be systematized and can sometimes be associated with other anomalies. We hereby report a 6-year-old Caucasian patient with systematized nevus spilus associated with torsion dystonia, a combination not published thus far.