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Wang H, Wang W, Lu J, Gu Y, Cui X, Wei C, Ren J, Gu B, Wang Z, Li Q. Distribution Patterns (7B Rule) and Characteristics of Large Congenital Melanocytic Nevi: A Retrospective Cohort Study in China. Front Med (Lausanne) 2021; 8:637857. [PMID: 33681263 PMCID: PMC7933508 DOI: 10.3389/fmed.2021.637857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Large congenital melanocytic nevus has a high risk of malignancy. However, few studies have summarized its characteristics, treatments, outcomes and malignancy incidence in Chinese patients. This paper reviews a retrospective cohort study evaluating 1,171 patients from Shanghai Ninth People's Hospital between 1 January 1989 and 31 August 2019 using electronic medical records and phone calls to collect clinical and pathological data in which 133 patients were diagnosed with a large congenital melanocytic nevus. Three patients relapsed, and none developed melanoma among the qualified patients. Besides, a new “7B” rule for distribution patterns of large congenital melanocytic nevi was proposed, including bonce, bolero, back, bathing trunk, breast/belly, body extremity, and body. The most common distribution pattern of large congenital melanocytic nevi was bonce, and all blue nevi distributed as bonce. Statistical analysis showed a significant difference (P = 0.0249) in the “7B” patterns between the melanocytic nevus and the neuronevus. In conclusion, the malignancy rate of large congenital melanocytic nevi is much lower in China than in other regions and people of other races. The pathology of large congenital melanocytic nevus may decide its “7B” distribution pattern.
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Affiliation(s)
- Huijing Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Lu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Yihui Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiwei Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjiang Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieyi Ren
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Braunberger TL, Adelman M, Shwayder TA, Clarke LE, Friedman BJ. Proliferative nodule resembling angiomatoid Spitz tumor with degenerative atypia arising within a giant congenital nevus. J Cutan Pathol 2020; 47:1200-1204. [PMID: 32776331 DOI: 10.1111/cup.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Abstract
Proliferative nodules arising within congenital melanocytic nevi often present a diagnostic challenge given a close resemblance to melanoma. Several morphologic variants have been characterized. In difficult cases, ancillary molecular tests can be used to better exclude the possibility of malignant degeneration. Herein, we report a case of an unusual proliferative nodule with overlapping features of angiomatoid Spitz tumor and ancient melanocytic nevus, which demonstrated normal findings on both chromosomal microarray and a gene expression profiling assay.
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Affiliation(s)
| | - Madeline Adelman
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tor A Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Ben J Friedman
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
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3
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Masson Regnault M, Mazereeuw-Hautier J, Fraitag S. [Early-onset melanoma (congenital, neonatal, infantile): A systematic review of literature cases]. Ann Dermatol Venereol 2020; 147:729-745. [PMID: 32563535 DOI: 10.1016/j.annder.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/09/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Neonatal and infantile malignant melanoma is rare. It may be difficult to diagnose and often carries a poor prognosis. MATERIAL AND METHODS We decided to review the data on congenital, neonatal and infantile malignant melanomas in order to understand their presentation (clinical, histological, molecular), diagnosis, management and outcomes. We performed a literature search of all cases of early-onset melanoma published in PubMed from its inception to March 2019 using the following keywords: "malignant melanoma" OR "melanoma" OR "pigmented nevus" OR "malignant pigmented" AND "infantile" OR "congenital" OR "children" OR "childhood" OR "infancy" OR "neonatal". Congenital melanoma associated with maternal-foetal transmission was not included in the study. RESULTS Sixty-five articles were selected and 85 cases were included in the study. Most patients were male (sex ratio: 1.6). The average age at diagnosis was 5.5 months (minimum-maximum: 0-24 months). The main site reported for congenital melanoma was the head-and-neck area and for neonatal and infantile melanoma the trunk. Half of all patients had a metastatic disease at the time of diagnosis. In metastatic cases, the prognosis was poor with the exception of patients undergoing complete excision of the tumour and metastases. The main treatment for cutaneous melanomas and operable metastasis was surgery, and secondarily, chemotherapy/immunotherapy. CONCLUSION Neonatal and infantile malignant melanoma are rarely reported and not well-documented. It is necessary to collect additional cases to improve our knowledge of this rare disease.
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Affiliation(s)
- M Masson Regnault
- Service de dermatologie, CHU de Poitiers, université de Poitiers, hôpital Jean-Bernard, Poitiers, France; Service de dermatologie, centre de références de maladies rares de la peau et des muqueuses, CHU de Toulouse, université Paul Sabatier, hôpital Larrey, Toulouse, France.
| | - J Mazereeuw-Hautier
- Service de dermatologie, centre de références de maladies rares de la peau et des muqueuses, CHU de Toulouse, université Paul Sabatier, hôpital Larrey, Toulouse, France
| | - S Fraitag
- Groupe hospitalier Necker-Enfants malades, service d'anatomopathologie, AP-HP, Paris, France
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Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
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Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
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Abstract
As cutaneous melanomas manifest a wide spectrum of clinical and pathologic presentations, several other lesions enter into their differential diagnosis. This article considers those entities, including melanocytic hyperplasia, cellular nodules in congenital nevi, atypical lentiginous melanocytic proliferations, "special site" nevi, epithelioid histiocytoma, neurothekeoma, cellular schwannoma, and proliferating scars.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Medical Center, Room 3020, 1215 Lee St, Charlottesville, Virginia 22908-0214.
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6
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Selected Benign Lesions That May Be Confused Pathologically With Cutaneous Melanoma. AJSP-REVIEWS AND REPORTS 2015. [DOI: 10.1097/pcr.0000000000000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Viana ACL, Gontijo B, Bittencourt FV. Giant congenital melanocytic nevus. An Bras Dermatol 2014; 88:863-78. [PMID: 24474093 PMCID: PMC3900335 DOI: 10.1590/abd1806-4841.20132233] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022] Open
Abstract
Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present
at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated
in <1:20,000 newborns. Despite its rarity, this lesion is important because it may
associate with severe complications such as malignant melanoma, affect the central
nervous system (neurocutaneous melanosis), and have major psychosocial impact on the
patient and his family due to its unsightly appearance. Giant congenital melanocytic
nevus generally presents as a brown lesion, with flat or mammilated surface,
well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily
a clinical diagnosis. However, congenital nevi are histologically distinguished from
acquired nevi mainly by their larger size, the spread of the nevus cells to the deep
layers of the skin and by their more varied architecture and morphology. Although
giant congenital melanocytic nevus is recognized as a risk factor for the development
of melanoma, the precise magnitude of this risk is still controversial. The estimated
lifetime risk of developing melanoma varies from 5 to 10%. On account of these
uncertainties and the size of the lesions, the management of giant congenital
melanocytic nevus needs individualization. Treatment may include surgical and
non-surgical procedures, psychological intervention and/or clinical follow-up, with
special attention to changes in color, texture or on the surface of the lesion. The
only absolute indication for surgery in giant congenital melanocytic nevus is the
development of a malignant neoplasm on the lesion.
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Affiliation(s)
- Ana Carolina Leite Viana
- Minas Gerais Federal University, Teaching Hospital, dermatology service, Belo HorizonteMG, Brazil, MD, MSc - Voluntary dermatologist at the dermatology service at Minas Gerais Federal University Teaching Hospital (UFMG) - Belo Horizonte (MG), Brazil
| | - Bernardo Gontijo
- Minas Gerais Federal University, Medical School, Belo HorizonteMG, Brazil, MD, PhD - Associate Professor of dermatology at Minas Gerais Federal University Medical School (UFMG) - Belo Horizonte (MG), Brazil
| | - Flávia Vasques Bittencourt
- Minas Gerais Federal University, Medical School, Belo HorizonteMG, Brazil, MD, PhD - Adjunct Professor of dermatology at Minas Gerais Federal University Medical School (UFMG) - Belo Horizonte (MG), Brazil
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Alikhan A, Ibrahimi OA, Eisen DB. Congenital melanocytic nevi: where are we now? Part I. Clinical presentation, epidemiology, pathogenesis, histology, malignant transformation, and neurocutaneous melanosis. J Am Acad Dermatol 2012; 67:495.e1-17; quiz 512-4. [PMID: 22980258 DOI: 10.1016/j.jaad.2012.06.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 11/15/2022]
Abstract
Congenital melanocytic nevi (CMN) are present at birth or arise during the first few weeks of life. They are quite common, may have a heritable component, and can present with marked differences in size, shape, color, and location. Histologic and dermatoscopic findings may help suggest the diagnosis, but they are not entirely specific. CMN are categorized based on size, and larger lesions can have a significant psychosocial impact and other complications. They are associated with a variety of dermatologic lesions, ranging from benign to malignant. The risk of malignant transformation varies, with larger CMN carrying a significantly higher risk of malignant melanoma (MM), although with an absolute risk that is lower than is commonly believed. They may also be associated with neuromelanosis, which may be of greater concern than cutaneous MM. The information presented herein aims to help dermatologists determine when it is prudent to obtain a biopsy specimen or excise these lesions, to obtain radiographic imaging, and to involve other specialists (eg, psychiatrists and neurologists) in the patient's care.
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Affiliation(s)
- Ali Alikhan
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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Funayama E, Sasaki S, Furukawa H, Hayashi T, Yamao T, Takahashi K, Yamamoto Y, Oyama A. Effectiveness of combined pulsed dye and Q-switched ruby laser treatment for large to giant congenital melanocytic naevi. Br J Dermatol 2012; 167:1085-91. [DOI: 10.1111/j.1365-2133.2012.11058.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Paradela S, Fernández-Torres R, Fonseca E. Controversias en el nevus congénito. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71903-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Paradela S, Fernández-Torres R, Fonseca E. Controversial Issues in Congenital Nevi. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Quaedvlieg PJF, Frank J, Vermeulen AHM, Toonstra J, van Neer FJMA. Giant ceribriform intradermal nevus on the back of a newborn. Pediatr Dermatol 2008; 25:43-6. [PMID: 18304152 DOI: 10.1111/j.1525-1470.2007.00580.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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13
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Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. Congenital Melanocytic Nevus: An Epidemiologic Study in Italy. Dermatology 2007; 214:227-30. [PMID: 17377384 DOI: 10.1159/000099587] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 09/14/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of congenital melanocytic nevi (CMN) among newborns ranges between 0.2 and 6% in the worldwide literature. In the only available study from Italy the rate was 1% at birth and 1.4% at 2 years of age. Some surveys performed among samples of children and adolescents in other countries showed a prevalence which ranged from 1.4 to 4.4%. Additional data on the frequency in adults are not available. OBJECTIVE The aim of this study was to estimate the prevalence of CMN in a large sample of a young male Italian population, which is deemed to be representative of the general population of the same age and sex. METHODS The potential conscripts resident in the coastal regions of southern Italy, enlisted for the compulsory service in the Italian Navy, were called at the age of 18 to the Draft's Council Medical Unit of the Italian Navy in Taranto to evaluate their psychophysical fitness to recruitment. All the subjects examined from September 2002 to March 2004 showing skin lesions evocative of CMN were referred by general practitioners of the Draft's Council Medical Unit to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis, which was based on the clinical features and the personal history. The confirmed cases were recorded in a predefined patient card, containing the main anamnestic and clinical data. Since the screening of small CMN in such a large sample of subjects was believed to be difficult, only CMN with a diameter >or=1.5 cm were recorded. RESULTS In 23,354 examined persons 157 CMN were diagnosed, with a prevalence of 0.67% (Bayesian 95% confidence interval 0.57-0.79); 126 (80.3%) CMN were medium-sized (>or=1.5 and <or=19.9 cm in diameter), and 31 (19.7%) were large (>or=20 cm in diameter). Three CMN (1.9%) were located on the face, 23 (14.6%) on the chest, 24 (15.2%) on the abdomen, 36 (22.9%) on the back, 48 (30.5%) on the lumbar area, 15 (9.5%) on the upper limb, 19 (12.1%) on the lower limb and 15 (9.5%) on the shoulder. No CMN was located on the head. In 19 cases (12.1%) >or=2 adjacent anatomical sites (shoulder/chest, shoulder/arm, etc.) were involved. In 73 moles (46.4%) terminal hairs were present. Eight CMN (5.1%) showed a zosteriform (i.e. segmental) feature. None of the examined subjects reported a personal history of malignant melanoma (MM), and no person with a history of MM was observed among all the enlisted men referred to the Department of Dermatology during the time of the study. CONCLUSION The prevalence of CMN in the Italian young male general population is roughly in agreement with the rates detected in general populations from other European studies. The observations of this study also suggest that the risk of appearance of MM, at least in childhood and adolescence, is limited for medium-sized CMN.
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Affiliation(s)
- Vito Ingordo
- Department of Dermatology, Italian Navy Main Hospital G. Venticinque, Taranto, Italy.
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Neinstein RM, Borschel GH, Zuker RM. Staged management of a congenital nevus of the breast and abdomen presenting in a female infant. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2006; 14:91-3. [PMID: 19554121 DOI: 10.1177/229255030601400208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of congenital melanocytic nevi is controversial. The authors describe their management of a congenital nevus covering the breast and abdomen of a one-month-old girl over a 16-year period. To prevent damage to the developing breast, a staged approach was used. The nevus over the abdomen was resected first at six years of age and the remaining portion was removed after breast development was complete at 16 years of age. The breast defect was resurfaced with a full thickness skin graft from the groin. The patient was pleased with the postoperative result. This staged approach allowed an optimized aesthetic result.
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Affiliation(s)
- Ryan M Neinstein
- University of Western Ontario, Schulich School of Medicine, London, Ontario
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15
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Abstract
BACKGROUND The risk of malignant melanoma in congenital melanocytic naevi (CMN) is a matter of controversial and ongoing debate. OBJECTIVES The purpose of this systematic review is to provide a careful and detailed summary of the published data, including several recently published studies. METHODS Articles on CMN (n=1424) were retrieved from Medline, 1966-October 2005. Case reports and studies lacking relevant clinical information were excluded. Only systematic collections of cases were taken into consideration. Series with fewer than 20 patients or studies with a mean follow-up of <3 years were regarded as epidemiologically less significant. RESULTS Fourteen articles were finally chosen for further analysis. The studies varied significantly with respect to study design (source of cases; retrospective vs. prospective analysis), age of patients, follow-up time, and naevus characteristics. The frequency of melanomas ranged between 0.05% and 10.7% and was significantly higher in smaller studies (P<0.0001). In a total of 6571 patients with CMN who were followed for a mean of 3.4-23.7 years, 46 patients (0.7%) developed 49 melanomas. The mean age at diagnosis of melanoma was 15.5 years (median 7). By comparison with age-adjusted data from the Surveillance, Epidemiology and End Results database, we calculated that patients with CMN carry an approximately 465-fold increased relative risk of developing melanoma during childhood and adolescence. Primary melanomas arose inside the naevi in 33 of 49 cases (67%). In seven cases (14%), metastatic melanoma with unknown primary was encountered; in four cases (8%) the melanoma developed at an extracutaneous site. The risk of developing melanoma and the rate of fatal courses were by far highest in CMN>or=40 cm in diameter. CONCLUSIONS The overall risk of melanoma of 0.7% in all 14 studies was lower than expected. The higher incidence of melanomas in smaller studies indicates selection bias. The melanoma risk strongly depends on the size of CMN and is highest in those naevi traditionally designated as garment naevi. The median age of 7 years at diagnosis of melanoma points to a risk maximum in childhood and adolescence. Future studies on CMN should report: (i) diameter, percentage of body surface, and localization of the CMN; (ii) percentage of naevus area removed by excision or subject to dermabrasion or other superficial treatments; (iii) mean and median age at entry into the study; (iv) mean and median follow-up time; (v) details on each melanoma case; (vi) standardized morbidity ratio of melanoma; and (vii) percentage of neurocutaneous melanosis.
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Affiliation(s)
- S Krengel
- Department of Dermatology, University of Kiel, Kiel, Germany.
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16
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Abstract
Congenital nevi are benign proliferations present at birth that consist of cells normally present in the skin. Many of these lesions are disfiguring and a source of psychosocial impairment. Because of location or extent of the lesion, surgical excision of the nevus may leave a defect without favorable reconstructive options. Laser ablation of such lesions has been used by several clinicians. A review of laser terminology is presented along with a review of nevus of Ota, nevus of Ito, café-au-lait macules, lentigines, and congenital melanocytic nevi. Although good results may be achieved with laser ablation of these lesions, laser treatment modalities for congenital melanocytic nevi remain controversial because of the potential for malignancy.
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Affiliation(s)
- Robert E H Ferguson
- Division Plastic Surgery, Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA
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17
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Abstract
Congenital nevi remain a constant and challenging clinical entity for plastic surgeons due to the unsettled question regarding the true incidence of conversion to melanoma. This paper will review the recent distinction described in the literature. To truly obtain a current authoritative accord, a new interdisciplinary consensus conference should probably be convened to review and initiate new standards regarding available treatment modalities and their indications.
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Affiliation(s)
- Dominic F Heffel
- Department of Surgery, Division of Plastic Surgery, Miller School of Medicine at the University of Miami, USA
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18
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Hale EK, Stein J, Ben-Porat L, Panageas KS, Eichenbaum MS, Marghoob AA, Osman I, Kopf AW, Polsky D. Association of melanoma and neurocutaneous melanocytosis with large congenital melanocytic naevi--results from the NYU-LCMN registry. Br J Dermatol 2005; 152:512-7. [PMID: 15787820 DOI: 10.1111/j.1365-2133.2005.06316.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Large congenital melanocytic naevi (LCMN), which develop in utero and are present in approximately one in 20,000 newborns, are associated with markedly increased risks of cutaneous melanoma, leptomeningeal melanoma and neurocutaneous melanocytosis (NCM). OBJECTIVES This study examined clinical characteristics associated with melanoma and NCM among patients with LCMN, and estimated the risk of developing melanoma and NCM in these patients. METHODS Two hundred and five LCMN patients enrolled in the New York University registry were studied. One hundred and seventy of these patients were followed prospectively. The remaining 35 patients had either melanoma at the time of entry into the registry (n = 6), or had insufficient follow-up information (n = 29). The outcome measures were the occurrence of melanoma and NCM. The associations between these outcomes and the clinical covariates (anatomical location of the LCMN, size of the LCMN, number of satellite lesions, family history of melanoma, patient sex and treatment) were assessed. RESULTS Four of 170 (2.3%) prospectively followed patients developed melanomas, representing a standardized morbidity ratio of 324. Among the entire cohort (n = 205), there were associations between increasing numbers of satellite naevi and the occurrence of melanoma (P = 0.04), and the presence of NCM (P = 0.06). Compared with patients who did not develop these diseases, median LCMN diameters were larger among patients who developed melanoma (49 vs. 39 cm) and NCM (55 vs. 46 cm). CONCLUSIONS In LCMN patients, increasing numbers of satellite lesions and larger LCMN diameters are associated with melanoma and NCM.
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Affiliation(s)
- E K Hale
- Oncology Section, Skin and Cancer Unit, New York University Medical Center, 550 First Avenue, H100, New York, NY 10016, USA
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Zaal LH, Mooi WJ, Sillevis Smitt JH, van der Horst CMAM. Classification of congenital melanocytic naevi and malignant transformation: a review of the literature. ACTA ACUST UNITED AC 2004; 57:707-19. [PMID: 15544766 DOI: 10.1016/j.bjps.2004.04.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2003] [Accepted: 04/23/2004] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Congenital naevi (CN) vary greatly in size, macroscopic appearance and histology. There is a practical need to subdivide CN according to size, since size differences have a direct bearing on cosmetic and resultant psychological problems, and on therapeutic options, and probably on the chance of malignant transformation. In this review, we summarise the literature on size subgroupings of CN, with special focus on giant congenital naevi and their risk of malignant transformation. MATERIALS AND METHODS A Medline literature search from 1966 to October 2002 was performed. Only English-language studies focusing on CN in association with melanoma were included. The final strategy consisted of textwords and medical subject heading (MeSH) terms on small, medium, large and giant congenital naevi combined with the textwords classification, histology and melanoma. Additional manual cross-referencing was performed. We excluded articles that dealt only with aspects of treatments. RESULTS A wide variety of criteria for size subgrouping of CN has been put forward in the literature and precludes a direct comparison of reported data (Table 1). We identified 35 such articles in the world literature in which no less than seven different definitions of minimum size of a giant CN were employed. Histologically, it is difficult or even impossible to conclude that a naevus is congenital or acquired, especially in case of a small lesion, since the differences are not absolute (Table 2). Giant CN have an increased risk for malignant transformation, but the reported incidence rates have differed widely from one to 31% (Table 3). Reported melanoma incidence rates have derived from retro- and prospective studies, reviews and case reports, and compared with each other using different definitions. On top of this, patients in different age groups were reported, who were registered in different referral centers. CONCLUSION To allow comparison of study results from different centers, it is essential that the size subclassification of CN is based on standard and generally accepted criteria. We recommend defining GCN as a CN covering one percent body surface area in face and neck and two percent elsewhere on the body. Based on a review of the world literature, we recommend prophylactic excision of all CN, in close communication with patient and family and individualising treatment accordingly.
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Affiliation(s)
- L H Zaal
- Department of Plastic, Reconstructive and Hand Surgery, Isala Klinieken, Zwolle, The Netherlands.
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20
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Callen JP. Kopf AW, Bart RS, Hennessey P. Congenital nevocytic nevi and malignant melanomas. J Am Acad Dermatol 2004. [DOI: 10.1016/j.jaad.2004.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Watt AJ, Kotsis SV, Chung KC. Risk of melanoma arising in large congenital melanocytic nevi: a systematic review. Plast Reconstr Surg 2004; 113:1968-74. [PMID: 15253185 DOI: 10.1097/01.prs.0000122209.10277.2a] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Large congenital melanocytic nevi are cutaneous lesions regarded by many as premalignant; estimates of malignancy incidence range from 0 to 42 percent. Given the often complex and extensive nature of large congenital melanocytic nevi resection and reconstruction, the risk of malignant transformation is a crucial factor that surgeons and families must weigh when deciding whether or not to excise the lesion. The authors conducted a systematic analysis of data from the existing literature to critically evaluate the published studies and to establish a crude incidence rate for the risk of malignant melanoma transformation in large congenital melanocytic nevi. After a comprehensive literature search, they analyzed data from eight studies (containing a total of 432 large congenital melanocytic nevi patients) of sufficient scientific quality. Twelve patients (2.8 percent) in this sample developed cutaneous malignant melanoma during the reported follow-up periods. Using a subset of this data and comparing the incidence rates to those of the Surveillance, Epidemiology, and End Results population-based database using a standardized morbidity ratio, the authors found that the large congenital melanocytic nevi patients had an increased risk of melanoma (standardized morbidity ratio, 2599; 95 percent confidence interval, 844 to 6064) compared with the general population. Regarding treatment before developing melanoma in the 12 patients, 50 percent were observed before diagnosis, 17 percent had partial excision, 8.3 percent had dermabrasion, 8.3 percent had a chemical peel, and 17 percent did not have any treatment information. These combined data are clinically useful when consulting with the parents of children with large congenital melanocytic nevi and in the management of older patients with existing lesions. This study shows that there is a significantly increased risk of melanoma in large congenital melanocytic nevi patients. The data also reveal the need for a standardized definition of large congenital melanocytic nevi and a long-term, prospective outcomes study to determine the true lifetime risk of melanoma in patients with and without surgical excision.
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Affiliation(s)
- Andrew J Watt
- University of Michigan School of Medicine, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor 48109-0340, USA
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Reynolds N, Kenealy J, Mercer N. Carbon dioxide laser dermabrasion for giant congenital melanocytic nevi. Plast Reconstr Surg 2003; 111:2209-14. [PMID: 12794461 DOI: 10.1097/01.prs.0000060115.98715.0f] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of giant congenital melanocytic nevi remains controversial. There is a balance to be achieved between minimizing the disfiguring appearance of these lesions, both before and after surgical treatment, and limiting the risk of malignant change. A series of seven patients who were treated in the same manner, with carbon dioxide laser dermabrasion, is presented. It has been 6 years since the first patient was treated in this way, and no cases of recurrence have been observed. This technique enables the removal of all or most of the pigmented lesion, with minimal scarring and without the need for disfiguring skin grafts. It has been well proved that there is an increased risk of malignant changes among patients with these lesions, although the amount of increased risk for the patient is not clear. Evidence from a review of the currently available literature is presented to indicate why this management method, at best, should decrease this risk and, at worst, should make no difference to the overall risk for individual patients.
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Affiliation(s)
- Nicholas Reynolds
- Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, United Kingdom.
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24
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Mones JM, Ackerman AB. Melanomas in prepubescent children: review comprehensively, critique historically, criteria diagnostically, and course biologically. Am J Dermatopathol 2003; 25:223-38. [PMID: 12775985 DOI: 10.1097/00000372-200306000-00007] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our series was comprised of 11 children age 10 years or younger (6 were younger than age 5) with primary cutaneous melanoma. All of the melanomas occurred de novo and all metastasized; one child died. In no instance was melanoma a clinical consideration, and in none did the histopathologist who first "signed out" the case make a diagnosis of melanoma. Despite the inability of clinicians and pathologists to diagnose correctly, with repeatability, melanomas that develop in children yet to be pubescent, those neoplasms, nonetheless, are melanomas and, therefore, criteria employed currently for diagnosis of melanoma, especially clinically, must be refined in order that they be applicable equally to melanomas in pre- and postpubescents. The vaunted ABCDs (Asymmetry, Border irregular, Color variability, Diameter >6.0mm) surely do not work for melanomas that appear in children who are prepubescent. Additionally, melanomas that occur in these children have distinctly different architectural and cytopathological features from those that arise in postpubescents, often being confused as they are by conventional microscopy with a Spitz's nevus. As a rule, melanomas in prepubescent children grow much more rapidly then those in adults but, like them, have the capability to disseminate widely and cause death.
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Affiliation(s)
- Joan M Mones
- Ackerman Academy of Dermatopathology, 145 East 32nd Street, 10th Floor, New York, NY 10016, USA.
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25
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Bastian BC, Xiong J, Frieden IJ, Williams ML, Chou P, Busam K, Pinkel D, LeBoit PE. Genetic changes in neoplasms arising in congenital melanocytic nevi: differences between nodular proliferations and melanomas. THE AMERICAN JOURNAL OF PATHOLOGY 2002; 161:1163-9. [PMID: 12368190 PMCID: PMC1867277 DOI: 10.1016/s0002-9440(10)64393-3] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Large congenital melanocytic nevi (CMN) are at an increased risk of developing melanoma. Several forms of secondary proliferations can arise in congenital nevi on rare occasions. Although some of these closely resemble melanoma both clinically and histologically, metastasis is rare. We used comparative genomic hybridization to analyze chromosomal aberrations in different types of proliferations arising in CMN and compared them to typical congenital nevi, clear-cut melanomas arising in congenital nevi, as well as primary cutaneous melanomas that were not associated with a CMN. Cases of CMN and CMN with secondary proliferations were assigned to six groups according to the predominant histological pattern: group I, bland congenital nevi (n = 6); group II, congenital nevi with foci of increased cellularity (n = 4); group III, CMN with a proliferation simulating superficial spreading melanoma in situ (n = 3); group IV, CMN with a proliferation simulating nodular melanoma (n = 9); group V, proliferating neurocristic hamartoma (n = 1); and group VI, melanoma arising in congenital nevus (n = 6). No aberrations were found in groups I to III, whereas seven of nine cases of group IV, and one of one case of group V, showed aberrations. In group IV six of seven cases with aberrations (86%) showed numerical aberrations of whole chromosomes exclusively. This pattern differed significantly from the findings in melanoma that arose within CMN (n = 6), group VI, or independent of CMN (n = 122) in which only 5% showed numerical changes only. The single case in group V showed aberrations similar to melanoma. The finding of frequent numerical chromosomal aberrations in atypical nodular proliferations arising in CMN identifies these as clonal neoplasms with a genomic instability consistent with a mitotic spindle checkpoint defect. This difference compared to the aberration pattern found in melanoma might explain their more benign clinical behavior and may be of diagnostic value in ambiguous cases.
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Affiliation(s)
- Boris C Bastian
- Department of Dermatology and Pathology, University of California at San Francisco Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California 94143-0808, USA.
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Abstract
While melanoma is uncommon in childhood, recent evidence suggests that its incidence is increasing in both adolescence and adulthood. Risk factors may be identifiable during childhood and include congenital nevi. Large congenital nevi carry a significantly increased risk for the development of melanoma, both cutaneous and extracutaneous. This risk appears to be greatest during early childhood. Large congenital nevi, particularly those overlying the head and neck, may also be associated with neurocutaneous melanosis. Symptomatic neurocutaneous melanosis, although rare, carries a poor prognosis. Conversely, asymptomatic neurocutaneous melanosis may be more common than previously recognized. For the most part, large congenital nevi are treated with primary excisions and closures, assisted by tissue-expansion techniques and skin grafting. Until the associated risks are better defined, therapy of small congenital nevi should be individualized, with consideration given to additional melanoma risk factors.
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Affiliation(s)
- Hanspaul S Makkar
- Department of Dermatology, University of California San Francisco, California 94115, USA
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Ahmed I, Tope WD, Young TL, Miller DM, Bloom KE. Neurocutaneous melanosis in association with encephalocraniocutaneous lipomatosis. J Am Acad Dermatol 2002; 47:S196-200. [PMID: 12140461 DOI: 10.1067/mjd.2002.110073] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a white female infant with neurocutaneous melanosis (NCM) and encephalocraniocutaneous lipomatosis (ECCL). Multiple, giant and small congenital melanocytic nevi (CMN) were observed on the head, neck and trunk and involved 70% of body surface area. Histologic examination of several CMN revealed atypical nodular proliferations of dermal nevomelanocytes. In a small (<1 cm) truncal CMN, single and dyscohesive intraepidermal nests of atypical nevomelanocytes simulating a superficial spreading melanoma, were observed. The placenta was grossly normal and histologically demonstrated multiple banal appearing nevomelanocytes within the stroma of its villi. At the 17-month follow-up no evidence of primary or metastatic melanoma was present. This previously undescribed association of NCM, ECCL and placental nevomelanocytes provides strong support for the hypothesized causal role of anomalous neural crest morphogenesis and migration in the development of all three disorders. The genetic mechanism underlying these complex birth defects has been hypothesized to result from the action of lethal autosomal dominant genes surviving by mosaicism.
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Affiliation(s)
- Iftikhar Ahmed
- Department of Dermatology, Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA
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Berg P, Lindelöf B. Congenital nevocytic nevi: follow-up of a Swedish birth register sample regarding etiologic factors, discomfort, and removal rate. Pediatr Dermatol 2002; 19:293-7. [PMID: 12220270 DOI: 10.1046/j.1525-1470.2002.00086.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital nevi both small and large are frequently removed. We attempted to study the removal rate and etiologic aspects of congenital nevi as well as their psychosocial effects through the use of a quality test. A questionnaire sent to a sample population of individuals with congenital nevocytic nevi (n=192) collected from the Swedish Medical Birth Register (SMBR) was used as a test of the register's quality and for collecting information on rate of removal and etiologic factors. The quality test indicated that only 85.3% of the nevi listed in the SMBR were true congenital nevocytic nevi. Of all true congenital nevocytic nevi reported in the questionnaire, 39.8% had been removed and none of the rest had developed malignant melanoma. The median time for follow-up was 14 years. The median age at removal of the nevi was 9.7 years. Eight percent of respondents believed that the skin lesion caused taunting and changed their social activities. No infection or illness during pregnancy was specifically related to the development of congenital nevi. In conclusion, the larger the nevi, the more frequently and earlier they are excised. With an excision rate of 40% of congenital nevocytic nevi, we found no malignant melanoma.
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Affiliation(s)
- Peter Berg
- Department of Dermatology, Karolinska Hospital and Institute, Stockholm, Sweden.
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29
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Pattee SF, Hansen RC, Bangert JL, Joganic EF. Giant congenital nevus with progressive sclerodermoid reaction in a newborn. Pediatr Dermatol 2001; 18:320-4. [PMID: 11576407 DOI: 10.1046/j.1525-1470.2001.01938.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Giant congenital melanocytic nevi are a rare occurrence in the pediatric population. The risk of malignant transformation associated with these lesions has been well established; however, the management strategies for giant congenital nevi remain controversial. We report an unusual sclerodermoid reaction in a giant congenital nevus in a 6-week-old Caucasian girl. Given its abnormal clinical appearance, the entire lesion was excised. The histology was consistent with an atypical compound/sclerosing spindle and epithelioid cell congenital nevus. No evidence of malignant change was seen histologically. The incidence of malignant transformation in giant congenital nevi has been difficult to calculate. Review of the literature yields an incidence of between 4 and 9%, favoring surgical excision of these lesions where possible. Atypical presentations of giant congenital nevi are rare, and we have found no other reported cases with a stromal change similar to that seen in our patient. We hypothesize that this change may represent an atypical host reaction to the nevus cells.
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Affiliation(s)
- S F Pattee
- Section of Dermatology, University of Arizona College of Medicine, Tucson, Arizona, USA.
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30
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Alvarez-Mendoza A, Reyes-Esparza J, Ruiz-Maldonado R, Lopez-Corella E, Juarez-Herrera NC. Malignant melanoma in children and congenital melanocytic nevi: DNA content and cell cycle analysis by flow cytometry. Pediatr Dev Pathol 2001; 4:73-81. [PMID: 11200494 DOI: 10.1007/s100240010130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant melanoma (MM) in children, although a rare neoplasm, can occur within a preexisting congenital melanocytic nevus (CMN). All the potential risk factors for this phenomenon are not well known, but increases in S phase and G2 + M phase of cell cycle, DNA aneuploidy, and cell cycle abnormalities in precursor lesions might be among the risk factors. Using paraffin-embedded tissue, we performed a retrospective analysis of DNA content, aneuploidy, and cell cycle by flow cytometry. Two groups of patients were analyzed: 28 children with CMN who did not developed MM, and 6 patients who further developed MM. In this second group, three patients had four biopsies done before the appearance of MM and in two patients biopsies were done after the appearance of MM. All CMN not associated with MM exhibited diploid cells only, their S phase was 11.5% (+/- 3.8), and their G2 + M phase was 2.5% (+/- 2.2). Among those patients who developed MM, 3/6 had an S phase > 15.5 and a G2 + M phase > 2.3 prior to the appearance of MM. Two out of six patients had a tetraploid DNA when MM developed and died with a disseminated MM. They had an S phase > 15.5 and their G2 + M phase was > 2.5. We propose that evaluation of DNA content and cell cycle by flow cytometry is a useful method to supplement biopsy findings in children with CMN who have lesions suspicious of developing a MM.
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Affiliation(s)
- A Alvarez-Mendoza
- Department of Pathology, National Institute of Pediatrics, Mexico City, Mexico
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31
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Bittencourt FV, Marghoob AA, Kopf AW, Koenig KL, Bart RS. Large congenital melanocytic nevi and the risk for development of malignant melanoma and neurocutaneous melanocytosis. Pediatrics 2000; 106:736-41. [PMID: 11015516 DOI: 10.1542/peds.106.4.736] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the risk for developing malignant melanoma and neurocutaneous melanocytosis (NCM) in patients with large congenital melanocytic nevi. DESIGN Follow-up data suitable for calculations were available on 160 patients in the New York University Registry of Large Congenital Melanocytic Nevi who had been free of known melanomas or NCM when entered into the Registry. The cumulative 5-year life-table risks for developing melanoma and NCM were calculated. The relative risk for developing melanoma, using a control general population reference group, was determined. RESULTS The 160 patients (median age at entry: 14 months) were followed prospectively for an average of 5.5 years. Three extracutaneous melanomas developed: 2 were in the central nervous system (CNS) and 1 was retroperitoneal. The 5-year cumulative life-table risk for developing melanoma was 2.3% (95% confidence interval [CI]:.8-6.6) and the relative risk was 101 (95% CI: 21-296). No melanoma occurred within a large congenital melanocytic nevus. Four patients developed manifest NCM, 2 with CNS melanomas. The 5-year cumulative life-table risk for developing NCM was 2.5% (95% CI:.8-7.2). Ten patients were excluded from the calculations because of preexisting disease on entry into the Registry: 5 with manifest NCM and 5 with melanomas (3 in large congenital melanocytic nevi, 1 in nonnevus skin, and 1 unknown primary). CONCLUSIONS Patients with large congenital melanocytic nevi are at increased risk for developing melanomas. There is also a significant increased risk for developing NCM. The high incidence of CNS involvement may influence decisions concerning treatment of the large congenital melanocytic nevi.
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Affiliation(s)
- F V Bittencourt
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York 10016, USA
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Abstract
Vascular and pigmentary lesions compromise most birthmarks. Lesions range from uncommon, to very common, some being essentially normal variants. The natural history of these varies from being transient phenomena of no significance to permanent cutaneous findings that may be associated with significant systemic complications or diseases. This article describes the most frequently encountered clinically important birthmarks, including congenital nevi, hypopigmented lesions, vascular malformations and hemangiomas, discussing clinical presentation, diagnosis, and findings that should prompt early assessment and treatment.
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Affiliation(s)
- M A Dohil
- Department of Pediatric and Adolescent Dermatology, Children's Hospital and Health Centers, San Diego, California, USA
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Zhu NW, Perks CM, Burd AR, Holly JM. Changes in the levels of integrin and focal adhesion kinase (FAK) in human melanoma cells following 532 nm laser treatment. Int J Cancer 1999; 82:353-8. [PMID: 10399952 DOI: 10.1002/(sici)1097-0215(19990730)82:3<353::aid-ijc8>3.0.co;2-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite the increase in laser therapy, concern remains that sublethal treatment of pre-malignant lesions may adversely affect the biological behaviour of surviving cells. Integrin receptors mediate interaction of cells with the extracellular matrix and their occupation leads to focal adhesion kinase (FAK) activation. Using our previously established model we have now investigated subcellular changes and compared integrin and FAK concentrations, the degree of FAK phosphorylation and its association with the beta1 integrin in laser vs. non-laser treated cells. We treated cells with laser generated from a frequency doubled Q-switched (Nd:YAG) laser system (532 nm) at 0.4 J/cm2 twice per week for 4 weeks. Using cell lysates we performed Western immunoblotting 24 hr later to detect integrin subunits and FAK proteins and immunoprecipitation to investigate FAK phosphorylation and its association with beta1. Cell morphology was examined using electron microscopy. SK23 and G361 cells exhibited an 3.4- and 11.2-fold increase, respectively, in FAK protein following laser treatment. FAK phosphorylation in SK23 cells was increased by 82%, whereas FAK phosphorylation in G361 cells was reduced slightly (2%). Furthermore, both alpha3 and 4 integrins were up-regulated, by approximately 4-fold and 7- to 9-fold, respectively. In addition, the beta1 integrin was proteolysed in both cell lines and the levels of FAK associated with beta1 was increased (2.1- and 2.7-fold, respectively). Finally, laser treatment of SK23 cells caused an increased number of cell processes. Sublethal 532 nm laser light thus induces changes in integrin and FAK concentrations and subsequently influences cellular attachment and morphology.
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Affiliation(s)
- N W Zhu
- University Department of Surgery, Bristol Royal Infirmary/University of Bristol, UK.
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Egan CL, Oliveria SA, Elenitsas R, Hanson J, Halpern AC. Cutaneous melanoma risk and phenotypic changes in large congenital nevi: a follow-up study of 46 patients. J Am Acad Dermatol 1998; 39:923-32. [PMID: 9843003 DOI: 10.1016/s0190-9622(98)70264-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Large congenital melanocytic nevi may undergo malignant transformation. Few prospective studies have evaluated the incidence of melanoma in large congenital nevi or have described how their phenotypic characteristics change over time. OBJECTIVE We attempted to ascertain the incidence of cutaneous melanoma in a cohort of patients with large congenital nevi and to evaluate the frequency and nature of several morphologic changes over time. METHODS Forty-six patients with large congenital nevi were prospectively followed up in our Pigmented Lesion Group. Large congenital nevi were defined as those occurring at birth and comprising 5% body surface area or greater in infants, children, and preadolescents and more than 20 cm in adolescents and adults. Information was obtained on location, satellitosis, changes in color and nodularity, and incidence of melanoma. The most atypical histologic findings from those who underwent biopsy were also noted. Standardized morbidity ratios (SMR) and 5-year cumulative risk were calculated and presented with corresponding 95% confidence intervals (CI). RESULTS Twenty-four male and 22 female patients (age range, 7 days to 36.7 years; mean, 8.4 years) with large congenital nevi were followed up prospectively for a total of 335 person-years (range, 0.17 to 17.5 person-years; mean, 7.3 person-years). Two patients (4.3%) experienced 3 cutaneous melanomas that originated in their primary congenital nevi. We found one case of neurocutaneous melanosis. No satellite, extremity, or extracutaneous melanomas were detected. The majority of nevi in our cohort were located on the posterior trunk, were accompanied by multiple satellite congenital nevi, and became lighter over time. In the 27 patients who underwent biopsies, the most atypical histologic findings included melanoma, atypical melanocytic dysplasia, neurocristic dysplasia, atypical neural crest hamartomas, atypical spindle cell tumors, and congenital nevi with dysplasia. The SMR comparing observed-to-expected melanoma incidence was 148 (95% CI 18, 535; P = .0002) indicating a substantially increased risk of melanoma in patients with large congenital nevi. The cumulative 5-year risk of cutaneous melanoma was 5.7% (95% CI 0%, 13.5%). CONCLUSION Our findings are consistent with the previously observed increased risk for the occurrence of cutaneous melanoma in patients with large congenital nevi. Although the number of patients with melanoma in this study is small, our observations and those of previous studies suggest that location and age correlates with melanoma risk. The majority of large congenital nevi are located on the trunk and may undergo several clinical changes as these patients age. Additional prospective studies are needed to gain more insight into the natural history and optimal management of large congenital nevi.
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Affiliation(s)
- C L Egan
- Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, USA
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Sahin S, Levin L, Kopf AW, Rao BK, Triola M, Koenig K, Huang C, Bart R. Risk of melanoma in medium-sized congenital melanocytic nevi: a follow-up study. J Am Acad Dermatol 1998; 39:428-33. [PMID: 9738777 DOI: 10.1016/s0190-9622(98)70319-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The risk of the occurrence of malignant melanoma (MM) in medium-sized (1.5 to 19.9 cm in diameter) congenital melanocytic nevi (CMN) is the subject of controversy. Universally accepted recommendations regarding the management of such lesions have not been made. OBJECTIVE Our purpose was to assess the risk of MM arising in medium-sized CMN. METHODS The study included 230 medium-sized CMN in 227 patients, first seen in a private dermatology practice from 1955 to 1996, who were followed up for MM arising within their CMNs. Criteria for entry into the study included (1) a clinically diagnosed medium-sized CMN, (2) minimum follow-up period of 1 year, and (3) a photograph of the lesion in the patient's medical record. RESULTS No MM occurred in a medium-sized CMN during an average follow-up of 6.7 years (median, 5.8 years) to an average age of 25.5 years (median, 19.1 years). CONCLUSION The results of this short-term follow-up study do not support the view that there is a clinically significantly increased risk for MM arising in banal-appearing medium-sized CMN or that prophylactic excision of all such lesions is mandatory. Lifelong medical observation seems a reasonable alternative for many medium-sized CMN.
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Affiliation(s)
- S Sahin
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
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36
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DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Huang CL, Wasti Q, Kopf AW, Bart RS. A study of large congenital melanocytic nevi and associated malignant melanomas: review of cases in the New York University Registry and the world literature. J Am Acad Dermatol 1997; 36:409-16. [PMID: 9091472 DOI: 10.1016/s0190-9622(97)80217-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with large congenital melanocytic nevi (LCMN) are at greater risk for the development of malignant melanoma (MM) than are persons in the general population. OBJECTIVE Our purpose was to identify the clinical features of LCMN in those patients in whom MMs actually developed. METHODS The records of 117 patients in the New York University Registry of LCMN and the reports of 172 cases of LCMN in the world literature were studied. RESULTS Of the 289 cases of LCMN studied, 34 patients (12%) had primary cutaneous MMs within their nevi; in two additional patients, MMs developed at cutaneous sites other than within their nevi. All patients in whom MM developed within LCMN had nevi in axial locations; however, 91% of the LCMN were axial. No MM was found that had arisen in any of the 26 LCMN confined to the extremities. In addition, no MM was found that had arisen in thousands of satellite nevi. CONCLUSION When MM develops within an LCMN, it generally does so in those LCMN in an axial location. The absence of cases of MM arising in LCMN confined to the extremities suggests that such nevi represent lower risk lesions, but the number of extremity nevi analyzed was too small to allow definitive conclusions. A striking finding was the absence of MMs arising in satellite nevi.
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Affiliation(s)
- M DeDavid
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA
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DeDavid M, Orlow SJ, Provost N, Marghoob AA, Rao BK, Wasti Q, Huang CL, Kopf AW, Bart RS. Neurocutaneous melanosis: clinical features of large congenital melanocytic nevi in patients with manifest central nervous system melanosis. J Am Acad Dermatol 1996; 35:529-38. [PMID: 8859278 DOI: 10.1016/s0190-9622(96)90674-x] [Citation(s) in RCA: 187] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with a large congenital melanocytic nevus (LCMN) may have associated leptomeningeal melanocytosis with or without central nervous system (CNS) melanomas. These patients are considered to have neurocutaneous melanosis, a disorder that, when symptomatic or otherwise manifest neurologically, carries a poor prognosis even in the absence of malignancy. OBJECTIVE Our purpose was to identify typical clinical features in patients who have manifest CNS melanosis in association with LCMN. METHODS The records of 117 patients with LCMN in the New York University Registry of LCMN and the reports of 172 cases of LCMN in the world literature were included for features that might signal a high risk for the development of manifest CNS involvement. RESULTS Of the 289 patients with LCMN, 33 had manifest CNS melanosis. In all 33 in whom symptomatic neurocutaneous melanosis was diagnosed, the LCMNs were present in a posterior axial location on the head, neck, back, and/or buttocks. "Satellite" nevi were known to be present in 31 of the 33 patients. CONCLUSION Patients with LCMN in a posterior axial location, especially when associated with "satellite" melanocytic nevi, are at greater risk for the development of manifest neurocutaneous melanosis than patients with LCMN limited to the extremities or those who are lacking satellite nevi.
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Affiliation(s)
- M DeDavid
- Ronald O. Pereiman Department of Dermatology, New York University School of Medicine, New York, USA
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Craver RD, Golladay SE, Warrier RP, Gates AJ, Nelson JS. Neurocutaneous melanosis with Dandy-Walker malformation complicated by primary spinal leptomeningeal melanoma. J Child Neurol 1996; 11:410-4. [PMID: 8877612 DOI: 10.1177/088307389601100515] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R D Craver
- Louisiana State University Medical Center, New Orleans Children's Hospital, USA
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Dawson HA, Atherton DJ, Mayou B. A prospective study of congenital melanocytic naevi: progress report and evaluation after 6 years. Br J Dermatol 1996; 134:617-23. [PMID: 8733360 DOI: 10.1111/j.1365-2133.1996.tb06959.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A prospective study of children with large congenital melanocytic naevi (CMNs) is in progress. Its aims are to observe the natural history and inheritance of CMNs, to record associated pathologies, and eventually to evaluate the effects of treatment. Information is obtained by patient-completed questionnaires and clinical assessment. One hundred and thirty-three children have been followed for a total of 452 patient years. The female/male ratio is 3:2. The characteristics, size and distribution at birth of the CMNs in this group of patients, and their development and associated abnormalities, are documented. After 5 years, affected children were compared with a matched cohort of normal children. Although the prevalence of neurological and developmental defects was higher in affected children, no malignant melanomas have been reported to date. The families of affected children had higher numbers of naevi and café-au-lait spots than those of normal children, suggesting a possible hereditary component. The mothers of affected children also reported an increased incidence of influenza-like illness and of severe nausea and vomiting in pregnancy. This study will continue for a further 4 years, in the first instance, after which we will seek relationships between characteristics of the naevi and outcome.
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Affiliation(s)
- H A Dawson
- St John's Dermatology Centre, St Thomas' Hospital, London, U.K
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Swerdlow AJ, English JS, Qiao Z. The risk of melanoma in patients with congenital nevi: a cohort study. J Am Acad Dermatol 1995; 32:595-9. [PMID: 7896948 DOI: 10.1016/0190-9622(95)90343-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Giant congenital nevi are associated with a greatly increased risk of melanoma, but this has not been quantified. Smaller congenital nevi are believed by some authors to be associated with increased risk, but this is uncertain and needs to be clarified. OBJECTIVE Our purpose was to analyze cause-specific mortality and cancer incidence risks in patients with congenital nevi according to size of the nevi. METHODS We followed up 265 patients with congenital nevi first treated at the Hospital for Sick Children or at St. John's Hospital in London during 1950 to 1984 for mortality to mid-1993 and for cancer incidence from 1971 to 1989. Mortality and cancer incidence rates in the cohort were compared with expectations from national mortality and cancer incidence rates by sex, age, and calendar period. RESULTS Among the 33 patients with a congenital nevus covering at least 5% of the body area, two melanomas occurred during follow-up; both were fatal. The relative risk of melanoma mortality in these patients was 1046 (95% confidence interval, 127 to 3779). In the remaining 232 patients, 68 of whom had a nevus covering 1% to 4% of the body, and 164 with nevi smaller than 1% of body area, no melanomas occurred (0.18 melanoma deaths expected). The difference in melanoma mortality risk between the group with a nevus covering at least 5% of the body and the group with smaller nevi was significant (p < 0.05). There was not a significantly increased risk of nonmelanoma mortality or of nonmelanoma cancer incidence overall in the cohort, although two lymphohematopoietic malignancies occurred. CONCLUSION The data show the large risk of melanoma in patients with nevi covering more than 5% of the body surface area. The results do not support the hypothesis of greatly increased risk in persons with congenital nevi smaller than this, but because the confidence intervals of the result were wide, the data are compatible with a sizable risk. Much larger studies than those that have so far been undertaken, or combined analysis of data from several studies, are needed to quantify more precisely the risk of melanoma in relation to size of nevi and to determine the appropriate clinical management of these lesions.
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Affiliation(s)
- A J Swerdlow
- Epidemiological Monitoring Unit, London School of Hygiene and Tropical Medicine, U.K
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Affiliation(s)
- M L Williams
- Department of Dermatology, University of California San Francisco 94143-0316
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Abstract
Melanocytic nevi have been reported in association with several congenital syndromes. This review describes the clinical and cutaneous manifestations of six syndromes associated with congenital melanocytic nevi, two associated with acquired nevi, and six associated with melanocytic nevi in which insufficient evidence exists to classify them as congenital or acquired. It is important to recognize these associations to evaluate and counsel patients with melanocytic nevi. Early recognition will also facilitate timely intervention.
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Affiliation(s)
- A A Marghoob
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY 10016
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Abstract
Six cases of malignant melanoma in children 14 years of age and younger are reported. The six cases were diagnosed among 850,000 consecutive skin biopsy specimens and consultation slides examined within a 32-year period. This series included an infant born with neurocutaneous melanosis, a child with malignant melanoma developing in a large congenital nevus at the age of 13 years, a superficial spreading malignant melanoma, Clark Level III, in a child with many dysplastic nevi, and three cases with primary nodular malignant melanoma, two of which showed histologic features of Spitz nevus. A review of the literature indicates that malignant melanoma in childhood is rare, and no large series have been investigated. It is not known whether the genetic and the environmental factors incriminated in the development of malignant melanoma in adults play a role in childhood melanomas. Data on the incidence of childhood melanoma in the population, the clinical and the histologic variations, and the prognosis are not adequate. A multiinstitutional study is needed to gather a large enough series to provide this information.
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Affiliation(s)
- A H Mehregan
- Pinkus Dermatopathology Laboratory, Monroe, Michigan 48161
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Greene MH. The prevention of cutaneous malignant melanoma: high-risk groups, chemoprevention, education, and screening. Cancer Treat Res 1993; 65:103-40. [PMID: 8104019 DOI: 10.1007/978-1-4615-3080-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Melanoma is a disease that need not be deadly. Advances in our understanding of the etiology and biology of melanoma over the past 20 years have brought us to the brink of a new era in which the twin goals of primary and secondary prevention may be within our grasp. There is ample reason to be optimistic that this can and will be accomplished.
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Affiliation(s)
- M H Greene
- Department of Medicine, Mayo Clinic Scottsdale, AZ 85259
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Reyes-Mugica M, Gonzalez-Crussi F, Bauer BS, Medina-Escobedo G. Bulky naevocytoma of the perineum: a singular variant of congenital giant pigmented naevus. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1992; 420:87-93. [PMID: 1539454 DOI: 10.1007/bf01605989] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe two instances of a previously unrecognized variant of congenital giant pigmented naevus (GPN), presenting as a bulky naevocytic tumour in the perineal region. In both cases the lesion was present at birth and attained massive dimensions. In addition to the characteristic histological patterns found in GPN, which included extensive areas with a neural appearance, these tumours presented an uncommon tendency to form pseudo-follicular structures lined by naevus cells. No features suggestive of malignant transformation were found. Because GPN may associate with an underlying malignancy, accurate diagnosis of this lesion is important in clinical practice.
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Affiliation(s)
- M Reyes-Mugica
- Department of Pathology, Children's Memorial Hospital, Northwestern University, Chicago, Illinois 60614
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Abstract
Melanocytic nevi are common in children and adolescents, and the preponderance of these lesions are benign. Congenital melanocytic nevi, dysplastic nevi, and large numbers of common acquired nevi, however, may indicate an increased risk of malignant melanoma. With the exception, possibly, of giant congenital nevi, melanoma associated with these lesions generally occurs in adulthood. Nonetheless, some patients can be identified as being at increased risk for the development of melanoma during childhood. The poor prognosis associated with advanced melanoma and the curability of early lesions underscore the importance of prompt recognition of melanoma when it does occur in children. Furthermore, physicians who care for children are in a key position to decrease risk of melanoma throughout the lifespan by encouraging avoidance of excessive sun exposure during childhood.
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Affiliation(s)
- M E Roth
- Division of Dermatology, Brown University, Providence, Rhode Island
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Affiliation(s)
- L F Eichenfield
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia
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49
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Abstract
Neurocutaneous melanosis is a rare congenital syndrome characterized by the presence of large or multiple congenital melanocytic nevi and benign or malignant pigment cell tumors of the leptomeninges. The syndrome is thought to represent an error in the morphogenesis of the embryonal neuroectoderm. We review 39 reported cases of neurocutaneous melanosis and propose revised criteria for diagnosis. Most patients with neurocutaneous melanosis presented in the first 2 years of life with neurologic manifestations of increased intracranial pressure, mass lesions, or spinal cord compression. Leptomeningeal melanoma was present in 62% of the cases, but even in the absence of melanoma, symptomatic neurocutaneous melanosis had an extremely poor prognosis. Useful diagnostic procedures include cerebrospinal fluid cytology and magnetic resonance imaging with gadolinium contrast. Patients may be aided by palliative measures such as shunt placement to reduce intracranial pressure. Dermatologists in their follow-up of patients with large or multiple congenital melanocytic nevi should be aware of this condition, to aid in prompt diagnosis and because the treatment of cutaneous lesions may be altered in the presence of symptomatic neurocutaneous melanosis.
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Affiliation(s)
- J N Kadonaga
- Department of Dermatology, University of California School of Medicine, San Francisco 94143
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Rivers JK, Frederiksen PC, Dibdin C. A prevalence survey of dermatoses in the Australian neonate. J Am Acad Dermatol 1990; 23:77-81. [PMID: 2365880 DOI: 10.1016/0190-9622(90)70190-s] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A group of 420 neonates underwent total cutaneous and oral mucosal examinations during the first week of life. Skin lesions were seen in almost every baby (99.3%). The eight most common dermatoses were desquamation (65.0%), Epstein's pearls (56.0%), sebaceous hyperplasia (48.0%), milia (36%), toxic erythema (34.8%), salmon patch (33.8%), hypertrichosis (29.0%), and Mongolian spot (25.5%). Congenital melanocytic nevi were clinically diagnosed in 9 of 420 babies (2.1%); the majority of the lesions were small, that is, less than 1.5 cm in diameter. These neonates had a dark complexion (all had brown or black hair, and most had an olive skin color) and came from families with no previous history of cutaneous melanoma. In contrast, all 19 babies with a previous family history of melanoma had a fair complexion (blond or light brown hair and alabaster skin color) but no congenital melanocytic nevi. These findings may suggest that small congenital melanocytic nevi are markers for persons with a decreased risk of melanoma, because dark-skinned persons are at a lower risk. On the other hand, small congenital melanocytic nevi may be precursors of melanoma. Only prospective studies will determine the magnitude of this risk and thereby optimize management.
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Affiliation(s)
- J K Rivers
- Department of Surgery, University of Sydney, Camperdown, New South Wales, Australia
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