[Acral eruptive nevi after chemotherapy in children with acute lymphoblastic leukemia]

Eruptive acral lentiginosis following chemotherapy for acute lymphoblastic leukemia: A case series

Lentigines are brown macules which develop due to increased proliferation of melanocytes at the dermo-epidermal junction. We report three cases of acral lentiginosis in children following chemotherapy for acute lymphoblastic leukaemia (ALL) which have persisted following cessation of chemotherapy, despite avid photoprotection. Generalised eruptive naevi with subsequent development of dysplastic naevi and melanoma in situ have been reported following chemotherapy, highlighting the importance of continued clinical observation.

Common and not so Common Melanocytic Lesions in Children and Adolescents

The acquired melanocytic nevus is the most common lesion encountered by pediatric pathologists and dermatopathologists in their daily practice. In most cases, there are few difficulties in histopathologic diagnosis. However, it is the acquired melanocytic lesion known as the Spitz nevus, with its intrinsic atypical features which becomes the challenge since it exists along a histopathologic and biologic continuum from the atypical Spitz tumor to spitzoid melanoma. The frustration with some of these spitzoid lesions is that even the "experts" cannot agree as to the differentiation of one from the other even at the level of molecular genetics. Other melanocytic lesions are discussed including the congenital melanocytic nevus with its proliferative nodule(s) and melanoma as the ultimate complication. Although uncommon, cutaneous melanoma in the first 2 decades is emerging as a clinical problem especially in young women in the second decade of life. These are ultraviolet-associated neoplasms whose histopathologic and prognostic features are identical to the adult experience. Considerable progress has been made over the past 15 to 20 years in our understanding of cutaneous melanocytic lesions, but gaps still exist in the important group of spitzoid lesions. It can also be anticipated that more cutaneous melanomas in children will be seen in the future based upon epidemiologic studies.

Drug-induced eruptive melanocytic nevi

INTRODUCTION

The sudden eruption of melanocytic nevi has been associated with a number of conditions, such as bullous skin diseases, immunodeficiency and immunosuppression. The exact mechanisms leading to the development of eruptive melanocytic nevi are unknown. Areas covered: The aim of this article is to review the literature concerning eruptive melanocytic nevi following the administration of immunosuppressive drugs and other medications. Expert opinion: The literature regarding the development of eruptive nevi in association with pharmacological therapies includes a relatively low number of reports. Prevalence of this phenomenon is likely to be underestimated, thus reporting should be encouraged in order to better define the actual significance and related clinical implications. The development of multiple melanocytic nevi during immunosuppressive treatments highlights the importance of immune system integrity in the regulation of nevi growth. The observation of eruptive nevi as an unexpected effect of targeted therapies for specific types of cancer, including melanoma, provided intriguing hints to understand the mechanisms underlying this paradoxical event. The synergistic role of additional triggers in the occurrence of drug-induced eruptive nevi has not been explored and may be an interesting area of research.

[Childhood eruptive nevi: a case report]

"Eruptive nevi" is a phenomenon characterized by a rapid appearance of multiple melanocytic nevi. It is mainly developed in three groups of patients: those with systemic immunosuppression, bullous cutaneous disorders, and a melanocytic stimulation drug. We report on the case of an 11-year-old boy who was diagnosed with acute lymphoblastic leukemia. A few months after the beginning of the chemotherapy, he developed multiple pigmented lesions over the skin. Eruptive nevi syndrome has been described in the literature in 29 cases in the context of severe bullous disease and in immunosuppression. Nevi most often appear on the trunk and extremities, notably on the feet in the context of immunosuppression. They are localized in areas of bullous lesions in bullous diseases. Due to an increased melanocytic stimulation in eruptive nevi patients, long-term surveillance of individuals who have developed eruptive nevi is required, and increased sun prevention should be suggested.

The dysplastic nevus: from historical perspective to management in the modern era: part I. Historical, histologic, and clinical aspects

Since its description in the 1970s, the dysplastic nevus has been a source of confusion, and whether it represents a precursor to melanoma remains a controversial subject. Although a Consensus Conference in 1992 recommended that the term "dysplastic nevus" no longer be used, the histologic diagnosis continues to present a therapeutic quandary for dermatologists and other physicians, and there remains significant variation in clinical management. In part I of this continuing medical education review, we will discuss the historical origins of the term, the evidence for its distinct histologic basis, and its clinical significance.

Focal acral hyperpigmentation in a patient undergoing chemotherapy with capecitabine

Capecitabine is a prodrug of fluorouracil. Systemic immunosuppression has been reported as a cause of eruptive pigmented lesions, although the mechanisms causing this eruption are not known. A 58-year-old woman undergoing chemotherapy with capecitabine presented with multiple pigmented macules on the skin and tongue, and generalized hyperpigmentation, which finally faded after the drug was discontinued. Capecitabine may induce the growth of normal and dysplastic melanocytic nevi, and lentiginous melanocytic hyperplasia. Careful follow-up is mandatory, since the risk of developing melanoma in these cases remains uncertain.