Treatment of maxillofacial congenital melanocytic nevus with percutaneous radiofrequency thermal ablation: A case series study

When congenital melanocytic nevus (CMN) is in the maxillofacial region, a safer, more effective and fewer side-effects treatment is needed for patients with high requirement for appearance. The objective of this study was to investigate the effectiveness of radiofrequency thermal ablation (RFA) for CMN in the maxillofacial region. We reviewed 21 patients treated with RFA for CMN followed by a blinded retrospective analysis of serial photographs taken during the course of their therapy. Questionnaires were used to evaluate perceived therapeutic response and complications of this treatment. Most CMNs stopped growing, faded in color and became smaller. Reduction in size of 90% to 100% was obtained in two patients (10%), 75% to 90% in six patients (29%), 50% to 75% in two patients (10%), <50% in eight patients (38%), and three had no reduction (13%). Clear effect of clinical response score was obtained in two patients (10%), excellent in four patients (19%), good in 14 patients (67%), and fair in one patient (4%). No serious complication, severe hypertrophic scarring, and evidence of recurrence was observed in any case. Percutaneous RFA, as a minimally invasive and safe treatment, may provide an alternative treatment for maxillofacial CMN.

Carbon dioxide ablative laser treatment of acquired junctional melanocytic nevi

BACKGROUND

Junctional melanocytic nevi are common. Furthermore, surgical treatment of these nevi can be challenging due to scar formation.

AIMS

The study aims to detect the efficacy and safety of the CO₂ fractional laser for treating acquired junctional melanocytic nevi and usefulness of dermatoscopy for the monitoring of the nevus.

METHODS

We conducted a retrospective review of 618 patients with 1545 facial junctional melanocytic nevi. CO₂ fractional laser was applied to 2-month intervals until complete clearance was reached. The effect of the therapy was monitored by clinical and dermatoscopy. The Global Assessment Scale (GAS) scores were used to assess the results.

RESULTS

1320 nevi (85%) were treated in just one session. In addition, 120 (8%) and 75 (5%) required second and third sessions, respectively. Only thirty nevi (2%) need more than three sessions. Consequently, at the end of one-year follow-up, patients' (97%) and physicians' (95%) GAS scores were rated as excellent and good, respectively. Moreover, hyper/hypopigmentation, fibrosis, dimples, erythema, and scars were observed as side effects at the 1-year follow-up.

CONCLUSIONS

CO₂ laser is effective in completely removing small acquired junctional melanocytic nevus. Furthermore, dermatoscopy appears to be helpful for monitorization of the nevi in the follow-up period.

Neuropeptides Profile and Increased Innervation in Becker's Nevus

Background

Melanocytes are derived from neural crest, and various pigmentary disorders may accompany abnormalities in nerve system or develop following dermatome, suggesting that melanocyte and pigmentation may be closely related to neural factors. There are reports of Becker's nevus (BN) showing linear and segmental configuration, suggesting the association of BN with nerve system. However, there are no studies regarding the expression of neuropeptides in BN.

Objective

We investigated the expression of neuropeptides and innervation in BN.

Methods

Polymerase chain reaction (PCR) array of 84 genes related to neuronal process was done. Among the genes with 10-fold or more increase in lesional, real-time PCR was performed for neuropeptide Y (NPY), galanin, neurotensin (NTS) and their receptors skin compared to normal skin. IHC stain was done to look for the expression of NPY, galanin, NTS and their receptors and the distribution of protein gene products (PGP) 9.5 immunoreactive nerve fibers.

Results

PCR array revealed that 16 out of 84 genes related to neuronal process were increased by 10-fold or more in lesional skin. In real-time PCR of NPY, galanin, NTS and their receptors, statistically significant increase of NPY1R (p<0.05) and marginally significant increase of NPY2R, GAL2R, and NTS2R (p<0.1) was verified in lesional skin. In immunohistochemistry, NPY, NPY1R NPY2R, and NTS2R were highly expressed in lesional skin and increased PGP 9.5 immunoreactive linear nerve fibers were found in the epidermis of BN.

Conclusion

NPY, galanin, NTS and their receptors and increased innervation may play a role in the pathogenesis of BN.

Distribution of the neuro-regulatory peptide galanin in the human eye

Galanin (GAL) is a neuro-regulatory peptide involved in many physiological and pathophysiological processes. While data of GAL origin/distribution in the human eye are rather fragmentary and since recently the presence of GAL-receptors in the normal human eye has been reported, we here systematically search for sources of ocular GAL in the human eye. Human eyes (n=14) were prepared for single- and double-immunohistochemistry of GAL and neurofilaments (NF). Cross- and flat-mount sections were achieved; confocal laser-scanning microscopy was used for documentation. In the anterior eye, GAL-immunoreactivity (GAL-IR) was detected in basal layers of corneal epithelium, endothelium, and in nerve fibers and keratinocytes of the corneal stroma. In the conjunctiva, GAL-IR was seen throughout all epithelial cell layers. In the iris, sphincter and dilator muscle and endothelium of iris vessels displayed GAL-IR. It was also detected in stromal cells containing melanin granules, while these were absent in others. In the ciliary body, ciliary muscle and pigmented as well as non-pigmented ciliary epithelium displayed GAL-IR. In the retina, GAL-IR was detected in cells associated with the ganglion cell layer, and in endothelial cells of retinal blood vessels. In the choroid, nerve fibers of the choroidal stroma as well as fibers forming boutons and surrounding choroidal blood vessels displayed GAL-IR. Further, the majority of intrinsic choroidal neurons were GAL-positive, as revealed by co-localization-experiments with NF, while a minority displayed NF- or GAL-IR only. GAL-IR was also detected in choroidal melanocytes, as identified by the presence of intracellular melanin-granules, as well as in cells lacking melanin-granules, most likely representing macrophages. GAL-IR was detected in numerous cells and tissues throughout the anterior and posterior eye and might therefore be an important regulatory peptide for many aspects of ocular control. Upcoming studies in diseased tissue will help to clarify the role of GAL in ocular homeostasis.

Galanin family of peptides in skin function

The skin, the largest organ of the body, functions as a barrier between the body proper and the external environment, as it is constantly exposed to noxious stressors. During the last few years, the concept of an interactive network involving cutaneous nerves, the neuroendocrine axis, and the immune system has emerged. The neuroendocrine system of the skin is composed of locally produced neuroendocrine mediators that interact with specific receptors. Among these mediators are neuropeptides, including members of the galanin peptide family--galanin, galanin-message associated peptide, galanin-like peptide, and alarin--which are produced in neuronal as well as nonneuronal cells in the skin. Here, we review the expression of the galanin peptides and their receptors in the skin, and the known functions of galanin peptides in different compartments of the skin. We discuss these data in light of the role of the galanin peptide family in inflammation and cell proliferation.

Laser Erbium: YAG no tratamento de nevos melanocíticos

FUNDAMENTOS - Os nevos melanocíticos adquiridos são observados em grande parte da população e o resultado da sua excisão, dependendo da localização, extensão e fatores inerentes ao paciente, pode ser insatisfatório. OBJETIVO - Avaliar o uso do laser Erbium: YAG no tratamento de nevos melanocíticos adquiridos MÉTODOS - Foram selecionados nove pacientes, seis homens e três mulheres, brancos, com idade entre 20 e 60 anos e desejo de remover um nevo melanocítico composto no tronco. Metade do nevo foi tratada com laser, e a outra metade foi utilizada como controle. Após um mês da aplicação, foram avaliados a cicatrização, o resultado estético e a persistência de células névicas e melanina. RESULTADOS - Houve rápida cicatrização e ótimo resultado estético, no entanto, o exame histopatológico demonstrou a permanência de células névicas e melanina em sete e em nove das amostras examinadas, respectivamente. CONCLUSÃO - A utilização do laser Erbium:YAG, com os parâmetros utilizados neste estudo, não foi capaz de destruir completamente as células névicas melanocíticas e a melanina, não sendo, portanto, recomendada para o tratamento dessas lesões, dada a possibilidade de transformação maligna futura.