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Al-Adwan S, Alqaisi KM, Al Katheri G. Nevus Variations in the Jordanian Population: Effects of Age, Medical Conditions, Environment, Congenital, Inherited, and Genetic Factors. Clin Cosmet Investig Dermatol 2024; 17:17-29. [PMID: 38193026 PMCID: PMC10773247 DOI: 10.2147/ccid.s433447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024]
Abstract
Background Nevi is a common benign proliferation of melanin-producing cells. Many triggers can influence their transformation into either benign or malignant, thus it is important to understand these triggers and their incidence across different populations to take adequate prevention. Here, we aim to examine the different etiologies of nevi changes across the Jordanian population. Methods We carried out a cross-sectional observational study focusing on patients seeking dermatological consultation for normal nevi or nevi with minimal changes. Demographic and clinical variables were collected from the patient's case history. Nevi's characteristics were also recorded. A skilled dermatologist assessed nevi morphology and changes using the ABCDE criteria for potential signs of melanoma. Nevi biopsy samples were fixed in formalin and sent for histopathological analysis and were stained with hematoxylin and eosin (H&E). Results A total of 231 patients were enrolled, with a majority of females (85%) and a median age of 37. Past medical history was positive in 17% of the samples, with hypertension, endocrine diseases, and diabetes mellitus being the most common. The majority of patients (61%) had fewer than three nevi. Changes in nevus size, configuration, and color were reported in 10% of patients, with multiple changes observed in 36% of patients. Microscopic analysis revealed polypoidal intradermal melanocytic blue nevi as the most common histopathological finding (84%). Positive medical history and the number of nevi were significantly associated with nevi changes. Conclusion Our results report that the number of nevi, as well as medical history, is linked to changes in their appearance. Additionally, we provide a detailed account of the various types of observed changes and their occurrence rates.
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Affiliation(s)
- Safwan Al-Adwan
- Department of Cosmetic Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Khalid M Alqaisi
- Department of Cosmetic Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Ghassan Al Katheri
- Department of Pathology, Humboldt General Hospital, Winnemucca, Nevada, 89446, USA
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2
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Zhong Z, Yang T, Liu S, Wang S, Zhou S, Du S, Zheng L, Wang X, Wang H, Wang Y, Gao M. Case report: Gene mutation analysis and skin imaging of isolated café-au-lait macules. Front Genet 2023; 14:1126555. [PMID: 37025448 PMCID: PMC10071509 DOI: 10.3389/fgene.2023.1126555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Café-au-lait macules (CALMs) are common birthmarks associated with several genetic syndromes, such as neurofibromatosis type 1 (NF1). Isolated CALMs are defined as multiple café-au-lait macules in patients without any other sign of NF1. Typical CALMs can have predictive significance for NF1, and non-invasive techniques can provide more accurate results for judging whether café-au-lait spots are typical. Objectives: The study aimed to investigate gene mutations in six Chinese Han pedigrees of isolated CALMs and summarize the characteristics of CALMs under dermoscopy and reflectance confocal microscopy (RCM). Methods: In this study, we used Sanger sequencing to test for genetic mutations in six families and whole exome sequencing (WES) in two families. We used dermoscopy and RCM to describe the imaging characteristics of CALMs. Results: In this study, we tested six families for genetic mutations, and two mutations were identified as novel mutations. The first family identified [NC_000017.11(NM_001042492.2):c.7355G>A]. The second family identified [NC_000017.11(NM_001042492.2):c.2739_2740del]. According to genotype-phenotype correlation analyses, proband with frameshift mutation tended to have a larger number of CALMs and a higher rate of having atypical CALMs. Dermoscopy showed uniform and consistent tan-pigmented network patches with poorly defined margins with a lighter color around the hair follicles. Under RCM, the appearance of NF1 comprised the increased pigment granules in the basal layer and significantly increased refraction. Conclusion: A new heterozygous mutation and a new frameshift mutation of NF1 were reported. This article can assist in summarizing the properties of dermoscopy and RCM with CALMs.
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Affiliation(s)
- Zhenyu Zhong
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Tianhui Yang
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Siqi Liu
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Shan Wang
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Shan Zhou
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Shuli Du
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Liyun Zheng
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xiuli Wang
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Hui Wang
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Yifan Wang
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Min Gao
- Department of Dermatology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Dermatology, Anhui Medical University, Hefei, China
- Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
- Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
- *Correspondence: Min Gao,
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Lalor L, Davies OMT, Basel D, Siegel DH. Café au lait spots: When and how to pursue their genetic origins. Clin Dermatol 2020; 38:421-431. [PMID: 32972601 DOI: 10.1016/j.clindermatol.2020.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Café au lait spots are common birthmarks seen sporadically and in association with several genetic syndromes. Dermatologists are often asked to evaluate these birthmarks both by other physicians and by parents. In some cases, it is challenging to know when and how to pursue further evaluation. Diagnostic challenges may come in the form of the appearance of the individual lesions, areas and patterns of cutaneous involvement, and associated features (or lack thereof). In this review, we aim to clarify when and how to evaluate the child with multiple or patterned café au lait spots and to explain some emerging concepts in our understanding of the genetics of these lesions.
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Affiliation(s)
- Leah Lalor
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Olivia M T Davies
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Goudie C, Cullinan N, Villani A, Mathews N, van Engelen K, Malkin D, Irwin MS, Foulkes WD. Retrospective evaluation of a decision-support algorithm (MIPOGG) for genetic referrals for children with neuroblastic tumors. Pediatr Blood Cancer 2018; 65:e27390. [PMID: 30117275 DOI: 10.1002/pbc.27390] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neuroblastoma is the most common pediatric extracranial solid tumor. Germline pathogenic variants in ALK and PHOX2B, as well as other cancer predisposition genes, are increasingly implicated in the pathogenesis of neuroblastic tumors. A challenge for clinicians is the identification of children with neuroblastoma who require genetics evaluation for underlying cancer predisposition syndromes (CPS). PROCEDURE We developed a decisional algorithm (MIPOGG) to identify which patients with neuroblastic tumors have an increased likelihood of an underlying CPS. This algorithm, comprising 11 Yes/No questions, evaluates features in the tumor, personal and family history that are suggestive of an underlying CPS. We assessed the algorithm's performance in a retrospective cohort. RESULTS Two hundred and nine of 278 consecutive patients with neuroblastic tumors at The Hospital for Sick Children (2007-2016) had sufficient clinical data for retrospective application of the decisional algorithm. Fifty-one of 209 patients had been referred to genetics for CPS evaluation; 6/51 had a genetic or clinical confirmation of a CPS. The algorithm correctly identified all six children (Beckwith-Wiedemann (n = 2), Fanconi anemia, RB1, PHOX2B, chromosome duplication involving ALK) as requiring a genetic evaluation by using clinical features present at diagnosis. The level of agreement between the algorithm and physicians was 83.9%, with 15 more patients identified by the algorithm than by physicians as requiring a genetics referral. CONCLUSIONS This decisional algorithm appropriately detected all patients who, following genetic evaluation, were confirmed to have a CPS and may improve the detection of CPS in patients with neuroblastic tumors compared with current practice.
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Affiliation(s)
- Catherine Goudie
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Noelle Cullinan
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Anita Villani
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Natalie Mathews
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kalene van Engelen
- Department of Clinical and Metabolic Genetics, The Hospital for Sick Children, Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - David Malkin
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Meredith S Irwin
- Division of Haematology-Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - William D Foulkes
- Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
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5
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Picosecond 532-nm neodymium-doped yttrium aluminium garnet laser—a novel and promising modality for the treatment of café-au-lait macules. Lasers Med Sci 2017; 33:693-697. [DOI: 10.1007/s10103-017-2373-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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6
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St John J, Summe H, Csikesz C, Wiss K, Hay B, Belazarian L. Multiple Café au Lait Spots in a Group of Fair-Skinned Children without Signs or Symptoms of Neurofibromatosis Type 1. Pediatr Dermatol 2016; 33:526-9. [PMID: 27469520 DOI: 10.1111/pde.12936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of six or more café au lait (CAL) spots is a criterion for the diagnosis of neurofibromatosis type 1 (NF-1). Children with multiple CAL spots are often referred to dermatologists for NF-1 screening. The objective of this case series is to characterize a subset of fair-complected children with red or blond hair and multiple feathery CAL spots who did not meet the criteria for NF-1 at the time of their last evaluation. METHODS We conducted a chart review of eight patients seen in our pediatric dermatology clinic who were previously identified as having multiple CAL spots and no other signs or symptoms of NF-1. RESULTS We describe eight patients ages 2 to 9 years old with multiple, irregular CAL spots with feathery borders and no other signs or symptoms of NF-1. Most of these patients had red or blond hair and were fair complected. All patients were evaluated in our pediatric dermatology clinic, some with a geneticist. The number of CAL spots per patient ranged from 5 to 15 (mean 9.4, median 9). CONCLUSION A subset of children, many with fair complexions and red or blond hair, has an increased number of feathery CAL spots and appears unlikely to develop NF-1, although genetic testing was not conducted. It is important to recognize the benign nature of CAL spots in these patients so that appropriate screening and follow-up recommendations may be made.
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Affiliation(s)
- Jessica St John
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Heather Summe
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts
| | - Courtney Csikesz
- Dermatology Professionals, North Attleboro, Massachusetts.,Department of Dermatology, Roger Williams Medical Center, Providence, Rhode Island
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts.,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts
| | - Beverly Hay
- Division of Genetics, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts. .,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts.
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7
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Menon K, Dusza SW, Marghoob AA, Halpern AC, Nehal KS. Classification and Prevalence of Pigmented Lesions in Patients with Total-Body Photographs at High Risk of Developing Melanoma. J Cutan Med Surg 2016; 10:85-91. [PMID: 17241580 DOI: 10.2310/7750.2006.00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The classification of many pigmented lesions is not well defined, and an association with melanoma has not been established. Objective: To better define the spectrum of pigmented lesions (excluding common and dysplastic nevi) and explore links to melanoma. Methods: Retrospective review of patients with total-body digital photographs at high risk of developing melanoma from the Memorial Sloan-Kettering Cancer Center Dermatology Service. Results: Among 598 patients, 7.7% had café au lait spots, 2.8% had nevi spilus, 2.3% had congenital nevus–like nevi, 2% had “other” lesions, 1.2% had segmental speckled lentiginous nevi, and 1% had agminated nevi. There was no statistical difference in the prevalence rates of these pigmented lesions in patients with or without a history of melanoma or > 100 nevi. Conclusions: A wide range of pigmented lesions require further classification and study to explore possible links to melanoma.
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Affiliation(s)
- Kavita Menon
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA
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8
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Abstract
A new or changing melanocytic nevus in a child or adolescent often leads to concern in parents and physicians. To avoid undue alarm and unnecessary procedures, dermatologists should be aware of the natural history and clinical spectrum of nevi in pediatric patients, as well as findings that are potentially worrisome in this age group. This review provides an update on melanocytic nevi in children, focusing on their dynamic evolution over time, molecular insights into nevogenesis, and phenotypic markers for increased risk of melanoma in adolescence and adulthood. Special considerations for Spitz nevi and nevi located in particular sites (eg, scalp, acral, genital) are highlighted. Current understanding of the risks associated with congenital melanocytic nevi of different sizes and strategies for the management of children with numerous acquired nevi, Spitz nevi, and congenital nevi are also discussed.
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9
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Vourc'h-Jourdain M, Martin L, Barbarot S. Large congenital melanocytic nevi: Therapeutic management and melanoma risk. J Am Acad Dermatol 2013. [DOI: 10.1016/j.jaad.2012.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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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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Abstract
Café-au-lait, also referred to as café-au-lait spots or café-au-lait macules, present as well-circumscribed, evenly pigmented macules and patches that range in size from 1 to 2 mm to greater than 20 cm in greatest diameter. Café-au-lait are common in children. Although most café-au-lait present as 1 or 2 spots in an otherwise healthy child, the presence of multiple café-au-lait, large segmental café-au-lait, associated facial dysmorphism, other cutaneous anomalies, or unusual findings on physical examination should suggest the possibility of an associated syndrome. While neurofibromatosis type 1 is the most common syndrome seen in children with multiple café-au-lait, other syndromes associated with one or more café-au-lait include McCune-Albright syndrome, Legius syndrome, Noonan syndrome and other neuro-cardio-facialcutaneous syndromes, ring chromosome syndromes, and constitutional mismatch repair deficiency syndrome.
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Affiliation(s)
- Kara N Shah
- Department of Pediatrics and Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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12
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Price HN, Schaffer JV. Congenital melanocytic nevi-when to worry and how to treat: Facts and controversies. Clin Dermatol 2010; 28:293-302. [PMID: 20541682 DOI: 10.1016/j.clindermatol.2010.04.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital melanocytic nevi (CMN) are evident in 1% to 6% of neonates. In some studies, nevi with clinical, dermatoscopic, and histologic features identical to CMN have had a prevalence of more than 15% in older children and adults, possibly reflecting the "tardive" appearance of nevi programmed from birth. There is ongoing debate about the magnitude of the risk of melanoma and other complications associated with CMN of various sizes and the best approach to management of these lesions. We review the natural history of CMN, including proliferative nodules and erosions during infancy, neurotization, and spontaneous regression, and features of variants such as speckled lentiginous and congenital blue nevi. The risk of melanoma arising within small-sized (<1.5 cm) and medium-sized CMN is low (likely <1% over a lifetime) and virtually nonexistent before puberty. Recent data suggest that melanoma (cutaneous or extracutaneous) develops in approximately 5% of patients with a large (>20 cm) CMN, with about half of this risk in the first few years of life. Melanoma and neurocutaneous melanocytosis (NCM) are most likely in patients with CMN that have a final size of >40 cm in diameter, numerous satellite nevi, and a truncal location. One-third of individuals with NCM have multiple medium-sized (but no large) CMN. In patients at risk for NCM, a screening gadolinium-enhanced magnetic resonance imaging, preferably before age 6 months, and longitudinal neurologic assessment are recommended. Management of CMN depends on such factors as the ease of monitoring (more difficult for large, dark, thick nevi) and cosmetic and psychologic benefits of excision or other procedures. CMN require lifelong follow-up. Periodic total body skin examinations are necessary for all patients with large CMN, even when complete resection (often impossible) has been attempted.
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Affiliation(s)
- Harper N Price
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 560 1st Ave, New York, NY 10016, USA
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13
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Stratakis CA. Genetics of Carney Complex and Related Familial Lentiginoses, and other Multiple Tumor Syndromes. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513810009168808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Corradin MT, Zattra E, Fiorentino R, Alaibac M, Belloni-Fortina A. Nevus Spilus and Melanoma: Case Report and Review of the Literature. J Cutan Med Surg 2010; 14:85-9. [DOI: 10.2310/7750.2009.08090] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Nevus spilus is characterized by a pigmented patch with scattered flat or maculopapular speckles. Nevus spilus was first described by Burkley in 1842. Since then, this lesion has been widely debated in the literature, particularly for the possible occurrence of melanoma within the lesion. Objective: We describe the case of a 65-year-old female presenting with a nodular achromic melanoma that occurred within a nevus spilus on the left thigh. Conclusion: Our observation is consistent with the idea that this entity in some circumstances may have the ability to evolve into a malignant melanoma.
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Affiliation(s)
- Maria Teresa Corradin
- From the Units of Dermatology and Pathology, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, Padua, Italy, and Unit of Dermatology, University of Padua, Padua, Italy
| | - Edoardo Zattra
- From the Units of Dermatology and Pathology, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, Padua, Italy, and Unit of Dermatology, University of Padua, Padua, Italy
| | - Renzo Fiorentino
- From the Units of Dermatology and Pathology, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, Padua, Italy, and Unit of Dermatology, University of Padua, Padua, Italy
| | - Mauro Alaibac
- From the Units of Dermatology and Pathology, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, Padua, Italy, and Unit of Dermatology, University of Padua, Padua, Italy
| | - Anna Belloni-Fortina
- From the Units of Dermatology and Pathology, Azienda Ospedaliera Santa Maria degli Angeli di Pordenone, Padua, Italy, and Unit of Dermatology, University of Padua, Padua, Italy
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15
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Meguerditchian AN, Cheney RT, Kane JM. Nevus Spilus with Synchronous Melanomas: Case Report and Literature Review. J Cutan Med Surg 2009; 13:96-101. [DOI: 10.2310/7750.2008.07090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Nevus spilus is a rare, acquired, and often large cutaneous lesion consisting of a light brown background macule containing varying numbers of small darker macular or papular areas. Objective: Nevus spilus may contain dysplastic melanocytic elements, and there are also reports of melanoma arising from nevus spilus. However, the absolute risk for malignant transformation is not well defined. Conclusion: We discuss a case of synchronous melanomas arising from a nevus spilus and potential management recommendations based on a review of the pertinent literature.
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Affiliation(s)
- Ari-Nareg Meguerditchian
- From the Departments of Surgical Oncology and Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - Richard T. Cheney
- From the Departments of Surgical Oncology and Pathology, Roswell Park Cancer Institute, Buffalo, NY
| | - John M. Kane
- From the Departments of Surgical Oncology and Pathology, Roswell Park Cancer Institute, Buffalo, NY
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Gallus S, Naldi L. Distribution of congenital melanocytic naevi and congenital naevus-like naevi in a survey of 3406 Italian schoolchildren. Br J Dermatol 2008; 159:433-438. [DOI: 10.1111/j.1365-2133.2008.08656.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Csoma Z, Erdei Z, Bartusek D, Dosa-Racz E, Dobozy A, Kemeny L, Olah J. The prevalence of melanocytic naevi among schoolchildren in South Hungary. J Eur Acad Dermatol Venereol 2008; 22:1412-22. [PMID: 18637860 DOI: 10.1111/j.1468-3083.2008.02887.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Malignant melanoma is an increasing public health problem worldwide; accordingly, identification of the constitutional and environmental factors which contribute to the development of the disease, and hence identification of the individuals at high risk of melanoma, is an indispensable step in all primary prevention efforts. OBJECTIVES This paper aims to assess the prevalence of different pigmented lesions among schoolchildren and to investigate their relationship with phenotypic pigmentary characteristics, sun exposure and other factors. PATIENTS/METHODS A cross-sectional study was performed in two secondary schools in Szeged, Hungary. A total of 1320 schoolchildren, aged 14 to 18 years, underwent a whole-body skin examination. A standardized questionnaire was used to collect data on phenotypic, sun exposure and other variables. RESULTS One to 10 common melanocytic naevi were found in 27% of the participants, and the naevus numbers were in the range of 10-100 in 67%; 5.4% of them had more than 100 common melanocytic naevi. The prevalence of clinically atypical naevi was 24.3%. Statistically significant associations were found between the number of pigmented lesions and gender, hair colour, eye colour, skin phototype, a history of severe painful sunburns and a family history of a large number of melanocytic naevi. CONCLUSION Our study population displayed a markedly high prevalence of clinically atypical melanocytic naevi. Moreover, a considerable proportion of the investigated individuals had multiple common melanocytic naevi. Since the presence of a large number of melanocytic naevi is a strong predictor for future melanoma development, health educational programmes on melanoma prevention should be aimed at young age groups.
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Affiliation(s)
- Z Csoma
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
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Kakkar S, Mendiratta V, Sharma N, Aneja S, Harjai B. Cutaneous manifestations of seizure disorder in children--a study of 100 seizure patients. Pediatr Dermatol 2007; 24:579-81. [PMID: 17958825 DOI: 10.1111/j.1525-1470.2007.00534.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hanayama H, Terashi H, Hashikawa K, Tahara S. Congenital melanocytic nevi and nevus spilus have a tendency to follow the lines of Blaschko: an examination of 200 cases. J Dermatol 2007; 34:159-63. [PMID: 17291295 DOI: 10.1111/j.1346-8138.2007.00242.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There have been few reports about the characteristics of the pigmentary arrangement of congenital melanocytic nevi (CMN) and nevus spilus (NS). Though the lines of Blaschko, which don't correspond to other lines such as Langer's lines and skin dermatomes, are well known to be followed by some rare pigmentary disorders, the relationship between these two disorders and the lines of Blaschko has not been discussed. Therefore, through an examination of 200 cases, we investigated whether or not the arrangement of CMN and NS follow the lines of Blaschko. Thirty-nine out of 92 cases (42.4%) of CMN and 67 out of 108 cases (62.0%) of NS were considered to follow the lines of Blaschko. Today, the idea is widely accepted that two functionally different cells proliferate during early embryogenesis of the skin which is caused from mosaicism and, as a result, the lines of Blaschko appear visually. In our results, we found that there were some cases of CMN and NS which showed a relationship with the lines of Blaschko, which is meaningful considering that the lesions and the lines are both related to pigmentary gene anomalies. The result was compared with CMN and NS by the chi(2) test. NS showed a predominant tendency to follow the lines with a significant difference (P = 0.0055). This may indicate that the lines of Blaschko reflect more clearly the proliferation of the epidermal cells than other cells in growth of the skin of the embryo. Further studies are required to elucidate the reason why some cases follow these lines and others do not.
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Affiliation(s)
- Hiromi Hanayama
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan.
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Vidaurri-de la Cruz H, Happle R. Two Distinct Types of Speckled Lentiginous Nevi Characterized by Macular versus Papular Speckles. Dermatology 2006; 212:53-8. [PMID: 16319475 DOI: 10.1159/000089023] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 05/27/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Speckled lentiginous nevus (SLN; synonym: nevus spilus) is a darkly spotted light-brown macule that mostly occurs as an isolated lesion of rather limited dimensions but sometimes may involve large areas of the body. So far, this skin disorder has been considered to represent one clinical entity. OBJECTIVE Because SLN is occasionally associated with complex birth defects such as phacomatosis pigmentovascularis, phacomatosis pigmentokeratotica, or SLN syndrome, we tested our idea that two different types of SLN may exist, each one associated with a particular syndrome. METHODS A review of case reports on SLN published during the years 1970-2004 was performed. RESULTS This evaluation of cases provided evidence that two different types of SLN exist, in the form of macular versus papular SLN, each one being related to a specific syndrome. Macular SLN is characterized by a tannish-brown background with darker flat speckles. The distribution of speckles is rather even and resembles a polka-dot pattern. Histopathologically, this type of SLN is characterized by what has been called a 'jentigo' pattern in the darker speckles and by some nests of melanocytes at the dermoepidermal junction at the tips of the papillae, whereas the background pigmentation shows the microscopical features of a lentigo. Papular SLN is characterized by a light-brown macule superimposed by multiple melanocytic nevi in the form of papules or nodules that show a more uneven distribution reminiscent of a star map. Small dark macules may likewise be present. Histopathologically, the papular component consists of dermal or compound melanocytic nevi. A separation of the two types of SLN is important because our analysis showed that macular SLN is a hallmark of a particular type of phacomatosis pigmentovascularis, whereas papular SLN is typically present in phacomatosis pigmentokeratotica as well as in SLN syndrome. CONCLUSIONS Macular SLN and papular SLN appear to be two distinct cutaneous entities. This dichotomy may turn out to be important when such nevi will be analyzed at the molecular level.
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Abstract
Small and medium congenital melanocytic nevi are relatively common but present a small but significant risk of malignant transformation. Because prophylactic excision of all nevi is impractical, dermoscopic evaluation has a role in the clinical decision-making process. Dermoscopy of benign congenital nevi reveals a globular or homogenous pattern, black or brown dots and globules, small milia-like cysts within the globules, and terminal hairs. Dermoscopic criteria of melanoma are outlined here, with discussion of common scoring methods, the seven-point checklist, the ABCD rule, pattern analysis, and the Menzies criteria. Serial examination of congenital nevi with dermoscopy and excision of those lesions with malignant criteria are useful in the management of congenital melanocytic nevi.
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Affiliation(s)
- Rashmi Lodha
- Family Department of Plastic and Reconstructive Surgery, University of Miami School of Medicine, Miami, FL 33136, USA
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Abstract
This article discusses the care of patients with CMN, who often require a multidisciplinary approach involving pediatricians, family physicians, internists, dermatologists, psychologists, plastic surgeons, neurologists, and radiologists. The cosmetic and psychosocial issues, combined with the knowledge of the increased risk of developing melanoma or NCM, is a huge burden that many of these patients and their families have to carry. This article describes the importance for physicians to help these patients and families come to terms with these issues, as well as remind their patients and their family members that although melanoma, NCM, or other complications can develop, most affected individuals do not develop any complications. The article mentions that there are many healthy, happy, functional adults with large, small, and multiple CMN alive today.
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Affiliation(s)
- Ashfaq A Marghoob
- Department of Medicine, Dermatology Division, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Moehrle M, Lischner S, Dunsche A, Breuninger H, Hauschild A. Cerebriform giant melanocytic nevus of the scalp: report of two cases with different surgical approaches. Dermatol Surg 2002; 28:75-9. [PMID: 11991276 DOI: 10.1046/j.1524-4725.2002.01105.x] [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: 11/20/2022]
Abstract
Cerebriform giant melanocytic nevus of the scalp is an extremely rare malformation. Clinical appearance with maceration and fetor within the crypts and the risk of malignant transformation may require surgical therapy. We report two cases with different methods of surgical management. A 27-year-old woman noticed a swelling of the parietal scalp that developed over a period of 4 years into a gyrus-like tumor measuring 12 cm x 18 cm. The crypts between the gyri could not be inspected. Serial excisions under subcutaneous infusion anesthesia were performed to reduce the size of the nevus and to flatten the surface of the scalp. The second patient, a 26-year-old man, demonstrated a giant 10 cm x 10 cm cerebriform nevus on the occiput. The nevus also contained areas of fetid maceration. After implanting a tissue expander under general anesthesia the nevus was excised. The defect was closed using a rotation flap.
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Affiliation(s)
- Matthias Moehrle
- Department of Dermatology, Eberhard-Karls-University, Tuebingen, Germany.
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Cerebriform Giant Melanocytic Nevus of the Scalp. Dermatol Surg 2002. [DOI: 10.1097/00042728-200201000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Braun RP, Calza AM, Krischer J, Saurat JH. The use of digital dermoscopy for the follow-up of congenital nevi: a pilot study. Pediatr Dermatol 2001; 18:277-81. [PMID: 11576398 DOI: 10.1046/j.1525-1470.2001.01940.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One of the main problems in the management of congenital nevi is the potential risk for malignant transformation and the resulting need for follow-up examination. Dermoscopy is a noninvasive technique that has been shown to be useful for the follow-up of benign melanocytic skin lesions as well as the early diagnosis of malignant melanoma. Therefore we thought to use the digital dermoscopy (DD) technique for the follow-up of congenital nevi. For documentation purposes we registered an overview, and the following standardized dermoscopic images of every lesion: representative architectural pattern, border of the lesion, and regions of "special interest." In all instances the examination with digital dermoscopy was well tolerated by the patients and the integration of the parents to the "live" examination on the computer screen was appreciated. The follow-up was easy to perform with these standardized documents. We showed the feasibility of follow-up of congenital nevi using digital dermoscopy. Furthermore, we identified three different patterns as well as some typical structures seen in congenital nevi by DD.
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Affiliation(s)
- R P Braun
- Pigmented Skin Lesion Unit, Department of Dermatology, University Hospital Geneva, Geneva, Switzerland.
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Abstract
Single café-au-lait macules (CALMs) are common in the pediatric population and in most children represent a normal finding. It is important to recognize whether the presence of multiple CALMs in a particular patient is normal or indicates an association with a multisystem disorder. This article addresses issues concerning the prevalence, genetics, and natural history of CALMs in the general population and reviews disorders in which CALMs are present as a characteristic trait.
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Affiliation(s)
- M Landau
- Division of Dermatology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Affiliation(s)
- A R Rhodes
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania, 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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Rivers JK, MacLennan R, Kelly JW, Lewis AE, Tate BJ, Harrison S, McCarthy WH. The eastern Australian childhood nevus study: prevalence of atypical nevi, congenital nevus-like nevi, and other pigmented lesions. J Am Acad Dermatol 1995; 32:957-63. [PMID: 7751465 DOI: 10.1016/0190-9622(95)91331-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Various melanocytic lesions are frequently observed. An understanding of phenotypic factors and environmental stimuli that are associated with these lesions may help explain their pathogenesis. OBJECTIVE This study was undertaken to determine the prevalence of atypical nevi, blue nevi, cafe-au-lait macules, congenital nevus-like nevi, halo nevi, nevi spili, nevi 5 mm or more in diameter, and skin-colored melanocytic nevi in a population of schoolchildren and to explore risk factors including solar radiation in the development of these melanocytic lesions. METHODS A cross-sectional study was performed by the same medical investigators to examine schoolchildren in three Australian cities that span a wide range of latitudes. RESULTS Data from 1123 white Australian schoolchildren, 6 to 15 years of age, were analyzed. Acquired melanocytic nevi (atypical nevi, nevi > or = 5 mm in diameter, and skin-colored nevi) were more likely to develop in older fair-skinned subjects who had freckles and lived closest to the equator. Café-au-lait macules and congenital nevus-like nevi were observed in 36.3% and 4.4% of the total population, respectively. Prevalence for both these types of melanocytic lesions increased significantly with decreasing latitude. Halo nevi were present in 5.3% of the subjects and were usually solitary. These lesions were related to the presence of atypical nevi primarily by virtue of their size rather than of other features of clinical atypia. CONCLUSION Like melanocytic nevi in general, large and atypical nevi are strongly influenced by geographic location and, by implication, degree of solar radiation. The same can be said for congenital nevus-like nevi, which suggests that many so-called congenital nevi are in fact acquired early in life.
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Affiliation(s)
- J K Rivers
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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McLean DI, Gallagher RP. "Sunburn" freckles, café-au-lait macules, and other pigmented lesions of schoolchildren: the Vancouver Mole Study. J Am Acad Dermatol 1995; 32:565-70. [PMID: 7896944 DOI: 10.1016/0190-9622(95)90338-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Relatively few studies have evaluated the prevalence of pigmented lesions in children. OBJECTIVE We assessed the prevalence and constitutional correlates of "sunburn" freckles, café-au-lait macules, congenital nevi, and several other pigmented lesions. METHODS Six specially trained nurses examined 1592 Vancouver schoolchildren, 6 to 18 years old, under uniform lighting conditions and counted all pigmented lesions except those on the genitals, buttocks, and breasts in girls. RESULTS In the 1146 white children of European origin, 378 Asian children, and 68 Indo-Pakistani children, the prevalence of one or more café-au-lait macules was essentially equivalent (28%). The prevalence of Becker's nevus, nevus spilus, and congenital nevi were also similar among white and Asian children. White children of European origin had a higher prevalence of sunburn freckles than the other ethnic groups. The prevalence among children of European descent was higher in subjects with light skin color, a propensity to burn rather than tan in the sun, a history of severe or frequent sunburn, freckling, and a high count of acquired melanocytic nevi. CONCLUSIONS For most pigmented lesions prevalence rates were similar in the three ethnic groups examined. The results also suggest that the presence of large sunburn freckles in children of European descent correlates strongly with phenotypic risk factors that have been shown to be predictive of increased melanoma risk in adulthood. Parents should be counseled to take precautions with these children early in life in regard to overexposure to sunlight.
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Affiliation(s)
- D I McLean
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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Borroni G, Larizza D, Vignati G, Zaccone C, Zanetta R, Vignoli G, Brazzelli V, Bobba C, Rabbiosi G. The dermatological spectrum of Turner syndrome. J Eur Acad Dermatol Venereol 1994. [DOI: 10.1111/j.1468-3083.1994.tb00372.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Affiliation(s)
- M L Williams
- Department of Dermatology, University of California San Francisco 94143-0316
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