Synchronous melanomas arising within nevus spilus

Nevus Spilus With Dermatoheliosis: A Histologic Mimicker of Melanoma in Situ at Melanoma Excision Margins

ABSTRACT

Nevus spilus, or speckled lentiginous nevus, is a relatively common lesion that presents at birth or in early childhood. It consists of a background tan patch, which appears similar to a café au lait macule or lentigo simplex on histology, studded with various types of nevi. Rarely, these nevi can undergo malignant transformation to melanoma. When melanoma develops within a heavily photodamaged nevus spilus, evaluating excision margins may be challenging because the combined histologic features of nevus spilus and severe dermatoheliosis can mimic melanoma in situ. We report a case of an elderly man with extensive sun damage who developed malignant melanoma within an occult nevus spilus, resulting in multiple excisions with false-positive margins.

Synchronous Melanoma: Definition, Prognosis, and Implications. A Comprehensive Review of Literature

Background

Although multiple primary melanomas (MPMs) have been reported in the literature, the subgroup of synchronous melanomas (SMs) remains understudied.

Methods

We conducted a comprehensive systematic review of the English literature from 1972 to 2023 to characterize SM. Our objective was to clarify the definition, determine incidence and prognosis, and present recommendations.

Results

We found 18 case series articles and six case reports that met our criteria. Twelve of eighteen studies defined SM as a second primary melanoma identified within 1 month. The total number of SM patients reported was 1083. The cumulative percentage of MPM in total melanoma patients was 2.9 %, and the cumulative percentage of SM patients in MPM patients was 31.3%. SM patients trended toward higher body anatomical concordance, older age, and male sex. Despite limited data, SMs do not show a worse prognosis for patients compared with single melanomas.

Conclusions

Despite a lack of consensus in the past, we recommend that SM be defined as a second primary melanoma detected within 1 month of the initial diagnosis. SMs comprise almost one-third of MPM cases and do not seem to carry any worse prognosis than the patients presenting with single melanoma. We believe older age and male sex may be more prone to SM. We recommend patient education, self-skin evaluations and TSE at initial and follow-up visits. Neither randomized controlled trials nor meta-analyses on SM exist. Ideally, further studies with a large cohort of patients are needed to accurately define SM.

Phakomatosis pigmentovascularis type Ⅲa mainly manifested by zosteriform nevus spilus: a case report with dermoscopic features

A case of phakomatosis pigmentovascularis (PPV) type III a with a zosteriform distribution of nevus spilus as the main manifestation was reported. A 41-year-old man was born with a zosteriform distribution of pigmented rash on the left half-body, namely upper limb, shoulder and back. Physical examination revealed light brown pigments in a giant zosteriform distribution on the extensor side of the left upper limb and the left shoulder and back, with scattered brown spots and patches of variant sizes on the surface, which are consistent with the appearance of nevus spilus (NS). A relatively small area of dark red patch occurred on the left anterior shoulder, which showed telangiectasia and fading after pressing. It was consistent with the performance of a port-wine stain (PWS). Dermoscopy showed a clearer appearance and localized fusion of blood vessels and pigmented patch. He has no systemic involvement. The patient was diagnosed with phakomatosis pigmentovascularis type Ⅲa. NS and PWS can be treated with lasers if required.

The spectrum of melanocytic nevi and their clinical implications

The magnitude of the topic of melanocytic nevi (MN) is directly related to its relevance in everyday clinical work. The different MN have different prognostic significance in regard to comorbidity and possible risk of transformation. In addition to the criteria of the ABCDE rule, relevant criteria in the assessment of an MN are the time of occurrence, the growth tendency, the distribution and the comparison with other MN of the respective individual.

The present CME article provides an overview of the knowledge that has been gained with regard to the development and genetic background of MN and any risk of degeneration that may exist. In addition, certain clinical and/or dermatoscopic features may provide the clinician with a decision‐making aid in the management of different MNs.

Treatment of Nevus Spilus with dual-wavelength copper vapor laser

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

Congenital Pigmentary Anomalies in the Newborn

Congenital pigmentary anomalies may be evident at birth or soon after, with some birthmarks becoming apparent later in infancy or early childhood. It is important to recognize various pigmentary anomalies in the neonate, most of which are benign but a subset of which are associated with cutaneous morbidity or systemic ramifications and require further evaluation. This review will focus on pigmentary mosaicism, congenital melanocytic nevi, nevus spilus, dermal melanocytosis, and pigmentary anomalies associated with neurofibromatosis type 1 (café au lait spots, freckling, plexiform neurofibromas, nevus anemicus), tuberous sclerosis (hypomelanotic macules), and incontinentia pigmenti.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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