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Nagshabandi KN, Shadid A, AlHargan AH. Blue nevus on the scalp: Clinical and dermoscopic features. J Family Med Prim Care 2024; 13:1586-1587. [PMID: 38827723 PMCID: PMC11141961 DOI: 10.4103/jfmpc.jfmpc_1665_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Khalid Nabil Nagshabandi
- Department of Dermatology, College of Medicine, King Saud University and King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia
| | - Asem Shadid
- Department of Dermatology, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia
| | - Abdullah H. AlHargan
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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2
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Rao X, Kang Z, Chen J, Wang T, Ma M, Yang S, Wu Z, Wang B, Zhang Q. Invasive cellular blue nevus in the cervical spine: A case report. Medicine (Baltimore) 2024; 103:e37097. [PMID: 38335405 PMCID: PMC10860939 DOI: 10.1097/md.0000000000037097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Cellular blue nevus is an uncommon neoplasm in the spine. PATIENT CONCERNS Here, we present a case of a 24 years old male with a 2 months history of numbness in the right upper limb and shoulder. DIAGNOSIS Cervical spine and subcutaneous tissue invasive cellular blue nevus. INTERVENTIONS The patient underwent C4 laminectomy and partial C3 and C5 laminectomy for total resection of the lesion. Histopathology revealed a nodular tumor with unclear boundaries, which was composed of heavily pigmented dendritic cells and more pigmented spindle cells. OUTCOMES There was no recurrence during 3 years follow-up. CONCLUSION Invasive cellular blue nevus of the spine can be wrongly diagnosed as spinal meningeal melanocytoma and meningeal melanoma due to its special cell behavior and rarity. Therefore, it is important to understand its pathological and clinical characteristics to avoid over-treatment.
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Affiliation(s)
- Xianfeng Rao
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Zhengwen Kang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Jianwei Chen
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Tong Wang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Mengyao Ma
- Department of Pathology, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Shenzhen, China
| | - Shuwen Yang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Zetao Wu
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Bo Wang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
| | - Qiusheng Zhang
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen University First Affiliated Hospital, Clinical College of Shantou University Medical College, Shenzhen, China
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3
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Yumeen S, Mirza FN, Mirza HN, Zogg CK, Leventhal JS, Cohen JM. Malignant blue nevus: Characterization of US epidemiology and prognostic factors of a rare neoplasm with aggressive clinical course using the Surveillance, Epidemiology, and End Results Program database. J Am Acad Dermatol 2023; 89:843-846. [PMID: 37343827 DOI: 10.1016/j.jaad.2023.05.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Sara Yumeen
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fatima N Mirza
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Humza N Mirza
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Cheryl K Zogg
- Yale School of Medicine, New Haven, Connecticut; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Division of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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4
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Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Inyang B, Koshy FS, George K, Poudel P, Chalasani R, Goonathilake MR, Mohammed L. Recognizing Histopathological Simulators of Melanoma to Avoid Misdiagnosis. Cureus 2022; 14:e26127. [PMID: 35875272 PMCID: PMC9299949 DOI: 10.7759/cureus.26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigation in surgical pathology. After describing the basic features of nevi and melanoma, this article describes the detailed clinical and histological features of those lesions that share many similar features with melanoma. The entities included are Spitz nevi and atypical Spitz tumors (AST), Reed nevus, dysplastic nevus, cellular blue nevus (CBN), deep penetrating nevus, combined nevus, recurrent nevus, irritated nevus, congenital pattern nevus, acral nevus, and nevi of special sites. Knowledge of these imitators can help pathologists distinguish between benign and malignant cases and avoid misdiagnosis.
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5
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Martin B, de la Fouchardiere A, Markiewicz D, Bartolo E, Bhargava K, Lewis F, Calonje E. Subungual melanoma with blue naevus-like morphological features: a clinicopathological retrospective analysis of nine cases. Pathology 2022; 54:541-547. [PMID: 35346503 DOI: 10.1016/j.pathol.2021.12.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Melanocytic lesions in the nail apparatus are often challenging. Both subungual melanomas (SUM) and blue naevus of the nail are very rare. Occasionally, melanomas may mimic blue naevus histologically. Benign and malignant blue melanocytic lesions are commonly associated with G protein mutations, a distinct abnormality not associated with conventional subungual melanomas. We describe the clinical, histological and immunohistochemical features of nine cases of SUM with blue naevus-like morphological features. Mutations in exon 4 and 5 of GNAQ and GNA11 were investigated in two cases, which showed no mutations. RNA-seq of one case revealed unknown mutations along with mutations in ATM, METK and ARID1A. Our study delineates a variant of SUM that mimics blue naevus. Awareness of this pitfall is important when evaluating heavily pigmented lesions around the nail in order to avoid misdiagnosis. Appropriate sampling of subungual lesions and clinicopathological correlation are paramount to reach the correct diagnosis.
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Affiliation(s)
- Blanca Martin
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK.
| | | | | | | | - Kapil Bhargava
- The Royal London Hospital - Barts Health NHS Trust, London, UK
| | - Fiona Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
| | - Eduardo Calonje
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Trust, London, UK
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6
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HMB45 protein expression and the immunohistochemical maturation in common blue nevi: a reappraisal. An Bras Dermatol 2022; 97:387-390. [PMID: 35272922 PMCID: PMC9133253 DOI: 10.1016/j.abd.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
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7
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Blue Nevus of the Hard Palate: The Importance of a Careful Examination in an Emergency Setting. Case Rep Dermatol Med 2022; 2022:6329334. [PMID: 35211347 PMCID: PMC8863491 DOI: 10.1155/2022/6329334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
Oral common blue nevus is an asymptomatic, benign, rare, pigmented lesion and sometimes clinically indistinguishable from other pigmented lesions such as the cellular blue nevus or early-stage malignant melanoma. Since it shows clinical similarities with a malignant lesion and with cellular blue nevus that can itself suffer malignant transformation, the decisive diagnosis is crucial for adequate treatment, follow-up, and prognosis. Diagnosis confirmation is given by histological analysis, the reason why most oral pigmented lesions are excised. The following case presents an asymptomatic oral pigmented lesion of the hard palate discovered during observation in an emergency setting due to an abscess of dental origin. The lesion was fully excised, and histological examination reported a “common blue nevus.” In this case, we intend to present a rare lesion of the oral cavity and the importance of performing a routine oral examination when given a chance as a preventive approach.
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8
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Cunha JLS, Tomo S, Marinho Neto E, Silva JVR, Sá MC, de Carvalho Melo AU, de Albuquerque-Júnior RLC. An extensive intraoral blue nevus in an elder patient. Gerodontology 2021; 38:445-448. [PMID: 34786758 DOI: 10.1111/ger.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a rare case of intraoral extensive blue nevus in an elder patient. BACKGROUND Oral blue nevi is a well-recognised skin melanocytic neoplasm that rarely occurs in the oral cavity and may mimic melanoma in the early stages. METHODS An incisional biopsy was performed, and the diagnosis was blue nevus. CONCLUSION Both the clinician and pathologist must be aware of such a presentation to diagnose and treat appropriately.
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Affiliation(s)
- John Lennon Silva Cunha
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Saygo Tomo
- Oral Oncology Center, School of Dentistry, São Paulo State University (UNESP), Araçatuba, Brazil
| | | | - João Vitor Rocha Silva
- Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University (UNIT), Aracaju, Brazil
| | - Melka Coelho Sá
- Department of Dentistry, Federal University of Sergipe (UFS), Aracaju, Brazil
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9
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Boven L, Noonan M, Sans-Cuellar H, Dela-Cruz N, Nathan C, Gungor A. Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old. Am J Otolaryngol 2021; 42:103139. [PMID: 34174671 DOI: 10.1016/j.amjoto.2021.103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022]
Abstract
The cellular blue nevus tumor is a type of dendritic melanocytic nevus that is typically benign and exceedingly rare. The incidence of all blue nevi is about 1%, usually affecting the adult population and appearing on the extremities, sacrococcygeal or gluteal regions. There have only been a handful of case reports cited in the literature where cellular blue nevi present in the head and neck region, usually affecting the scalp and young adult population (7, 8). As such, it is exceedingly rare to encounter a cellular blue nevus tumor in the neck or infiltrating into neck lymph nodes. Here we report a rare case of a cellular blue nevus tumor presenting as a right neck mass in a pediatric 16-year-old patient, shown to invade into the submandibular lymph node and surrounding soft tissue. It is important to be aware of the cellular blue nevus tumor as a differential diagnosis in pediatric neck masses. Histological evaluation is necessary to determine tumor aggression and malignant potential which can guide further treatment in pediatric patients.
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Affiliation(s)
- L Boven
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA.
| | - M Noonan
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - H Sans-Cuellar
- Department of Radiology, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - N Dela-Cruz
- Department of Pathology, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - C Nathan
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
| | - A Gungor
- Department of Otolaryngology-H&N Surgery, Louisiana State University Health-Shreveport, 1501 King's Highway, Shreveport, LA 71130, USA
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10
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Higgins AD, Shalin SC. Blue nevus with smooth muscle hyperplasia: A rare hamartoma. J Cutan Pathol 2021; 49:310-313. [PMID: 34716951 DOI: 10.1111/cup.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
A limited number of distinct histopathological variants of blue nevus exist, and hamartomatous proliferations involving melanocytic components, dendritic, or otherwise, have also been described. Blue nevus/smooth muscle hamartomas represent a rarely described entity. In this paper, we add two examples of this unusual hamartoma to the existing literature. These additional blue nevus/smooth muscle hamartomas occurred on the left mid-upper back of a 50-year-old woman and the central upper back of a 54-year-old man. Both lesions were clinically atypical pigmented lesions. Histopathologic review of both specimens revealed proliferations of predominantly spindled and pigmented dermal melanocytes with associated smooth muscle hyperplasia, compatible with blue nevus/smooth muscle hamartoma. Both specimens were accompanied by subtle changes suggesting follicular induction, a phenomenon previously described as occurring in a minority of specimens. A brief re-examination of recently diagnosed blue nevus at our institution did not reveal any additional cases in which a subtle smooth muscle component had been missed, suggesting this type of hamartoma is, indeed, exceedingly rare.
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Affiliation(s)
- Alyssa D Higgins
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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11
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Ng A, Wanat KA, Chiu YE. A skin-colored sacral papule. Pediatr Dermatol 2021; 38:1312-1314. [PMID: 34750879 DOI: 10.1111/pde.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ashley Ng
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Karolyn A Wanat
- Departments of Dermatology and Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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12
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Cho WC, Prieto VG, Aung PP. Melanocytic lesions with blue naevus-like (dendritic) morphology: an update with an emphasis on histopathological, immunophenotypic, and molecular features. Histopathology 2021; 79:291-305. [PMID: 33772838 DOI: 10.1111/his.14371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
An accurate diagnosis of melanocytic lesions requires a thorough histopathological evaluation accompanied by appropriate correlation with clinical examination findings. Although most melanocytic lesions can readily be classified as one of the defined diagnostic entities according to well-established diagnostic criteria, a subset of melanocytic lesions, particularly those with blue naevus-like (pigmented dendritic) morphology, have notoriously constituted an enduring challenge for pathologists. These lesions are rare and often show histological ambiguities, with features of both benignity and malignancy, thereby making accurate risk assessment and prediction of their biological behaviours difficult on histological grounds alone. Herein, we outline a practical and systematic approach for the diagnosis of melanocytic lesions with dendritic morphology, with a particular focus on histological and immunophenotypic features that help to distinguish one entity from another. In this review, we provide the most current knowledge on these melanocytic lesions in the literature and our experience with these rare entities, and we discuss the utility of molecular techniques as an ancillary tool, especially in histologically ambiguous and/or borderline lesions.
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Affiliation(s)
- Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Benton S, Zhao J, Asadbeigi S, Kim D, Zhang B, Gerami P. Pigmented Epithelioid Melanocytoma: Morphology and Molecular Drivers. Surg Pathol Clin 2021; 14:285-292. [PMID: 34023106 DOI: 10.1016/j.path.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pigmented epithelioid melanocytoma (PEM) was originally described based on keen morphologic analysis identifying a group of melanocytic tumors sharing heavily pigmented epithelioid melanocytes. It is defined as heavily pigmented epithelioid, spindled, and dendritic melanocytes with characteristic vesicular nuclei, prominent nucleoli, and melanophages. PEM often involves regional lymph nodes. Recent advances in molecular analysis have allowed for subclassification of PEM into more specific subsets of melanocytic tumors. The most common subsets include PRKCA fusions, which result in pure PEMs with sheets of monomorphic epithelioid melanocytes, and PEMs with combined pattern and mutations in both PRKAR1A and BRAF.
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Affiliation(s)
- Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Sepideh Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA.
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14
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BAP-1 Expression Status by Immunohistochemistry in Cellular Blue Nevus and Blue Nevus-like Melanoma. Am J Dermatopathol 2021; 42:313-321. [PMID: 32310893 DOI: 10.1097/dad.0000000000001551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The family of blue nevi includes the common blue nevus (BN), cellular blue nevus (CBN), and atypical BN, while melanomas with BN-like morphology can either arise in association with a blue nevus (MABN) or in the de novo setting mimicking cellular blue nevus (MMCBN). Recent molecular and immunohistochemical studies have demonstrated loss of BAP-1 in MABN/MMCBN but not in BN/CBN, suggesting that loss of BAP-1 correlates with a malignant phenotype in these lesions. In this study, we applied anti-BAP-1 antibodies to a series of CBN/BN (n = 11) and MABN/MMCBN (n = 4). Nuclear BAP-1 expression was detected in the majority of CBN/BN (n = 10/11) but was lost in 1 case. Most cases of MABN/MMCBN showed loss of nuclear BAP-1 expression (n = 3/4), with one case of MMCBN showing preserved BAP-1 expression. Demonstration of BAP-1 loss in a single case of CBN and preservation of BAP-1 expression in 1 case of MMCBN may indicate that detection of alterations in BAP-1 protein expression by immunohistochemistry may not be a completely reliable biomarker for the distinction of BN/CBN from MABN/MMCBN. Further investigation of the significance of BAP-1 loss/preservation in BN-like tumors is warranted.
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15
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Takashima A, Wada M, Asai J, Takenka H, Katoh N. Subcutaneous nodule showing loss of BAP1 in large plaque‐type blue nevus: Melanoma or not? J Dermatol 2020; 47:e437-e438. [DOI: 10.1111/1346-8138.15591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ayaka Takashima
- Department of Dermatology Graduate School of Medical Science Kyoto Prefectural University of Medicine KyotoJapan
| | - Makoto Wada
- Department of Dermatology Graduate School of Medical Science Kyoto Prefectural University of Medicine KyotoJapan
| | - Jun Asai
- Department of Dermatology Graduate School of Medical Science Kyoto Prefectural University of Medicine KyotoJapan
| | - Hideya Takenka
- Department of Dermatology Kyoto City Hospital Kyoto Japan
| | - Norito Katoh
- Department of Dermatology Graduate School of Medical Science Kyoto Prefectural University of Medicine KyotoJapan
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16
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Maredia H, Eseonu A, Rozati S. Disseminated Eruptive Blue Nevi in a Young Adult Patient. Cureus 2020; 12:e11298. [PMID: 33282575 PMCID: PMC7710343 DOI: 10.7759/cureus.11298] [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] [Indexed: 11/16/2022] Open
Abstract
Common blue nevi tend to be singular or localized, with multiple eruptive blue nevi being a rare occurrence. We report the case of a young adult who presented with multiple asymptomatic lesions that had appeared gradually over a few years. Physical examination revealed 30 distinct, blue-gray macules diffusely over the medial buttocks, lower back, and dorsal arms. Histopathology showed pigmented dendritic melanocytes with associated melanophages, features characteristic of blue nevus. This case demonstrates that eruptive blue nevi can present as numerous, disseminated lesions over multiple anatomic sites. Recognition of the various patterns of eruptive blue nevi and their benign nature can reduce unnecessary biopsies and work-up.
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Affiliation(s)
- Hasina Maredia
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Amarachi Eseonu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sima Rozati
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA
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17
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Dehavay F, Goettmann S, Zaraa I, Moulonguet I, André J, Caucanas M, Baran R, Richert B. Nail Unit Blue Nevi: A 11-Case Series and Review of the Literature. Skin Appendage Disord 2020; 6:287-295. [PMID: 33088814 DOI: 10.1159/000509204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background Blue nevus of the nail apparatus is a rare entity and only isolated cases are reported in the literature. Objective The aim of this study was to better characterize blue nevus at the nail unit. Methods Retrospective analysis of all nail unit blue nevi from the Nail Group of the French Society of Dermatology was compared to the literature. Results Eleven cases were retrieved from 2002 to 2019 with an average age of 45 years. The majority were women (9/11) and acquired (10/11). Hands were more frequently involved (9/11) with a predilection for the thumb and 2 cases were located on the hallux. Nail unit blue nevus mostly presented as a well-delimited blue spot of the lunula (9/11) and histologically was of the common type (10/11). There was no malignancy. Conclusion Nail unit blue nevus is a rare asymptomatic benign entity, mostly acquired on the thumb or the hallux of women. The most frequent presentation is a painless blue spot on the lunula. Congenital blue nevi seem to only affect the paronychium. Main differential diagnosis is melanoma and histopathological examination is mandatory.
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Affiliation(s)
- Florence Dehavay
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sophie Goettmann
- Department of Dermatology, Hôpital Bichat - Claude Bernard, Paris, France
| | - Ines Zaraa
- Dermatology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Josette André
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Bertrand Richert
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
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18
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Assarzadegan N, Salimian K, Hutchings D, Windon AL, Voltaggio L, Montgomery EA. Clinicopathological study of blue nevi of the gastrointestinal (GI) tract: first case series. J Clin Pathol 2020; 74:167-170. [PMID: 32631943 DOI: 10.1136/jclinpath-2020-206757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 01/18/2023]
Abstract
AIM Blue nevus (BN) is a benign melanocytic proliferation that is typically cutaneous. Extracutaneous BN is infrequent and is reported in the mucosa of various organs. Gastrointestinal (GI) tract BN is rare. Here, we describe the clinicopathological findings of the largest series of GI tract BNs. METHODS A search of our Pathology Data System (1984-2019) identified six GI tract blue nevi. Clinical information, pathology reports and available H&E-stained section slides were reviewed. RESULTS Lesions predominated in the middle-aged adults (mean 54, range 27-80) with a slight female predominance (66%). Most cases arose in the rectum and colon (83%), with one gastric lesion (17%). Four cases were identified during endoscopic examination performed either for screening or for unrelated symptoms (66%). Two patients presented with rectal bleeding (33%) unassociated with the BN. Endoscopically, most lesions appeared as superficial hyperpigmented areas (83%). One case was described as abnormal mucosa (17%). Microscopically, the mucosa was involved in all of the cases (100%). One case showed submucosal extension in addition to the mucosal component (17%). Lesions showed a proliferation of bland spindle cells with abundant granular pigment. No nuclear atypia or mitoses were identified. Immunostains showed immunoreactivity for melanocytic markers. Follow-up information available for five patients showed no recurrences to date (mean follow-up 1 year). CONCLUSIONS BN is a benign melanocytic proliferation. It is important to be aware of the occurrence of such lesions outside of the skin and consider the possibility of BN when pigmented lesions are encountered in the GI tract.
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Affiliation(s)
| | - Kevan Salimian
- Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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CYSLTR2-mutant Cutaneous Melanocytic Neoplasms Frequently Simulate "Pigmented Epithelioid Melanocytoma," Expanding the Morphologic Spectrum of Blue Tumors: A Clinicopathologic Study of 7 Cases. Am J Surg Pathol 2020; 43:1368-1376. [PMID: 31162285 DOI: 10.1097/pas.0000000000001299] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recurrent activating Gαq mutations in the spectrum of blue nevi have been well studied. However, the clinicopathologic characteristics of the recently described CYSLTR2-mutant and PLCB4-mutant blue nevi remain limited, owing to their rarity. Herein, we present 7 CYSLTR2-mutant melanocytic neoplasms, including 1 cellular blue nevus, 4 atypical cellular blue nevi, and 2 blue nevus-like melanomas. They occurred on the scalp, breast, flank, forearm, thigh, leg, and ankle of 3 male patients and 4 female patients, with a median age of 43 (25 to 81) years at diagnosis. Five exhibited an exophytic growth, and 6 were heavily pigmented. A fascicular arrangement of medium to large spindle melanocytes was seen in 6 cases, but epithelioid cytology was present in only 2 cases, one of them being focal. A junctional component was present in 3 cases. Immunoreactivity for HMB45 was diffusely present, except in 1 cellular blue nevus. BAP1 nuclear immunoexpression was lost in 1 melanoma case. A canonical CYSLTR2 L129Q hotspot mutation was present in all cases. Altogether, these histopathologic findings suggest that CYSLTR2-mutant melanocytic blue neoplasms frequently exhibit a heavily pigmented exophytic tumor with a silhouette resembling "pigmented epithelioid melanocytoma" rather than usual cellular blue nevus. Moreover, most of these tumors were not clinically recognized as blue nevi and not located in the classic topography of cellular blue nevus aside from the scalp. However, a fascicular arrangement of medium to large-sized spindled melanocytes, as well as a lack of epithelioid or nevoid melanocytes, could be potential diagnostic clues to morphologically distinguish CYSLTR2-mutant tumors from "pigmented epithelioid melanocytoma."
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Elder DE, Bastian BC, Cree IA, Massi D, Scolyer RA. The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway. Arch Pathol Lab Med 2020; 144:500-522. [PMID: 32057276 DOI: 10.5858/arpa.2019-0561-ra] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There have been major advances in the understanding of melanoma since the last revision of the World Health Organization (WHO) classification in 2006. OBJECTIVE.— To discuss development of the 9 distinct types of melanoma and distinguishing them by their epidemiology, clinical and histologic morphology, and genomic characteristics. Each melanoma subtype is placed at the end of an evolutionary pathway that is rooted in its respective precursor, wherever appropriate and feasible, based on currently known data. Each precursor has a variable risk of progression culminating in its fully evolved, invasive melanoma. DATA SOURCES.— This review is based on the "Melanocytic Tumours" section of the 4th edition of the WHO Classification of Skin Tumours, published in 2018. CONCLUSIONS.— Melanomas were divided into those etiologically related to sun exposure and those that are not, as determined by their mutational signatures, anatomic site, and epidemiology. Melanomas on the sun-exposed skin were further divided by the histopathologic degree of cumulative solar damage (CSD) of the surrounding skin, into low and high CSD, on the basis of degree of associated solar elastosis. Low-CSD melanomas include superficial spreading melanomas and high-CSD melanomas incorporate lentigo maligna and desmoplastic melanomas. The "nonsolar" category includes acral melanomas, some melanomas in congenital nevi, melanomas in blue nevi, Spitz melanomas, mucosal melanomas, and uveal melanomas. The general term melanocytoma is proposed to encompass "intermediate" tumors that have an increased (though still low) probability of disease progression to melanoma.
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Affiliation(s)
- David E Elder
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Boris C Bastian
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Ian A Cree
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Daniela Massi
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Richard A Scolyer
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
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Qiu CC, Brown AE, Lobitz GR, Shanker A, Hsu S. The color of skin: black diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:447-467. [PMID: 31896402 DOI: 10.1016/j.clindermatol.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gradations in skin color are a consequence of differing amounts of melanin and their varying distribution. Although many darkly pigmented skin lesions are melanocytic and can be attributed to melanin content, the color of a black lesion can also be due to blood, necrotic tissue, or exogenous pigment. The source, pattern, and distribution of the color in black lesions usually offer important insight into its etiology. This contribution reviews conditions that can take on a black color, discussing the cause of the hue and any additional impact sun exposure may have.
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Affiliation(s)
- Connie C Qiu
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Ashley E Brown
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gabriella R Lobitz
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Akshay Shanker
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
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22
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Blebea C, Li D, Castelo‐Soccio L, Chu EY. Generalized congenital epithelioid blue nevi (pigmented epithelioid melanocytomas) in an infant: Report of case and review of the literature. J Cutan Pathol 2019; 46:954-959. [DOI: 10.1111/cup.13544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Catherine Blebea
- Department of DermatologyPerelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
| | - Dong Li
- Center for Applied GenomicsThe Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Leslie Castelo‐Soccio
- Division of Pediatrics, Section of DermatologyThe Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Emily Y. Chu
- Department of DermatologyPerelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania
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23
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Kim YJ, Cohen PR. Blue Nevus Developing at a Combined Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination Site: Case Report and Summary of Vaccine-Associated Cutaneous Lesions. Cureus 2019; 11:e4997. [PMID: 31497428 PMCID: PMC6707821 DOI: 10.7759/cureus.4997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Skin reaction may develop at the site of vaccine administration. A 54-year-old woman who developed a cellular blue nevus at the site of the combined tetanus, diphtheria, and acellular pertussis (Tdap) vaccine injection four years prior to presentation is described. In addition to blue nevus, other reactions at combined tetanus, diphtheria, and pertussis vaccine injection sites include abscess, deep reactive nodular infiltrates of mixed inflammation, and necrotizing granuloma. In conclusion, blue nevus can be added to the list of cutaneous events that can occur at Tdap vaccination sites.
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Affiliation(s)
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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24
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Matsumoto A, Nijhawan RI. Cells to Surgery Quiz: June 2019. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Herwig-Carl MC, Loeffler KU, Grossniklaus HE. Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases. Ocul Oncol Pathol 2019; 5:290-297. [PMID: 31367593 DOI: 10.1159/000496557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
Background Melanocytoma (magnocellular nevus) is a jet-black benign lesion histologically composed of polygonal tumor cells with small, inconspicuous nuclei and abundant cytoplasm. Melanocytomas in general are rare. Most cases occur in the optic nerve head. Conjunctival melanocytoma (magnocellular nevus) is extremely rare, and only 3 lesions of the ocular surface have been reported. Objectives To describe the clinical and histological spectrum of conjunctival melanocytoma and discuss differential diagnoses of this rare lesion. Method Four heavily pigmented conjunctival lesions were excised for slight tumor growth and histologically processed. The specimens were routinely stained with hematoxylin and eosin and periodic acid-Schiff. Sections were bleached and immunohistochemical stains were performed for CD68, HMB-45, S100, melanin, and Ki-67. Results Histological examination revealed findings of a conjunctival melanocytoma in 3 cases. The fourth case was diagnosed histologically as a combined melanocytic lesion with a compound nevus and an inverted type A nevus. None of the lesions exhibited transition towards malignancy. The differential diagnoses included conjunctival melanoma, granular cell nevus, compound nevus with reactive changes, and blue nevus. Conclusions Conjunctival melanocytic lesions suspicious for melanocytoma should be bleached to evaluate their cytologic features. CD68 can be helpful in identifying heavily pigmented melanomacrophages which may mimic a melanocytoma. As conjunctival melanocytomas are extremely rare, their pathogenesis may be different from that of other conjunctival nevi.
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Affiliation(s)
| | | | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
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Baykal C, Yılmaz Z, Sun G, Büyükbabani N. The spectrum of benign dermal dendritic melanocytic proliferations. J Eur Acad Dermatol Venereol 2019; 33:1029-1041. [DOI: 10.1111/jdv.15492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- C. Baykal
- Department of Dermatology and Venereology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Z. Yılmaz
- Department of Dermatology and Venereology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - G.P. Sun
- Department of Dermatology and Venereology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - N. Büyükbabani
- Department of Pathology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
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27
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Mesbah Ardakani N. Dysplastic/Clark naevus in the era of molecular pathology. Australas J Dermatol 2019; 60:186-191. [PMID: 30854639 DOI: 10.1111/ajd.13019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 01/03/2023]
Abstract
Dysplastic naevus has been a controversial entity since its first description by Clark in 1978. Despite a recent paradigm shift from the initially proposed notion that dysplastic naevus is a precursor to melanoma, its management has been increasingly more aggressive in the last decade. The latter is due to an unresolved uncertainty regarding its biological nature which necessitates further clarification. Recent molecular genetics, epigenetic and transcriptomic discoveries have revealed that a subset of dysplastic naevi exhibits a genomic profile which is intermediate between that of benign naevus and melanoma. This group of lesions often shows somatic mutations in non-V600E BRAF, NRAS and TERT and hemizygous deletion of CDKN2A gene as well as upregulation of genes involved in proliferation, cell adhesion and migration, and epidermal and follicular keratinocyte-related genes. These new genomic insights suggest that a proportion of dysplastic naevi have a greater propensity to evolve to melanoma; however, the clinical and histopathological features of this proposed intermediate category are still to be elucidated by further research.
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Affiliation(s)
- Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.,School of Veterinary and Life Science, Murdoch University, Perth, Western Australia, Australia
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Belysheva TS, Vishnevskaya YV, Nasedkina TV, Emelyanova MA, Abramov IS, Orlova KV, Lubchenko LN, Utyashev IA, Doroshenko MB, Demidov LV, Aliev MD. Melanoma arising in a Giant congenital melanocytic nevus: two case reports. Diagn Pathol 2019; 14:21. [PMID: 30782194 PMCID: PMC6381634 DOI: 10.1186/s13000-019-0797-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background A giant congenital melanocytic nevus (GCMN) is found in 0.1% of live-born infants. If present, the lesion has a chance of about 6% to develop into malignant melanoma. Both children and adults can be affected by malignant melanoma arising in a giant congenital nevus. Up to 95% of GCMNs harbor NRAS mutations, and mutations in the BRAF, MC1R, TP53, and GNAQ genes have also been described. The individualization of therapy is required, but diagnostic and prognostic criteria remain controversial. Case presentations We report two cases: 1) melanoma arising in a giant congenital nevus during the first month of life complicated with neurocutaneous melanosis (NCM), and 2) melanoma arising in a giant congenital nevus during the first 6 months of life. Pathology, immunohistochemistry, and genetic analyses of tumor tissue were performed. The first case revealed only a non-pathogenic P72R polymorphism of the TP53 gene in the homozygote condition. For the second case, a Q61K mutation was detected in the NRAS gene. Conclusion Malignant melanoma associated with GCMN is rare and therefore poorly understood. Outcomes have been linked to the stage at diagnosis, but no additional pathological prognostic factors have been identified. The most frequent genetic event in giant CMNs is NRAS mutations, which was discovered in one of our cases. To accumulate evidence to improve disease prognosis and outcomes, children with congenital melanocytic nevus should be included in a systemic follow-up study from birth.
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Affiliation(s)
- Tatiana S Belysheva
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Yana V Vishnevskaya
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Tatiana V Nasedkina
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Marina A Emelyanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Ivan S Abramov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Kristina V Orlova
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.
| | - Ludmila N Lubchenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Igor A Utyashev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Marina B Doroshenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Lev V Demidov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Mamed D Aliev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
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A teenager with a black nodule on the buttock. J Paediatr Child Health 2019; 55:241-242. [PMID: 30746882 DOI: 10.1111/jpc.2_14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
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Abstract
Although spongiotic (eczematous), psoriatic and cutaneous skin infections are among the most common in dermatology consultations, melanocytic lesions - including the different types of nevi and melanomas - are among those that cause a great deal of concern and stress to patients and their clinicians. A diagnosis of benign melanocytic nevus carries a very good prognosis. However, a diagnosis of melanoma might indicate more aggressive treatment, lifelong surveillance and a worse prognosis. Differentiating between these conditions is not always a straightforward process for clinicians and pathologists. Therefore, knowledge of melanoma mimickers is very important for clinicians in general, and dermatologists and pathologists in particular. In this review, we called attention to some of the more frequent benign but unusual melanocytic lesions that are of diagnostic concern for clinicians evaluating these cutaneous proliferations.
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Affiliation(s)
- Caroline Bsirini
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Morkin MI, Hofmann RJ, Laver NV. Subepithelial conjunctival nevus with atypia: Expanding our understanding of a challenging diagnosis. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Slater K, Hoo PS, Buckley AM, Piulats JM, Villanueva A, Portela A, Kennedy BN. Evaluation of oncogenic cysteinyl leukotriene receptor 2 as a therapeutic target for uveal melanoma. Cancer Metastasis Rev 2018; 37:335-345. [DOI: 10.1007/s10555-018-9751-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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ALK Rearrangements Are Infrequent in Cellular Blue Nevus and Deep Penetrating Nevus. Am J Dermatopathol 2018; 40:469-478. [PMID: 29923908 DOI: 10.1097/dad.0000000000001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies have identified kinase fusions in Spitzoid melanocytic neoplasms, and approximately 10% of Spitzoid neoplasms harbor anaplastic lymphoma kinase (ALK) rearrangements and corresponding ALK immunoreactivity. Deep penetrating nevi (DPN), a subset of melanocytic neoplasms, have histologic and immunohistochemical overlap that have historically supported classification of DPN with blue/cellular blue nevi (CBN). However, HRAS mutations have rarely been detected in DPN, thereby also linking them to Spitz nevi. The purpose of this study was to see if DPN or CBN possess ALK rearrangements, thereby providing more evidence that these melanocytic lesions may be pathogenetically related to Spitzoid neoplasms. Using ALK immunohistochemistry as a surrogate for ALK rearrangement, the authors examined 26 DPN, 30 CBN, and 4 conventional blue nevi. ALK immunoreactive cases underwent fluorescent in situ hybridization to investigate for the presence of ALK gene rearrangement. Patchy and focal ALK immunostaining was found in only 1 case of DPN (1/26, 3.8%). Seven cases of CBN (7/30; 23%) showed ALK immunostaining (6 focal/patchy, 1 strong and diffuse). Fluorescent in situ hybridization using ALK break-apart probes showed various degrees of gain of 2p23 and rare ALK break-apart signals. Four CBN showed ALK rearrangement in 2%-4% of cells. Two cases of CBN showed gain of 2p23 in 10%-20% of cells. In our study, ALK rearrangements are uncommon in both CBN and DPN, making ALK an unlikely driver in tumorigenesis and classification of these melanocytic variants. However, our study did identify ALK molecular changes and immunohistochemical staining patterns that have not been previously described in CBN or DPN.
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Sayed-Ahmed I, Murillo JC, Monsalve P, Ulloa JP, Fernandez MP, Wong J, Elgart G, Galor A, Dubovy SR, Karp CL. Blue Nevi of the Ocular Surface: Clinical Characteristics, Pathologic Features, and Clinical Course. Ophthalmology 2018; 125:1189-1198. [PMID: 29551421 DOI: 10.1016/j.ophtha.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 02/05/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Blue nevus is a melanocytic tumor that is commonly found in the skin. Extracutaneous presentations, including the ocular surface, are rare. As such, the purpose of this study was to characterize the clinical features and clinical course of congenital melanocytic tumor (blue nevus) of the conjunctiva. DESIGN Retrospective, noncomparative case series. PARTICIPANTS Twenty-one patients with 23 blue nevi of the ocular surface that were excised surgically between 2000 and 2016. METHODS Chart review of patients identified from a database search of the Florida Lions Ocular Pathology Laboratory records. Pathologic diagnoses were confirmed by 2 pathologists (S.R.D. and G.E.). All specimens were bleached and, tissue permitting, stained using SOX10 (MilliporeSigma, Darmstadt, Germany) and CD68 (Leica Biosystems, Nussloch, Germany). MAIN OUTCOME MEASURES Clinical characteristics, pathologic features, and clinical course. RESULTS Mean age of the population was 55±15 years; 71.4% (n = 15) were white and 57.1% (n = 12) were men. One patient had 3 lesions, for a total of 23 lesions examined. Clinically, 13 lesions were on the bulbar conjunctiva, 3 were on the tarsal conjunctiva, 3 were in the fornix, 2 were caruncular, 1 was episcleral, and 1 was at the limbus. Before excision, 8 patients were thought to have primary acquired melanosis, 4 with concern for primary conjunctival melanoma, and 1 thought to have metastatic disease from a plantar melanoma. Five lesions were thought to be benign, and in 8 patients, the lesions were identified incidentally after other ocular surgeries, with no diagnosis of the lesions before excision. Pathologic features were consistent with simple blue nevi in 21 lesions and cellular blue nevus in 2 lesions. No malignant transformations were noted in any patient over the mean 20.2-month follow-up period (range, 2 weeks-103 months). CONCLUSIONS Blue nevus is a rare deeply pigmented congenital melanocytic lesion with a benign clinical course that can appear clinically similar to primary acquired melanosis or melanoma.
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Affiliation(s)
| | | | - Pedro Monsalve
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Jan Paul Ulloa
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | - James Wong
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - George Elgart
- Department of Dermatopathology, University of Miami, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Florida Lions Eye Bank, Florida
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
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Malignant Blue Nevus: A Challenge for Dermatologists and Dermatopathologists. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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36
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Pérez-Alea M, Vivancos A, Caratú G, Matito J, Ferrer B, Hernandez-Losa J, Cortés J, Muñoz E, Garcia-Patos V, Recio JA. Genetic profile of GNAQ-mutated blue melanocytic neoplasms reveals mutations in genes linked to genomic instability and the PI3K pathway. Oncotarget 2018; 7:28086-95. [PMID: 27057633 PMCID: PMC5053711 DOI: 10.18632/oncotarget.8578] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/28/2016] [Indexed: 12/20/2022] Open
Abstract
Melanomas arising in association with a common or cellular blue nevus (MABN) comprise a relatively rare and heterogeneous group of lethal melanomas. Although GNAQ is known to be frequently mutated in common blue nevus, cellular blue nevus (CBN) and MABN and these malignant lesions present gross chromosome alterations harboring BAP1 mutations, little is known about other mutations that contribute to the development and progression of these neoplasms. Thus, the genetic profile of these tumors is important to increase the number of intervention and treatment modalities. Here, we characterized and genetically profiled two different sections of a rare MABN and two CBNs from three different patients. All of the samples harbored a GNAQ mutation, exhibited RAS pathway activation, and harbored additional mutations in genes associated with genomic instability and epigenetic regulation (KMT2C, FANCD2, ATR, ATRX, NBN, ERCC2, SETD2, and WHSC1). In addition, all neoplasms harbored mutations that directly or indirectly affected either the regulation or activation of the PI3K pathway (PIK3CA, NF1, INPP5B and GSK3B). Our results not only help understand the genetic complexity of these blue melanocytic lesions but provide a rationale to use the combination of PI3K/MTOR and MEK1/2 inhibitors against these types of tumors.
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Affiliation(s)
- Mileidys Pérez-Alea
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Oncology Program, Vall d'Hebron Research institute, VHIR-Vall d'Hebron Hospital, Barcelona-UAB 08035, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group Translational Research Program, Vall d'Hebron Institute of Oncology-VHIO, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Ginevra Caratú
- Cancer Genomics Group Translational Research Program, Vall d'Hebron Institute of Oncology-VHIO, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Judit Matito
- Cancer Genomics Group Translational Research Program, Vall d'Hebron Institute of Oncology-VHIO, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Berta Ferrer
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Oncology Program, Vall d'Hebron Research institute, VHIR-Vall d'Hebron Hospital, Barcelona-UAB 08035, Barcelona, Spain.,Anatomy Pathology Department, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Javier Hernandez-Losa
- Anatomy Pathology Department, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Javier Cortés
- Clinical Oncology Program, Vall d'Hebron Institute of Oncology-VHIO, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Eva Muñoz
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Oncology Program, Vall d'Hebron Research institute, VHIR-Vall d'Hebron Hospital, Barcelona-UAB 08035, Barcelona, Spain.,Clinical Oncology Program, Vall d'Hebron Institute of Oncology-VHIO, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Vicente Garcia-Patos
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Oncology Program, Vall d'Hebron Research institute, VHIR-Vall d'Hebron Hospital, Barcelona-UAB 08035, Barcelona, Spain.,Dermatology Department, Vall d'Hebron Hospital, Barcelona-UAB, Barcelona 08035, Spain
| | - Juan A Recio
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Oncology Program, Vall d'Hebron Research institute, VHIR-Vall d'Hebron Hospital, Barcelona-UAB 08035, Barcelona, Spain
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Sohier P, Legrand L, Aktary Z, Grill C, Delmas V, Bernex F, Reyes-Gomez E, Larue L, Vergier B. A histopathological classification system of Tyr::NRAS Q61K murine melanocytic lesions: A reproducible simplified classification. Pigment Cell Melanoma Res 2017; 31:423-431. [PMID: 29224244 DOI: 10.1111/pcmr.12677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/12/2017] [Indexed: 12/29/2022]
Abstract
Genetically engineered mouse models offer essential opportunities to investigate the mechanisms of initiation and progression in melanoma. Here, we report a new simplified histopathology classification of mouse melanocytic lesions in Tyr::NRASQ61K derived models, using an interactive decision tree that produces homogeneous categories. Reproducibility for this classification system was evaluated on a panel of representative cases of murine melanocytic lesions by pathologists and basic scientists. Reproducibility, measured as inter-rater agreement between evaluators using a modified Fleiss' kappa statistic, revealed a very good agreement between observers. Should this new simplified classification be adopted, it would create a robust system of communication between researchers in the field of mouse melanoma models.
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Affiliation(s)
- Pierre Sohier
- Institut Curie, INSERM U1021, Normal and Pathological Development of Melanocytes, PSL Research University, Orsay, France.,CNRS UMR3347, Univ Paris-Sud, Univ Paris-Saclay, Orsay, France.,Equipe Labellisée Ligue Contre le Cancer, Orsay, France
| | - Léa Legrand
- INSERM U1053, Team 3 Oncogenesis of Cutaneous Lymphomas, Univ. Bordeaux, Bordeaux, France.,Pathology Department, CHU Bordeaux, Pessac, France
| | - Zackie Aktary
- Institut Curie, INSERM U1021, Normal and Pathological Development of Melanocytes, PSL Research University, Orsay, France.,CNRS UMR3347, Univ Paris-Sud, Univ Paris-Saclay, Orsay, France.,Equipe Labellisée Ligue Contre le Cancer, Orsay, France
| | - Christine Grill
- Institut Curie, INSERM U1021, Normal and Pathological Development of Melanocytes, PSL Research University, Orsay, France.,CNRS UMR3347, Univ Paris-Sud, Univ Paris-Saclay, Orsay, France.,Equipe Labellisée Ligue Contre le Cancer, Orsay, France
| | - Véronique Delmas
- Institut Curie, INSERM U1021, Normal and Pathological Development of Melanocytes, PSL Research University, Orsay, France.,CNRS UMR3347, Univ Paris-Sud, Univ Paris-Saclay, Orsay, France.,Equipe Labellisée Ligue Contre le Cancer, Orsay, France
| | | | - Edouard Reyes-Gomez
- INRA, UMR955 Génétique Fonctionnelle et Médicale, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,UMR955 Génétique Fonctionnelle et Médicale, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France.,Unité d'Embryologie, d'Histologie et d'Anatomie Pathologique, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, France
| | - Lionel Larue
- Institut Curie, INSERM U1021, Normal and Pathological Development of Melanocytes, PSL Research University, Orsay, France.,CNRS UMR3347, Univ Paris-Sud, Univ Paris-Saclay, Orsay, France.,Equipe Labellisée Ligue Contre le Cancer, Orsay, France
| | - Béatrice Vergier
- INSERM U1053, Team 3 Oncogenesis of Cutaneous Lymphomas, Univ. Bordeaux, Bordeaux, France.,Pathology Department, CHU Bordeaux, Pessac, France
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38
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Quhill H, Rundle PA, Mudhar HS. Conjunctival Blue Naevus in an Anophthalmic Socket. Ocul Oncol Pathol 2017; 3:220-223. [PMID: 29071272 DOI: 10.1159/000460820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/31/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE OF THE STUDY To describe an unusual brown pigmented lesion of the conjunctiva in an anophthalmic socket in a 16-year-old male. PROCEDURES A 16-year-old male patient presented with socket irritation whilst wearing an artificial eye due to meibomian gland dysfunction. An area of flat, subepithelial, dark brown pigmentation with irregular and indistinct borders on the bulbar conjunctiva of the anophthalmic socket was seen. The patient believed it had been present for at least 2 years. His past ocular history was of childhood trauma to the right eye at the age of 9 years, and he underwent primary enucleation and hydroxyapatite orbital implant insertion at that time. Unfortunately, the implant extruded and was removed a year later. RESULTS An incisional biopsy of the pigmented lesion showed a conjunctival, subepithelial bland spindle cell melanocytic lesion, with uniform-sized and -shaped melanosomes. Immunohistochemistry showed the cells to express Melan A and HMB45 and they were negative for CD68 and pan-cytokeratins. The features were of a common blue naevus. CONCLUSION This is the first documentation of a post-enucleation conjunctival naevus in an anophthalmic socket. We propose a pathogenesis and suggest surveillance as there is a risk of transformation to melanoma.
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Affiliation(s)
- Hibba Quhill
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul A Rundle
- Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
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39
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Baraldi C, Corti B, Lambertini M, Fanti PA, Patrizi A, Dika E. Large plaque-type blue naevus with cellular nodules: a rare unrecognized melanocytic tumour. J Eur Acad Dermatol Venereol 2017; 32:e132-e133. [PMID: 29024276 DOI: 10.1111/jdv.14634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 12/01/2022]
Affiliation(s)
- C Baraldi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - B Corti
- Pathology Unit, Department of Diagnostic and Prevention Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Lambertini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - P A Fanti
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - A Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - E Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Toledo-Pastrana T, Rodríguez Pérez I, Eguino Gorrochategui P. Malignant Blue Nevus: A Challenge for Dermatologists and Dermatopathologists. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:181-183. [PMID: 28963027 DOI: 10.1016/j.ad.2017.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/18/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- T Toledo-Pastrana
- Dermatology Department, Donostia University Hospital, San Sebastián, Spain.
| | - I Rodríguez Pérez
- Pathology Department, Donostia University Hospital, San Sebastián, Spain
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Abstract
BACKGROUND Differentiating benign blue nevi from blue nevus-like melanoma can be diagnostically challenging. We aimed to determine the utility of immunohistochemical staining for p16 and cyclin D1 in distinguishing benign blue nevi and malignant melanoma. MATERIALS AND METHODS Thirty-two biopsy specimens taken between 2007 and 2015 were obtained from the Department of Pathology at the Queen's Medical Center in Honolulu, HI. These included 9 common blue nevi, 8 cellular blue nevi (2 with atypical features), and 15 malignant melanomas (3 blue nevus-like melanoma). The primary outcome was the difference in p16 and cyclin D1 staining between benign blue nevi and malignant melanoma. Staining of specimens for p16 and cyclin D1 was graded on the strength of staining, and the percent of tumor that stained positive. A specimen was deemed positive if it showed 2+ staining in ≥50% of the tumor. RESULTS The majority (82%) of blue nevi stained negative for p16. There was not a significant difference between p16 staining in benign blue nevi and melanoma (P=0.06). Eleven (73%) melanomas stained positive for cyclin D1 with a sensitivity of 0.73 and positive predictive value of 1.0. All blue nevi were negative for cyclin D1, making its specificity 1.0 and its negative predictive value 0.8. This difference in cyclin D1 staining in blue nevi and melanoma was significant (P=0.0001). CONCLUSIONS Cyclin D1 may be useful in differentiating benign blue nevi from melanoma.
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Habougit C, Michiels-Marzais D, Wang Q, Pissaloux D, de la Fouchardiere A. Linear variant of large plaque-type blue naevus with subcutaneous cellular nodules. Pathology 2017; 49:542-544. [PMID: 28673427 DOI: 10.1016/j.pathol.2017.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Qing Wang
- Department of Pathology, Centre Leon Berard, Lyon, France
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44
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Cho ES, Cho HM, Nam W, Kim HS. Multiple Oral Deep Penetrating Nevi Extending to the Masseter and Buccal Fat Pad. J Oral Maxillofac Surg 2017; 75:2579-2592. [PMID: 28662374 DOI: 10.1016/j.joms.2017.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
Abstract
The deep penetrating nevus (DPN) is a rare benign melanocytic tumor often clinically and histopathologically mistaken for malignant melanoma (MM) and other nevus types. This report describes an extremely rare case of multiple lesions of a large DPN in the oral cavity with extensive infiltration to the minor salivary gland, buccal fat pad, buccinators, and masseter muscles, yet with preservation of the normal anatomic architecture. After receiving a diagnosis of MM in another hospital, the patient was at risk for receiving a wide excision that included the masticatory muscles, facial nerve, and overlying skin. Histopathologically, distinct cellular properties were completely masked with heavy pigmentation, thus precluding a proper distinction of benignity versus malignancy. The proliferative capacity of the tumor was analyzed further by immunohistochemistry of bleached tissue sections and tumor behavior was indirectly evaluated by insufficient tumor stromal interaction, with the conclusion that the specimen was benign. Conservative surgery was limited to the oral cavity. Multiple DPNs in the oral cavity merit attention because of the high risk of being mistaken for MM, which would require a wider surgical excision of the head and neck region.
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Affiliation(s)
- Eunae S Cho
- Basic Research Assistant Professor, Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Hye-Min Cho
- Resident, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Woong Nam
- Professor, Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyun Sil Kim
- Associate Professor, Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea.
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SF3B1 and BAP1 mutations in blue nevus-like melanoma. Mod Pathol 2017; 30:928-939. [PMID: 28409567 PMCID: PMC5533514 DOI: 10.1038/modpathol.2017.23] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Abstract
Blue nevi are melanocytic tumors originating in the cutaneous dermis. Malignant tumors may arise in association with or resembling blue nevi, so called 'blue nevus-like melanoma', which can metastasize and result in patient death. Identifying which tumors will behave in a clinically aggressive manner can be challenging. Identifying genetic alterations in such tumors may assist in their diagnosis and prognostication. Blue nevi are known to be genetically related to uveal melanomas (eg, both harboring GNAQ and GNA11 mutations). In this study, we analyzed a large cohort (n=301) of various morphologic variants of blue nevi and related tumors including tumors diagnosed as atypical blue nevi (n=21), and blue nevus-like melanoma (n=12), screening for all gene mutations known to occur in uveal melanoma. Similar to published reports, we found the majority of blue nevi harbored activating mutations in GNAQ (53%) or GNA11 (15%). In addition, rare CYSLTR2 (1%) and PLCB4 (1%) mutations were identified. EIF1AX, SF3B1, and BAP1 mutations were also detected, with BAP1 and SF3B1 R625 mutations being present only in clearly malignant tumors (17% (n=2) and 25% (n=3) of blue nevus-like melanoma, respectively). In sequencing data from a larger cohort of cutaneous melanomas, this genetic profile was also identified in tumors not originally diagnosed as blue nevus-like melanoma. Our findings suggest that the genetic profile of coexistent GNAQ or GNA11 mutations with BAP1 or SF3B1 mutations can aid the histopathological diagnosis of blue nevus-like melanoma and distinguish blue nevus-like melanoma from conventional epidermal-derived melanomas. Future studies will need to further elucidate the prognostic implications and appropriate clinical management for patients with tumors harboring these mutation profiles.
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Borgenvik TL, Karlsvik TM, Ray S, Fawzy M, James N. Blue nevus-like and blue nevus-associated melanoma: a comprehensive review of the literature. ANZ J Surg 2017; 87:345-349. [PMID: 28318130 DOI: 10.1111/ans.13946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/24/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malignant blue nevus, blue nevus-associated melanoma and blue nevus-like melanoma are all terms used to describe malignant melanomas arising from, in association with, or resembling blue nevi. This review is aimed at summarizing the available literature to reduce the confusion surrounding this rare malignancy, and aid the surgeon in choosing further diagnostic or therapeutic measures. METHODS We conducted a search of Medline, Embase, Science Direct, Scopus and the Cochrane Library for all full text articles published in English that reported on a malignant melanoma arising from, in association with, or resembling a blue nevus. RESULTS We identified 91 cases that fit the criteria above. The mean age at diagnosis was 45 years, with a slight male predominance (males: 48; females: 43). Metastatic cases were reported in 55% (n = 50), of which 16 were metastatic at the time of diagnosis, 16 developed metastases within the first year and 18 within 5 years of initial diagnosis. The mean Breslow thickness was 6.8 mm at the time of diagnosis (n = 39). CONCLUSIONS The histological criteria for diagnosing this malignancy are very poorly defined, and may contribute to the substantial confusion surrounding the terminology. There is no consensus on which prognostic indicators predictive of outcome in 'conventional' malignant melanoma are applicable to blue nevus-like melanoma/blue nevus-associated melanoma. However, two larger case series have demonstrated a significant association between Breslow thickness (or largest tumour dimension when non-epidermal) and recurrence-free survival, as well as rate of local recurrence, but larger studies are needed to confirm this.
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Affiliation(s)
| | - Tina M Karlsvik
- Department of Surgery, Ostfold Hospital Trust, Kalnes, Norway
| | - Saikat Ray
- Department of Plastic Surgery, St. Andrew's Centre for Burns and Plastic Surgery, Chelmsford, UK
| | - Monica Fawzy
- Department of Plastic Surgery, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Nick James
- Department of Plastic Surgery, East and North Hertfordshire NHS Trust, Stevenage, UK
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Weissinger SE, Frick M, Möller P, Horst BA, Lennerz JK. Performance Testing of RREB1, MYB, and CCND1 Fluorescence In Situ Hybridization in Spindle-Cell and Desmoplastic Melanoma Argues for a Two-Step Test Algorithm. Int J Surg Pathol 2017; 25:148-157. [PMID: 27899693 DOI: 10.1177/1066896916680072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diagnostic confirmation of spindle-cell melanoma (SM) or desmoplastic melanoma (DM) as a melanoma can be challenging. In conventional melanoma (CM), a recently established fluorescence in situ hybridization (FISH) assay for RREB1, MYB, CCND1 can be helpful. Here, we determined the presence of RREB1, MYB, and CCND1 abnormalities in an SM/DM/mixed cohort. METHODS We assembled 49 cases and performed 3 separate hybridizations for RREB1/MYB/CCND1. We assessed clinical utility in diagnostically challenging cases and performed a cost and turnaround time analysis. RESULTS With regard to the diagnosis of melanoma, the FISH assay is 76% sensitive (n = 31/41 true positives melanomas) and 88% specific (n = 1/8 false positive desmoplastic nevi). The prevalence of abnormalities in DM is lower (12/19 cases, 63%; P = .03) than in SM (15/18 cases, 83%; P = .27), mixed (4 of 4 cases), or the reported sensitivity in CM (345/411 cases, 84%). The implied genetic differences in DM result in a higher false negative rate in DM (37%). Despite these limitations, when restricted to diagnostically challenging cases (n = 23), the FISH assay and, in particular, RREB1 was able to confirm melanoma in 70% (n = 16/23). Individual probe sensitivities ( RREB1 > MYB > CCND1) and a cost and turnaround time analysis argues for a 2-step test algorithm that reduces the economic impact of FISH testing considerably (~55%; n = 69 vs 123 hybridizations). CONCLUSION We propose a step-by-step genetic testing algorithm to support the diagnosis of melanoma in the setting of SM/DM and show that FISH testing is useful in diagnostically challenging cases.
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Affiliation(s)
| | | | | | - Basil A Horst
- 2 Columbia University Medical Center, New York, NY, USA
| | - Jochen K Lennerz
- 1 University of Ulm, Ulm, Germany
- 3 Massachusetts General Hospital/Harvard Medical, Boston, MA, USA
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48
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49
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Möller I, Murali R, Müller H, Wiesner T, Jackett LA, Scholz SL, Cosgarea I, van de Nes JAP, Sucker A, Hillen U, Schilling B, Paschen A, Kutzner H, Rütten A, Böckers M, Scolyer RA, Schadendorf D, Griewank KG. Activating cysteinyl leukotriene receptor 2 (CYSLTR2) mutations in blue nevi. Mod Pathol 2017; 30:350-356. [PMID: 27934878 PMCID: PMC5518680 DOI: 10.1038/modpathol.2016.201] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/26/2016] [Accepted: 10/18/2016] [Indexed: 01/12/2023]
Abstract
Blue nevi are common melanocytic tumors arising in the dermal layer of the skin. Similar to uveal melanomas, blue nevi frequently harbor GNAQ and GNA11 mutations. Recently, recurrent CYSLTR2 and PLCB4 mutations were identified in uveal melanomas not harboring GNAQ or GNA11 mutations. All four genes (GNAQ, GNA11, CYSLTR2, and PLCB4) code for proteins involved in the same signaling pathway, which is activated by mutations in these genes. Given the related functional consequences of these mutations and the known genetic similarities between uveal melanoma and blue nevi, we analyzed a cohort of blue nevi to investigate whether CYSLTR2 and PLCB4 mutations occur in tumors lacking GNAQ or GNA11 mutations (as in uveal melanoma). A targeted next-generation sequencing assay covering known activating mutations in GNAQ, GNA11, CYSLTR2, PLCB4, KIT, NRAS, and BRAF was applied to 103 blue nevi. As previously reported, most blue nevi were found to harbor activating mutations in GNAQ (59%, n=61), followed by less frequent mutations in GNA11 (16%, n=17). Additionally, one BRAF (1%) and three NRAS (3%) mutations were detected. In three tumors (3%) harboring none of the aforementioned gene alterations, CYSLTR2 mutations were identified. All three CYSLTR2 mutations were the same c.386T>A, L129Q mutation previously identified in uveal melanoma that has been shown to lead to increased receptor activation and signaling. In summary, our study identifies CYSLTR2 L129Q alterations as a previously unrecognized activating mutation in blue nevi, occuring in a mutually exclusive fashion with known GNAQ and GNA11 mutations. Similar to GNAQ and GNA11 mutations, CYSLTR2 mutations, when present, are likely defining pathogenetic events in blue nevi.
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Affiliation(s)
- Inga Möller
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Rajmohan Murali
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Thomas Wiesner
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Louise A Jackett
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia,Discipline of Pathology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia,Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Simone L Scholz
- Department of Ophthalmology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Ioana Cosgarea
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Johannes AP van de Nes
- Institute of Neuropathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Uwe Hillen
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Annette Paschen
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Heinz Kutzner
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | - Arno Rütten
- Dermatopathology Friedrichshafen, Friedrichshafen, Germany
| | | | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia,Discipline of Pathology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia,Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Klaus G Griewank
- Department of Dermatology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany,Dermatopathologie bei Mainz, Nieder-Olm, Germany
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Nako T, Hoashi T, Kanzaki A, Serizawa N, Funasaka Y, Saeki H. A case of blue naevus of the mucocutaneous junction of the lower eyelid margin associated with acquired bilateral naevus of Ota-like macule. Clin Exp Dermatol 2017; 42:339-341. [DOI: 10.1111/ced.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- T. Nako
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
| | - T. Hoashi
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
| | - A. Kanzaki
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
| | - N. Serizawa
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
| | - Y. Funasaka
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
| | - H. Saeki
- Department of Dermatology; Nippon Medical School; 1-1-5, Sendagi, Bunkyo-ku Tokyo 113-8603 Japan
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