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Atypical Nevi (atypical + nevi)
Selected AbstractsAtypical nevi of the scalp in adolescentsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 5 2007Giujeppe Fabrizi Background:, A few reports in the literature point out that in special areas of the body, nevi can have peculiar pseudomelanomatous features. In our routine work, we have met few examples of atypical nevi with peculiar features on the scalp of teenagers. To evaluate the frequency and the biological behaviour of these lesions, we have conducted a complete survey on melanocytic lesions on the scalp in a significant group of patients. Materials and methods:, Thirty-nine nevi of the scalp were from adolescents (12,18 years), 160 from adults, and 30 from children below the age of 12 years. Results:, About 10% of the melanocytic nevi of the scalp of adolescents have atypical cytological and architectural aspects that are different from those seen in Clark's dysplastic nevus. The most striking features were the presence of large bizarrely shaped nests scattered disorderly along the junction with follicular involvement. Other findings were pagetoid spread of cells above the junction and the discohesive pattern of the melanocytes in the nests. Mild cytological atypia was present but less significant. Such distinctive aspects are not found in nevi of the same site in adults or younger children. The general pattern of these atypical nevi of the scalp of adolescents closely recalls that of the so-called atypical nevi on special sites, i.e. nevi on mammary line, genitalia and body's folds. Despite the architectural and cytological atypia, clinical follow-up does not show any tendency to recur or proclivity to malignant behaviour. Conclusions:, Despite their similarities with melanoma, the nevi with atypical features of the scalp of adolescents are probably an entirely benign entity, at least at the moment of their excision. However, although benign, the relationship of this peculiar group of nevi with melanomas developed in adulthood remains entirely unknown, and the complete excision with conservative margins seems a recommendable procedure. [source] Acquired Melanocytic Lesions and the Decision to Excise: Role of Color Variegation and Distribution as Assessed by DermoscopyDERMATOLOGIC SURGERY, Issue 2 2005Stefania Seidenari MD Background Because melanoma may sometimes be difficult to differentiate from nevi with clinical atypia, many benign lesions also undergo surgical removal. Objective To assess color type and distribution in dermoscopic melanocytic lesion images and to analyze the influence of color parameters on the diagnostic process and the decision to excise. Methods Overall, 603 images, referring to 112 melanomas and 491 nevi, were retrospectively subdivided into four groups: "clearly benign,""follow-up,""dermoscopic atypical nevi," and "dermoscopic melanomas," according to their dermoscopic aspects. The frequency of color type, number, and asymmetry were evaluated on digital images. Results With respect to lesions not eligible for excision according to dermoscopy (but excised for cosmetic reasons), those excised with a suspicion of malignancy showed a higher number of colors, whose distribution was also more asymmetric. Moreover, the frequency of the presence of black and blue-gray progressively increased from clearly benign lesions to atypical nevi and dermoscopic melanomas. Conclusion In dermoscopic images, color parameters are essential elements for the diagnosis of atypical nevus, which can be differentiated from both a clearly benign lesion and a melanoma. Furthermore, pigmentation asymmetry and the presence of blue-gray represent the main color features, which should lead to the decision to excise. THIS STUDY WAS PARTIALLY SUPPORTED BY A GRANT FROM MINISTERO ISTRUZIONE UNIVERSITÇ E RICERCA. [source] Patterns of Detection of Superficial Spreading and Nodular-Type Melanoma: A Multicenter Italian StudyDERMATOLOGIC SURGERY, Issue 11 2004Paolo Carli Background. Nodular histotype represents the condition that is mostly associated with diagnosis of thick melanoma. Objective. The objectives were to evaluate variables associated with and pattern of detection of nodular melanomas and to investigate variables associated with early diagnosis in accordance with histotype (nodular vs. superficial spreading melanomas). Methods. From the original data set of 816 melanomas, all the invasive lesions classified as superficial spreading (n=500) and nodular (n=93) melanomas were considered for the study. A multivariate logistic analysis was performed. Results. Nodular melanomas did not significantly differ from superficial spreading melanomas regarding sex, anatomic site, number of whole-body nevi, and the presence of atypical nevi. As expected, nodular melanomas were represented by a higher percentage of thick (>2 mm) lesions compared to superficial spreading melanomas (64.5% vs. 9.6%, p<0.001). The pattern of detection significantly differed between nodular and superficial spreading melanomas, the former being more frequently self-detected (44.1% vs. 38.0%) or detected by the family doctor (34.4% vs. 11.4%). Female sex, high level of education, and detection made by a dermatologist had an independent, protective effect against late (>1 mm in thickness) diagnosis in superficial spreading melanomas. No protective variable associated with nodular melanomas was found. Conclusion. Patterns of detection for nodular melanomas significantly differ from those for superficial spreading melanomas. For superficial spreading, but not for nodular, melanomas, variables associated with protective effect against late diagnosis can be identified. [source] A large Norwegian family with inherited malignant melanoma, multiple atypical nevi, and CDK4 mutationGENES, CHROMOSOMES AND CANCER, Issue 1 2005Anders Molven Mutations in two loci encoding cell-cycle-regulatory proteins have been shown to cause familial malignant melanoma. About 20% of melanoma-prone families bear a mutation in the CDKN2A locus, which encodes two unrelated proteins, p16INK4A and p14ARF. Mutations in the other locus, CDK4, are much rarer and have been linked to the disease in only three families worldwide. In the 1960s, a large Norwegian pedigree with multiple atypical nevi and malignant melanomas was identified. Subsequently, six generations and more than 100 family members were traced and 20 cases of melanoma verified. In this article, we report that CDK4 codon 24 is mutated from CGT to CAT (Arg24His) in this unusually large melanoma kindred. Intriguingly, one of the family members had ocular melanoma, but the CDK4 mutation could not be detected in archival tissue samples from this subject. Thus, the case of ocular melanoma in this family was sporadic, suggesting an etiology different from that of the skin tumors. The CDK4 mutation in the Norwegian family was identical to that in melanoma families in France, Australia, and England. Haplotype analysis using microsatellite markers flanking the CDK4 gene and single-nucleotide polymorphisms within the gene did not support the possibility that there was a common founder, but rather indicated at least two independent mutational events. All CDK4 melanoma families known to date have a substitution of amino acid 24. In addition to resulting from selection pressure, this observation may be explained by the CG dinucleotide of codon 24 representing a mutational hot spot in the CDK4 gene. © 2005 Wiley-Liss, Inc. [source] Atypical nevi of the scalp in adolescentsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 5 2007Giujeppe Fabrizi Background:, A few reports in the literature point out that in special areas of the body, nevi can have peculiar pseudomelanomatous features. In our routine work, we have met few examples of atypical nevi with peculiar features on the scalp of teenagers. To evaluate the frequency and the biological behaviour of these lesions, we have conducted a complete survey on melanocytic lesions on the scalp in a significant group of patients. Materials and methods:, Thirty-nine nevi of the scalp were from adolescents (12,18 years), 160 from adults, and 30 from children below the age of 12 years. Results:, About 10% of the melanocytic nevi of the scalp of adolescents have atypical cytological and architectural aspects that are different from those seen in Clark's dysplastic nevus. The most striking features were the presence of large bizarrely shaped nests scattered disorderly along the junction with follicular involvement. Other findings were pagetoid spread of cells above the junction and the discohesive pattern of the melanocytes in the nests. Mild cytological atypia was present but less significant. Such distinctive aspects are not found in nevi of the same site in adults or younger children. The general pattern of these atypical nevi of the scalp of adolescents closely recalls that of the so-called atypical nevi on special sites, i.e. nevi on mammary line, genitalia and body's folds. Despite the architectural and cytological atypia, clinical follow-up does not show any tendency to recur or proclivity to malignant behaviour. Conclusions:, Despite their similarities with melanoma, the nevi with atypical features of the scalp of adolescents are probably an entirely benign entity, at least at the moment of their excision. However, although benign, the relationship of this peculiar group of nevi with melanomas developed in adulthood remains entirely unknown, and the complete excision with conservative margins seems a recommendable procedure. [source] Histologic features of melanocytic nevi seen in association with mycosis fungoidesJOURNAL OF CUTANEOUS PATHOLOGY, Issue 10 2003Jennifer M. McNiff Background:, Many different tumors have been reported to occur simultaneously as collision lesions. To date, no such events have been reported between mycosis fungoides (MFs) and melanocytic neoplasms. Methods:, Two cases are presented in which patches of MF were superimposed on melanocytic nevi. In addition, 967 biopsies of MF from 411 patients were identified in an 8-year retrospective database search. Patient pathology history summaries were reviewed to identify inflamed nevi, atypical nevi, and melanoma submitted for histologic evaluation from this population. Results:, The occurrence of MF in a congenital nevus was associated with a halo phenomenon restricted to the affected region of the nevus in one patient. In the other patient, nests of two morphologies (lymphocytic and melanocytic) in the same biopsy presented a potentially confusing histologic picture. No other cases of MF superimposed on a nevus were identified in 967 biopsies from 411 patients with a histological diagnosis of MF seen over the past 8 years. In this population, 57 biopsies of melanocytic lesions were identified from 28 patients, including three atypical nevi and three melanomas. Conclusions:, The presence of MF superimposed on a nevus is rare and may lead to confounding histologic features or the development of a halo nevus phenomenon. [source] The effects of gp100 and tyrosinase peptide vaccinations on nevi in melanoma patientsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 5 2006David S. Cassarino Background:, A new approach to prevent disease recurrence in high-risk melanoma patients involves immunization with gp100 and tyrosinase peptides. This is the first study to examine the effects of such treatments on nevi. Design:, We studied biopsies of ,clinically atypical' nevi from 10 patients before and after peptide vaccination. All had a cutaneous melanoma measuring at least 1.5 mm in depth, satellite metastases, or at least one positive lymph node. We performed immunohistochemical stains for CD3, CD4, CD8, MHC-I, MHC-II, CD1a, HMB-45, MART-1, tyrosinase, bcl-2, p53, and Ki-67 (mib-1). Results:, Immunohistochemistry showed no differences in staining due to vaccination in either the immunologic or melanocytic markers. However, there was a significant increase in both p53 and bcl-2 staining, and a trend toward decreased Ki-67 staining, in the nevi post-treatment. Discussion:, The primary goal of peptide vaccinations with gp100 and tyrosinase is to activate melanoma-specific T cells in order to prevent melanoma recurrence. Nevi were studied in order to assess the effects on benign melanocytes. No significant changes in lymphocytes, langerhans cells, expression of MHC antigens, or melanocytic markers were found. The increase in p53 and bcl-2 raises the possibility that vaccination with melanocytic antigens stimulates a response in benign melanocytes. [source] | ||||||||||