Melanocytic Nevi and Benign Melanocytic Proliferations
- Reeck MC, Chuang T-Y, Eads TJ, et al [Indiana Univ, Indianapolis; Roudebush
Veterans Affairs Med Ctr, Indianapolis, Ind]
The Diagnostic Yield in Submitting Nevi for Histologic Examination
J Am Acad Dermatol 40: 567-571, 1999
Clinically diagnosed benign pigmented lesions after removal are subjected to histologic study. Clinical confidence has to be balanced against pathological evaluation especially for possible malignant disease. Cost effectiveness thus enters the picture. 7734 skin biopsy records revealed 1946 referred as pigmented nevi. Out of these 45 showed malignancy. 12 represented melanomas, 30 basal cell carcinomas and 3 squamous cell carcinomas. Generally when non-dermatologists submitted the tissue chances of malignancy was 3.8% against 1.3% for the dermatologist. Additive descriptions viz. atypical irritated or possible malignancy by dermatologists increased the harvest rate of malignant change.
As long as routine staining e.g. HE is persevered with by the pathologist the procedure remains cost effective.
- Shea CR, Vollmer RT, Prieto VG [Duke Univ, Durham, NC]
Correlating Architectural Disorder and cytologic Atypia in Clark [Dysplastic] Melanocytic Nevi
Hum Pathol 30: 500-505, 1999
470 melanocytic nevi were examined between April and August of 1997. 166 were regarded as Clark Nevi [CN] . The diagnosis was based on extension of junctional component for 3 surrounding rete ridges beyond dermal components of fibrosis and inflammation.
The 166 specimens represented 122 subjects [mean age 32]. The lesions were located on the trunk, shoulder, or gluteal region in 47%, 67% were diagnosed as atypical, dysplastic, unusual growing or changing.
Abnormalities were confluence of junctional melanocytes [58%], absence of nest-formation on one or both sides [ 57%], and single cell proliferation [ 48%]. Nuclear abnormal shape or staining pattern was seen in 48%, larger cell size [ [62%] and hypertrophic nucleus [ 25%]. Hyperplastic nucleoli and hyperchromasia were absent.
Cell and nuclear behavior different from normal but not tantamount to malignancy in addition to architectural changes were observed.
- Snels DGCTM, Hille ETM, Gruis NA, et al [ Leiden Univ, The Netherlands]
Risk of Cutaneous Malignant Melanoma in Patients with Nonfamilial Atypical Nevi From a Pigmented Lesions Clinic
J Am Acad Dermatol 40: 686-693, 1999
This paper evaluates the risk of melanoma grising from non familial Atypical Nevi [AN], at a Pigmented Lesion Clinic [PLC] since inception in 1982, as a part of the Department of Dermatology. Each patient was photographed at yearly examinations. The type of lesion, histologic data to confirm or exclude AN was recorded, skin type and the age of discovery of a melanoma if it had occurred were noted. Those developing later were recorded, and compared
with data of Netherlands upto 1991.
Average age of entry was 29 years and the group of 195 comprised 98 men and 97 women. 147 of these visited the clinic and 48 were in communication. AN were distributed on the lower extremities of women more than men. Men had larger number of lesions and more on the trunk neck and head.
The total number of nevi measuring 5 mm or more was 2147. The number of AN in 147 subjects was 1433 [Male > Female]. Most patients had a type II skin. Those presenting with a melanoma at entry [n=14] and those having it and removed earlier [n=15] were excluded. If the risk of invasive melanoma in AN patients without any history of melanoma was 37 that for subjects with such a history was 41.
Patients with atypical nevi in a nonfamilial setting are at an increased risk of developing invasive melanoma. Location of the two are similar.
- Weinstock MA, Brodsky GL [VA Med Ctr, Providence, Rl; Rhode Island Hosp, Providence; Brown Univ, Providence, Rl; et al]
Bias in the Assessment of Family History of Melanoma and Its Association with Dysplastic Nevi in a Case-Control Study
J Clin Epidemiol 51: 1299-1303, 1998
Subjects with a family history of melanoma have a greater propensity for dysplastic nevi. How reliable is the propositor’s history? An attempt at evaluation is the subject of this paper. A total of 722 took part. 592 dysplastic nevi and 130 melanoma patients with age and sex matched controls comprised the study material. The first step was a question of melanoma in the family. If the answer was positive for a first or second degree relative permission to contact the member was taken. If the family member confirmed it request for getting medical records was made.
314 subjects [15%] gave a positive history of melanoma in the family. 76 of these [24%] confirmed the Proband’s history and in 39 patients [12%] the medical records affirmed the statement. Contact was made with 59% of first degree relatives and 48% refuted the presence of melanoma. Contacting second degree relatives proved of little value. Medical records gave a 17% positive rate. Thus relying on the propositor’s report of family history of melanoma proves to be inaccurate.
- Giam Y-C, Williams ML, LeBoit PE, et al [ Univ of California, San Francisco; New York Univ; Univ of California, San Diego]
Neonatal Erosions and Ulcerations in Giant Congenital Melanocytic Nevi
Pediatr Dermatol 16: 354-358, 1999
Any erosion or ulceration on a congenital melanocytic nevus is always suspected to represent a melanoma unless proved otherwise.
10 infants had giant melanocytic lesions located on the lumbosacral region, except one who had it on the occipital region. Erosions or ulcers were present at birth or developed within 2 or 3 days of it. They sat a top the thickest portion, and were single or multiple. In one a satellite nodule was affected thus. They healed spontaneously but 3 needed antibiotic therapy.
Histopathology of erosive lesions revealed and absent epidermis. Fibrin and neutrophils occupied this zone. With deeper ulcers granulating tissue and fibrosis were characteristic. The nevic component was made up small round melanocytes extending into the reticular dermis.
MRI in 4 of the ten infants revealed neurocutaneous melanosis.
Despite the absence of melanoma in these patients a biopsy of such lesions is a necessity if only to reassure the parents