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Pigmented Lesions

  • José Carlos Santos Mariante
  • Gabriela Fortes Escobar
Chapter

Abstract

In this chapter we define pigmented lesions and their differences between melanocytic lesions. Physicians are continuously consulted regarding tumors or tumor-like lesions of the skin, because of their high frequency and the public concern regarding skin cancer. Furthermore, their importance lies predominantly in the cosmetic defect they may create or in their occasional association with systemic disease. Considering these facts, it is important establish their types, origins, features, differences, and instruments for diagnosis and treatment.

Keywords

Pigmented lesions Melanocytic nevi Skin tumors Congenital melanocytic nevi Halo nevus Nevus spilus Becker’s nevus Freckles Lentigines Mongolian spots Blue nevi Spitz nevus Reed tumor Recurrent nevus Atypical nevus 

Notes

Glossary

Cryotherapy

A technique that uses an extremely cold liquid or instrument to freeze and destroy abnormal skin cells that require removal.

Electrolysis

Electrochemical process whereby current is passed between two electrodes through an ionized solution (electrolyte) to deposit positive ions (anions) on the negative electrode (cathode) and negative ions (cations) on the positive electrode (anode). It is used for removing unwanted hair by destroying the hair root.

Hydroquinone

An aromatic organic compound that is a type of phenol, having the chemical formula C6H4(OH)2. It is prescribed to reduce pigmentation of the skin in certain conditions whereby an excess of melanin causes hyperpigmentation.

HMB-45

A monoclonal antibody that reacts against an antigen present in melanocytic tumors such as melanomas. The use of immunohistochemistry with melanocytic markers such as HMB-45 and Melan A, increases the detection rate of micrometastases.

Ki-67

The Ki-67 protein (also known as MKI67) is a cellular marker for proliferation. It is strictly associated with cell proliferation.

Leptomeningeal melanocytosis

The excessive deposit of melanin by increasing the number of melanocytes, usually seen as a signal in the convexities of subarachnoid spaces, or brain parenchyma such as cerebellum, temporal lobes, pons, and medulla on noncontrast images.

Melanocytic

A type of lesion that contains nevus cells (a type of melanocyte).

Peeling

Peeling skin, called desquamation in medical terms, can be caused by different conditions. Very often, skin peels following chemical, thermal, or sunburn, with the latter being the most common cause.

Pseudopodia

Cytoplasmic structures found in some eukaryotes. Pseudopods are one of the three locomotion modes of unicellular organisms (together with flagella and cilia). Pseudopods can also capture prey by phagocytosis.

Tyrosinase

An oxidase that is the rate-limiting enzyme for controlling the production of melanin.

References

  1. 1.
    Hurwitz S. Cutaneous tumors in childhood. In: Hurwitz S (Org.). Clinical pediatric dermatology: a textbook of skin disorders of childhood and adolescence. Philadelphia: W.B. Saunders Company; 1993. p. 198–241.Google Scholar
  2. 2.
    Walton RG, Jacobs AH, Cox AJ. Pigmented lesions in newborn infants. Br J Dermatol. 1976;95:389–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Mishima Y. Macromolecular changes in pigmentary disorders. Arch Dermatol. 1965;91:519–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Masson P. My conception of cellular nevi. Cancer. 1951;4:9–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Braun RP, Rabinovitz HS, Oliviero M, Kopf AW, Saurat JH. Dermoscopy of pigmented skin lesions. J Am Acad Dermatol. 2005;52:109–21.CrossRefPubMedGoogle Scholar
  6. 6.
    Barnhill RL, Rabinovitz H. Neoplasias Melanocíticas Benignas. In: Bolognia JL, Jorizzo JL, Rapini RP (Org.). Dermatologia. São Paulo: Elsevier; 2011. p. 1713–40.Google Scholar
  7. 7.
    Rhodes AR, Sober AJ, Day CL. The malignant potential of small congenital nevocellular nevi: Na estimate based on histologic study of 234 primary cutaneous melanomas. J Am Acad Dermatol. 1982;6:230–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Illig L, Weidner F, Hundeiker M, et al. Congenital nevi <10 cm as precursors to melanoma. Arch Dermatol. 1985;121:1274–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Hurwitz S. Pigmented nevi: semin. Dermatology. 1988;7:17–25.Google Scholar
  10. 10.
    Rhodes AR, Mihm MC Jr. Origin of cutaneous melanoma in a congenital dysplastic nevus spilus. Arch Dermatol. 1990;126:500–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Cohen PR. Becker’s nevus. Am Fam Physician. 1988;37:221–6.PubMedGoogle Scholar
  12. 12.
    Fretzin DF, Whitney D. Familial Becker’s nevus. J Am Acad Dermatol. 1985;12:589–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Glinick SE, Alper JC, Bogaars H, et al. Becker’s melanosis: associated abnormalities. J Am Acad Dermatol. 1980;9:509–14.CrossRefGoogle Scholar
  14. 14.
    Tse Y, Levine VJ, McClain SA, Ashinoff R. The removal of cutaneous pigmented lesions with the Q-switched ruby laser and the Q-switched Nd:YAG laser: a comparative study. J Dermatol Surg Oncol. 1994;20:795–800.CrossRefPubMedGoogle Scholar
  15. 15.
    Jimbow K, Szabo G, Fitzpatrick TB. Ultrastructure of giant pigment granules (macromelanosomes) in cutaneous pigmented macules of neurofibromatosis. J Invest Dermatol. 1973;61:300–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Cole HN Jr, Hubler WR, Lund HZ. Persistent, aberrant Mongolian spots. Arch Dermatol Syph. 1950;61:244–60.CrossRefGoogle Scholar
  17. 17.
    Chan HH, Ying SY, Ho HS, et al. An in vivo trial comparing the clinical efficacy and complications of Q-switched 755 nm alexandrite and Q-switched 1064 nm Nd:YAG lasers in treatment of nevus of Ota. Dermatol Surg. 2000;26:919–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Spitz S. Melanomas of childhood. Am J Pathol. 1948;24:591–602.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Arbuckle S, Weedon D. Eosinophilic globules in the Spitz nevus. J Am Acad Dermatol. 1982;7:324–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Paniago-Pereira C, Maize JC, Ackerman AB. Nevus of large spindle and/or epithelioid cells (Spitz’s nevus). Arch Dermatol. 1978;114:1811–23.CrossRefPubMedGoogle Scholar
  21. 21.
    Hauschild A, Egberts F, Garbe C, Bauer J, Grabbe S, Hamm H, et al. Melanocytic nevi. J Dtsch Dermatol Ges. 2011;9(9):723–34.PubMedGoogle Scholar
  22. 22.
    King R, Hayzen BA, Page RN, Googe PB, Zeagler D, Mihm MC Jr. Recurrent nevus phenomenon: a clinicopathologic study of 357 cases and histologic comparison with melanoma with regression. Mod Pathol. 2009;22:611–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Fox JC, Reed JA, Shea CR. The recurrent nevus phenomenon: a history of challenge, controversy, and discovery. Arch Pathol Lab Med. 2011;135:842–6.PubMedGoogle Scholar
  24. 24.
    Tschandl P. Recurrent nevi: report of three cases with dermatoscopic-dermatopathologic correlation. Dermatol Pract Concepts. 2013;3:29–32.Google Scholar
  25. 25.
    Kelly JW, Shen S, Pan Y, Dowling J, McLean CA. Postexcisional melanocytic regrowth extending beyond the initial scar: a novel clinical sign of melanoma. Br J Dermatol. 2014;170:961–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Sommer LL, Barcia SM, Clarke LE, Helm KF. Persistent melanocytic nevi: a review and analysis of 205 cases. J Cutan Pathol. 2011;38:503–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Dummer R, Kempf W, Burg G. Pseudomelanoma after laser therapy. Dermatology. 1998;197:71–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Blum A, Hofmann-Wellenhof R, Marghoob AA, Argenziano G, Cabo H, Carrera C, et al. Recurrent melanocytic nevi and melanomas in dermoscopy: results of a multicenter study of the International Dermoscopy Society. JAMA Dermatol. 2014;150:138–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Botella-Estrada R, Nagore E, Sopena J, Cremades A, Alfaro A, Sanmartín O, et al. Clinical, dermoscopy and histologic correlation study of melanotic pigmentations in excision scars of melanocytic tumours. Br J Dermatol. 2006;154:478–84.CrossRefPubMedGoogle Scholar
  30. 30.
    Hoang MP, Prieto VG, Burchette JL, Shea CR. Recurrent melanocytic nevus: a histologic and immunohistochemical evaluation. J Cutan Pathol. 2001;28:400–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Neoplasms of the skin. In: Bolognia JL, Schaffer JV, Duncan KO, Ko CJ, editors. Dermatology essentials. EUA: Elsevier; 2014. p. 892–928.Google Scholar
  32. 32.
    Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part I. J Am Acad Dermatol. 2012;67:1.e1–16.CrossRefGoogle Scholar
  33. 33.
    Antonio JR, Soubhia RM, D’Avila SC, Caldas AC, Trídico LA, Alves FT. Correlation between dermoscopic and histopathologic diagnoses of atypical nevi in a dermatology outpatient clinic of the Medical School of São José do Rio Preto, SP, Brazil. An Bras Dermatol. 2013;88:199–203.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Kim CC, Swetter SM, Curiel-Lewandrowski C, Grichnik JM, Grossman D, Halpern AC, et al. Addressing the knowledge gap in clinical recommendations for management and complete excision of clinically atypical nevi/dysplastic nevi: pigmented lesion subcommittee consensus statement. JAMA Dermatol. 2015;151:212–8.CrossRefPubMedGoogle Scholar
  35. 35.
    NIH Consensus Development Conference. Diagnosis and treatment of early melanoma. Consens Statement. 1992;10:1–25.Google Scholar
  36. 36.
    Clark WHJ, Reimer RR, Greene M, Ainsworth AM, Mastrangelo MJ. Origin of familial malignant melanomas from heritable melanocytic lesions: “The B-K mole syndrome”. Arch Dermatol. 1978;114:732–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Lynch HT, Fusaro RM, Pester J, Lynch JF. Familial atypical multiple mole melanoma (FAMMM) syndrome: genetic heterogeneity and malignant melanoma. Br J Cancer. 1980;42:58–70.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Elder DE, Goldman LI, Goldman SC, Greene MH, Clark WH Jr. Dysplastic nevus syndrome: a phenotypic association of sporadic cutaneous melanoma. Cancer. 1980;46:1787–94.CrossRefPubMedGoogle Scholar
  39. 39.
    Rigel DS, Rivers JK, Friedman RJ, Kopf AW. Risk gradient for malignant melanoma in individuals with dysplastic naevi. Lancet. 1988;1:352–3.CrossRefPubMedGoogle Scholar
  40. 40.
    Reimer RR, Clark WH Jr, Greene MH, Ainsworth AM, Fraumeni JF Jr. Precursor lesions in familial melanoma. A new genetic preneoplastic syndrome. JAMA. 1978;239:744–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Eur J Cancer. 2005;41:28–44.CrossRefPubMedGoogle Scholar
  42. 42.
    Tucker MA, Halpern A, Holly EA, Hartge P, Elder DE, Sagebiel RW, et al. Clinically recognized dysplastic nevi. A central risk factor for cutaneous melanoma. JAMA. 1997;277:1439–44.CrossRefPubMedGoogle Scholar
  43. 43.
    Hofmann-Wellenhof R, Blum A, Wolf IH, Piccolo D, Kerl H, Garbe C, et al. Dermoscopic classification of atypical melanocytic nevi (Clark nevi). Arch Dermatol. 2001;137:1575–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Clemente C, Cochran AJ, Elder DE, Levene A, MacKie RM, Mihm MC, et al. Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme. Hum Pathol. 1991;22:313–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Tsao H, Bevona C, Goggins W, Quinn T. The transformation rate of moles (melanocytic nevi) into cutaneous melanoma: a population-based estimate. Arch Dermatol. 2003;139:282–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Lin WM, Luo S, Muzikansky A, Lobo AZ, Tanabe KK, Sober AJ, et al. Outcome of patients with de novo versus nevus-associated melanoma. J Am Acad Dermatol. 2015;72:54–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Fuller SR, Bowen GM, Tanner B, Florell SR, Grossman D. Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma. Dermatol Surg. 2007;33:1198–206.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Arumi-Uria M, McNutt NS, Finnerty B. Grading of atypia in nevi: correlation with melanoma risk. Mod Pathol. 2003;16:764–71.CrossRefPubMedGoogle Scholar
  49. 49.
    Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part II. J Am Acad Dermatol. 2012;67:19.e1–12.CrossRefGoogle Scholar
  50. 50.
    Halpern AC, Guerry D 4th, Elder DE, Trock B, Synnestvedt M, Humphreys T. Natural history of dysplastic nevi. J Am Acad Dermatol. 1993;29:51–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Barr RJ, Linden KG, Rubinstein G, Cantos KA. Analysis of heterogeneity of atypia within melanocytic nevi. Arch Dermatol. 2003;139:289–92.CrossRefPubMedGoogle Scholar
  52. 52.
    Strazzula L, Vedak P, Hoang MP, Sober A, Tsao H, Kroshinsky D. The utility of re-excising mildly and moderately dysplastic nevi: a retrospective analysis. J Am Acad Dermatol. 2014;71:1071–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Hocker TL, Alikhan A, Comfere NI, Peters MS. Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border. J Am Acad Dermatol. 2013;68:545–51.CrossRefPubMedGoogle Scholar
  54. 54.
    Silva JH, Sá BC, Avila AL, Landman G, Duprat Neto JP. Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma – review article. Clinics (Sao Paulo). 2011;66:493–9.CrossRefGoogle Scholar

Suggested Literature

  1. Farber MJ, Heilman ER, Friedman RJ. Dysplastic nevi. Dermatol Clin. 2012;30:389–404.CrossRefPubMedGoogle Scholar
  2. Kittler H, Tschandl P. Dysplastic nevus: why this term should be abandoned in dermatoscopy. Dermatol Clin. 2013;31:579–88.CrossRefPubMedGoogle Scholar
  3. Marghoob AA. Recurrent (persistent) nevi. In: Marghoob AA, Malvehy J, Braun RP, editors. Atlas of dermoscopy. London: Informa Healthcare; 2012. p. 198–202.CrossRefGoogle Scholar
  4. Nestle FO, Halpern AC. Melanoma. In: Bolognia JL, Jorizzo JL, Rapini RP (Org.). Dermatology. EUA: Elsevier; 2008. p. 1745–70.Google Scholar
  5. Rosendahl CO, Grant-Kels JM, Que SK. Dysplastic nevus: fact and fiction. J Am Acad Dermatol. 2015;73:507–12.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • José Carlos Santos Mariante
    • 1
  • Gabriela Fortes Escobar
    • 2
  1. 1.Dermatology of Mãe de Deus CenterPorto AlegreBrazil
  2. 2.Dermatology Service of Hospital de Clínicas de Porto AlegrePorto AlegreBrazil

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