Elena Inselvini

Basal cell carcinomas of covered and unusual sites of the body

Background The concept of unusual site for a basal cell carcinoma (BCC) has to be defined because there is much confusion about it. Basal cell carcinomas of covered areas of the body are sometimes considered as unusual because of their location. In this study an attempt is made to define what is an unusual site for a BCC according to experience and the problems encountered are briefly discussed.

Small Congenital Nevi Associated with Melanoma: Case Reports and Considerations

Melanocytic nevi, both congenital and acquired, are considered to be precursors of melanomas. Data about the malignant potential of these nevi are conflicting, particularly with reference to the nevus of the smallest size. Patients with preexisting melanocytic nevi (both congenital and acquired) have risks of developing melanoma that differ from those of subjects without them. The purpose of this study was to verify the presence of melanoma in preexisting nevi both congenital (congenital nevus associated melanoma) (CNAM) and acquired (ANAM). In particular, we investigated melanomas associated with small congenital nevi (SCN). A cohort of 190 patients with primary melanomas was studied. Congenital nevi were called “small” (SCN) when their diameters were less than 1.5 cm. Epiluminescence microscopy (ELM) was performed to further improve the clinical diagnosis and to observe the more subtle changes in the preexisting nevi. Forty of the 190 cases of melanoma were associated with preexisting nevi; of these, 15 had congenital features with a CNAM largest diameter of 1.5 cm. These 15 cases were melanomas of the superficial type with a mean tumor thickness lower than that of ANAM (0.33 vs 1.50). There were no differences between the locations of CNAM and other melanomas. Male patients were significantly more affected. ELM microscopy permitted us to detect the early malignant changes in nevi and thus to improve our diagnosis. A high percentage of small congenital nevi were found to be associated with melanomas. They may be considered as melanomas precursors. Because of their large number and frequency, prophylactic removal of all SCN is not feasible. However, they should be removed as soon as possible when clinical or ELM changes are observed.

Agminated intradermal Spitz nevi arising on an unusual speckled lentiginous nevus with localized lentiginosis : A continuum?

We report an 18-year-old boy with a congenital pigmented lesion measuring 2 x 6 cm on his right thigh. About a third of the lesion was composed of numerous lentiginous macules superimposed on histologically normal and clinically nontan skin; in the remainder of the lesion, several macules and papules with histologic features of junctional and compound nevi were superimposed on clinically normal skin, which had a lentiginous pattern histologically. Some years later, eruptive intradermal Spitz nevi developed at one corner of the lesion. The combined clinical and histological features of the lesion fulfill descriptions for both segmental lentiginosis and an unusual variant of speckled lentiginous nevus. Our case points out the limitations of using strict diagnostic criteria to define speckled lentiginous nevus and offers an opportunity to consider the natural history of the lesion as a continuum from lentigines to melanocytic nevi. Moreover, the presence of eruptive intradermal Spitz nevi arising within the area of speckled lentiginous nevus lacking a distinct tan background, suggests the possibility that the entire area of the lesion per se constitutes an environment where development of nevi is enhanced.

Giant Basal Cell Carcinomas: Report of Four Cases and Considerations

Four cases of giant basal cell carcinoma (BCC) are reported and the problems of giant BCCs are briefly discussed. In particular, we consider the relationship between the size of the tumor and its clinical behaviour. The importance of the site location in tumor development, the histologic subtypes involved, the associated findings, and problems of treatment are also discussed.

Agminate and Plaque-Type Blue Nevus Combined with Lentigo, Associated with Follicular Cyst and Eccrine Changes: A Variant of Speckled Lentiginous Nevus

Agminate and plaque-type blue nevi are rarely described. We report the occurrence of such a type of blue nevus associated with eccrine changes and a follicular cyst all arising on a macular brown background in a 38-year-old man. The patient presented numerous blue papules and a plaque, overlapping a light tan patch present since birth, on his left thigh. In addition, within the plaque, 3 papules, discharging at intervals a serous fluid, were present. Since the lesion hardened and enlarged, it was surgically excised. Histologic findings revealed a lentigo pattern of the epidermis, corresponding to the light tan macular background and a plaque-type blue nevus, and areas of eccrine ductal proliferations with a ruptured follicular cyst. The association of agminate and plaque-type blue nevus, arising on a light brown patch of lentigo, might represent a variant of speckled lentiginous nevus. Eccrine proliferations may be reactive in nature or represent a more complex hamartomatous lesion. The possibility of malignant transformation and the recent enlargement of the lesion caused by the ruptured follicular cyst convinced us to carry out a wide surgical excision.

Blue nevi and basal cell carcinoma within a speckled lentiginous nevus

We describe an unusual case of blue nevi and basal cell carcinoma arising within a speckled lentiginous nevus and discuss the relationship between epithelial tumors and nevoid growth of melanocytes.

Symmetrical, papular, eruptive auricular collagenomas

Collagenomas are connective tissue nevi of the skin consisting of excessive deposition of collagen in the dermis. We describe a patient with acquired eruptive collagenomas located on both ears. Histologically, thickening of the dermis, caused by collagen deposition was present.

Extensive unilateral speckled lentiginous nevus.

We report a case of speckled lentiginous nevus with extensive unilateral distribution in a 53-year-old man. The lesions involved the left back, extending from the midline anteriorly to the thorax, arm, and forearm. The background pigmentary patch covered only the back and upper arm. Histologic examination revealed a lentiginous pattern as well as a congenital nevocytic pattern, even in the areas where the background was nontanned skin. This combined clinical pattern in the same patient fits the descriptions for both the usual and unusual speckled lentiginous nevus. Cases with variants of extensive unilateral distribution are infrequent and pathologists should pay particular attention to them because of the possibility of their malignant transformation.

Sebaceoma arising in association with seborrheic keratosis

We report a case of a 60-year-old woman with a 4-year history of an asymptomatic plaque on her left cheek. The lesion was composed of two distinct adjacent and continuous parts comprising a lateral yellowish flat portion and a medial reddish nodular portion. Histologic examination revealed that the plaque was composed of two different adjacent tumors. The lateral portion of the plaque had the aspect of a seborrheic keratosis (SK) with hyperkeratosis and acanthosis with irregular proliferation of apparently benign basaloid and squamous keratinocytes and small horn pseudocysts. The medial portion showed a dermal tumor made up of differently sized lobules composed of immature sebocytes mixed with single or clustered mature sebaceous cells. Sebaceous ductal differentiation was visible. We made the diagnosis of SK associated with sebaceoma. The association of an SK with a benign neoplasm with sebaceous differentiation is rare. It may only be a coincidence, but a role for the preexisting SK cannot be ruled out.

Successful Cryotherapic Treatment and Overview of Multiple Clear Cell Acanthomas

BACKGROUND Clear cell acanthoma (CCA) is a usually solitary benign epidermal tumor. Multiple lesions are infrequently reported. OBJECTIVE A case of multiple eruptive CCA is reported in which a successful cryotherapic treatment was performed. METHODS A 59‐year‐old man with varicose veins and dry skin presented with 17 eruptive asymptomatic papulonodular lesions on both legs. RESULTS Two lesions were excised with a histologically confirmed diagnosis of CCA. Other lesions were treated with liquid nitrogen. All the lesions resolved with minimal residual scarring after three to four treatments. CONCLUSIONS Multiple CCA is a rare condition; fewer than 20 cases having been described. The presence of associated conditions like dry skin and varicose veins are discussed. Because of the tendency of persistence of the lesions, cryotherapic treatment may be a useful method of therapy.