Raffaella Vergani

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.

Relationship between cause of referral and diagnostic outcome in pigmented lesion clinics: a multicentre survey of the Italian Multidisciplinary Group on Melanoma (gipme)

&NA; Pigmented lesion clinics (PLCs) are permanent units to which subjects presenting with suspicious pigmented skin lesions can be rapidly referred and which can provide a prompt response to an individuals concern about melanoma. However, little is known about the melanoma detection rate in these clinics, in particular with regard to intermediate risk populations. We report a survey involving more than 1000 subjects consecutively referred by family doctors to six Italian PLCs. Using a histological diagnosis of melanoma as the endpoint, the pooled melanoma detection rate at these PLCs was 1.5% (one melanoma for diagnosed every 64 subjects examined), and the ratio between the number of melanomas and benign lesions excised for diagnostic verification was 1: 5.8 (16 melanomas and 93 benign lesions). Almost all the melanomas (15 out of 16) were detected in subjects who had requested referral for a specific doubtful lesion (group A) or for the presence of melanoma risk factors (previous melanoma, large number of common and atypical naevi, family history of melanoma) (group B). Only one melanoma was detected amongst the 418 subjects seeking consultation for concern about their moles (group C) (P = 0.004). The positive and negative predictive values of the referral groups A and B combined were 2.5% and 99.7%, respectively. Since the probability of detecting a melanoma in subjects referred only for reassurance about their moles, which nevertheless represented 43% of the subjects examined, is very low, an optimized role for PLCs in melanoma prevention would be to limit consultation to subjects who present for examination of a specific lesion or who have one or more risk factors for melanoma.

Observational study on the mitotic rate and other prognostic factors in cutaneous primary melanoma arising from naevi and from melanoma de novo

Melanomas can arise from naevi or appear de novo. The frequency or the effect of their origin on prognosis is still debated. Mitotic rate (MR) and ulceration of melanomas have been proposed as further new prognostic indexes.

Seborrheic Keratosis with Compound Nevus, Junctional Nevus and Basal Cell Carcinoma in the Same Lesion

Seborrheic keratosis can be associated with different neoplasms such as basal cell carcinomas, squamous cell carcinomas and melanomas. We describe an unusual case of a man who presented with a brown plaque on his back. The clinical diagnosis was melanoma. Histopathologic examination of the lesion revealed four neoplasms: a compound nevus, a junctional nevus, a superficial basal cell carcinoma and a seborrheic keratosis. Although this association most likely represents a chance phenomenon, we discuss the possibility that the seborrheic keratosis developed from the nevus, and that subsequently the junctional nevus and the basal cell carcinoma developed from the seborrheic keratosis.

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.

Acquired self‐healing Blaschko dermatitis in an adult

A 24‐year‐old woman with a 3 year history of Blasehkitis is presented. The dermatosis consisted of erythematous vesicular papules following Blasehkos lines on her left trunk. A moderate itching was described by the patient initially. Resolution occurred spontaneously after 3 months with hypopigmentation. Histological examination demonstrated a perivascular inflammatory infiltrate in the subpapillary dermis with lymphocytic exocytosis.

Giant nevoid hypertrichosis in an Iranian girl.

A 12‐year‐old Iranian girl and her father had an extensive congenital nevus consisting of long, black terminal hair involving the entire back and the posterior surface of the arms without pigmentary changes of the underlying skin. A physical examination revealed no other abnormalities. In this study the possibility of a genetically determined etiology is considered.

Plattenepithelkarzinom als Komplikation des Lupus vulgaris

ZusammenfassungDer Lupus vulgaris ist eine Form der Hauttuberkulose. Bei nicht korrekter Behandlung, führt ein chronisch-progressiver Verlauf zu Komplikationen wie Hauttumoren. Wir beschreiben einen 55-jährigen Patienten mit seit 10 Jahren an der linken Wange lokalisiertem, ulzeriertem und blutendem Lupus vulgaris und darin entwickeltem Plattenepithelkarzinom (PEK). Anhand der Literatur diskutieren wir die Ursachen, die noch heute zu einer so verspäteten Diagnose und Therapie geführt haben.AbstractLupus vulgaris represents a type of cutaneous tuberculosis that, if not correctly treated, presents a progressive chronic development whose long-term complications include cutaneous neoplasms. We report on a 55-year-old man presenting a 10-year-old ulcerated and bleeding lupus vulgaris lesion on the left cheek containing a squamous cell carcinoma. Reviewing the literature, we search for possible causes of delay in diagnosis that even now allowed therapy only after discovery of the tumoral complication.

Nodular melanomas: Analysis of the casistic and relationship with thick melanomas and diagnostic delay

The present study aimed to: (i) define thick melanomas related to nodular melanomas and other melanoma subgroups; and (ii) establish diagnostic delay in relation to the biological behavior of these melanomas and prevention programs. Cutaneous primary melanomas were studied. Nodular melanoma (NM), lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) were selected. A further category named vertical growth melanoma (VGM) was also utilized. Analysis for sex, age, different values of thickness (1–2 mm, >2 mm; 1–3 mm, >3 mm; >4 mm), delay to diagnosis and patterns of detection were performed in all of the different subtypes. Eighty‐seven patients with melanomas more than 1 mm of Breslows thickness out of 506 melanoma were collected. Twenty‐six were nodular cases, 39 SSM, five LMM and 17 VGM. Of those patients with NM, 42% had a thickness of more than 1–2 mm, 34% of 2–4 mm, 23% of more than 4 mm; and 54% with 1–3, 46% with more than 3 mm; and 58% with more than 2 mm. Even considering different values of thickness of more than 1 mm, a delay to diagnosis was significantly lower in NM (4.79 months) than in other subgroups. The value of more than 1 mm of Breslows thickness may be sufficient to consider a melanoma to be thick. The lower diagnostic delay of NM suggests that they represent faster growing lesions probably with a different biological behavior than other melanoma subtypes. VGM should not be confused with NM, having a longer delay and different clinical features compared with the latter. They represent an area of diagnostic carelessness than potentially be improved.

Relationship Between Cause Of Referral And Diagnostic Outcome In Pigmented Lesion Clinics Aimed To Melanoma Screening: A Multicenter Survey Of The Italian Multidisciplinary Group On Melanoma (Gipme)

BackgroundPigmented lesion clinics (PLCs) are a permanent structure for the rapid referral of subjects presenting suspicious pigmented skin lesions and they represent a prompt response to an individuals concern about melanoma. However, little is known about the actual melanoma detection activity of these clinics, in particular in intermediate risk populations. MethodsWe report a survey involving more than 1,000 subjects consecutively referred by family doctors to six italian PLCs. Diagnostic measures refer to histologic diagnosis of melanoma. ResultsOverall, the pooled melanoma detection rate at PLCs was 1.5% (one melanoma diagnosed every 64 subjects examined), and the ratio between the number of melanomas and benign lesions excised for diagnostic verification was 1: 5.8 (16/93). Almost all melanomas (15 out of 16) were detected in subjects who requested referral for a specific doubtful lesion (group A) or for presence of melanoma risk factors (previous melanoma, large number of common and atypical nevi, family history) (group B). Only 1 melanoma was detected in 418 subjects seeking consultation for concern about their moles (group C) (P=0.004). The positive and negative predictive values of the causes of referral A+B combined were 2.5%, and 99.7%, respectively. ConclusionsSince the very low probability of detecting a melanoma in subjects referred only for reassurance about their moles, which nevertheless represented 43% of the subjects examined, the optimized role of PLCs in melanoma prevention strategy would be reached by limiting consultation to subjects who present for examination of a specific lesion or who present one or more risk factors for melanoma.