11/54. Persistent and recurrent blue nevi.Persistence of common melanocytic nevi has been fairly well characterized, clinically and histologically. In contrast, persistence of blue nevi has been reported infrequently. To define this entity better, nine cases of biologically persistent and clinically recurrent blue nevi are described. The persistent lesions in four cases were spindle-fascicular blue nevi; one showed senescent or "ancient" change and one had additional deep penetrating/epithelioid blue nevus features with atypical changes worrisome for malignancy. These changes included increased cellularity, cellular pleomorphism, mitotic figures, and a lymphocytic infiltrate. Three were biphasic dendritic-sclerotic/spindle-fascicular blue nevi, one of which had atypical changes. One case was a dendritic-sclerotic ("common") blue nevus. The original histology in one case was unavailable, but the recurrence was a combined blue nevus. The interval from initial biopsy to biopsy of the recurrent lesion was often longer (mean 2.7 years) for recurrent blue nevi than for recurrent common compound or intradermal melanocytic nevi. In addition, in contrast to recurrent common melanocytic nevi, the recurrence, in at least one case, extended beyond the scar of the original excision. These cases demonstrated that blue nevi of all histiotypes and combinations are capable of persistence with clinical recurrence. The persistence usually was histologically similar to the original, but in some cases was more "cellular" because, for the most part, the excisions of the persistent lesion revealed a deeper spindle-fascicular ("cellular") component not evident in the original superficial biopsy. In two cases, the original blue nevus appeared completely banal, but the persistent/recurrent lesions were histologically distinct and demonstrated atypical histologic features. Yet, follow-up (average 3.7 years) supports benign biology. Clinical recurrence is often associated with malignant transformation in blue nevus, but this series demonstrates that malignant tumor progression is not necessarily the case. In the absence of necrosis en mass, marked cytologic atypia, and frequent mitotic figures, the described atypical morphologic parameters in previously biopsied small blue nevi are probably reactive and "pseudomalignant." awareness of this potential change may avoid diagnostic and prognostic errors.- - - - - - - - - - ranking = 1keywords = cell (Clic here for more details about this article) |
12/54. Large plaque-type blue nevus with subcutaneous cellular nodules.Unusual or atypical melanocytic nevi can be confused with malignant melanoma. The authors present two cases of an unusual variant of blue nevus that were misdiagnosed initially as malignancy. Both lesions were asymptomatic and characterized clinically by childhood onset, with slow enlargement during adolescence and subsequent nodule formation. One lesion, which measured 24 cm in greatest dimension, was located on the anterior chest wall of a 53-year-old woman. The other lesion, which measured approximately 15 cm in greatest dimension, was located on the lateral abdominal wall of a 20-year-old man. Both lesions were characterized by a multifocal dermal and subcutaneous proliferation of fusiform and dendritic pigmented melanocytes. The histologic appearance of individual foci ranged from dermal melanocytosis to common blue nevus and cellular blue nevus. The cellular foci were located in the subcutis and involved, in one patient, the stroma of the breast. The cells were immunoreactive for S-100 protein, gp100 (HMB-45), and Melan-A (A103). Ultrastructural analysis revealed melanocytes typical of blue nevus. The woman underwent complete excision of the lesion, and the man underwent only partial excision of the lesion. On clinical follow-up of 32 and 19 months, respectively, both patients are alive and well with no evidence of recurrence or progression. Because the lesions presented clinically as large plaques and were diagnosed histologically as blue nevi with subcutaneous foci of cellular blue nevus, we term this rare variant of blue nevus large plaque-type blue nevus with subcutaneous cellular nodules. Recognition of this lesion enhances our knowledge of the morphologic spectrum of melanocytic tumors and helps to avoid confusion with malignant melanoma.- - - - - - - - - - ranking = 2.25keywords = cell (Clic here for more details about this article) |
13/54. Multiple blue nevi of the vagina. A case report.BACKGROUND: Melanotic lesions of the vagina are very rare; clinically, most are suspected to be malignant melanomas. Occasional benign cases, however, require differential diagnostic consideration. We report a case of multiple (benign) blue nevi of the vagina. CASE: A 51-year-old woman presented with bluish black macules irregularly distributed throughout the vagina. Biopsies revealed pigmented cells in the dermis that proved to be melanocytes. The patient received no therapy. The lesions remained unchanged in the follow-up period. CONCLUSION: Multiple blue nevi could be a differential diagnosis for malignant melanoma of the vagina. Our patient showed no malignant transformation over a 29-year period. Therapy for blue nevi in the vagina does not require complete excision.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
14/54. A preliminary report of the treatment of blue nevus with dermal injection of riboflavin and exposure to near-ultraviolet/visible radiation (ribophototherapy).Dye lasers are useful for treating pigmented skin lesions, but their equipment is expensive and bulky. A simple and cheap phototherapy would be acceptable to dermatologists for treating pigmented skin lesions such as nevus of ota. We investigated as a pilot study whether dermal injection of riboflavin and exposure to near-ultraviolet/visible radiation (ribophototherapy) decreases the dermal pigment of blue nevi which are recalcitrant to laser therapy. The therapeutic efficacy was assessed by comparison of the amount of dermal pigment in hematoxylin-eosin specimens taken before and after treatment. pigmentation of the nevus became faint to the depth of 1 mm with little noticeable epidermal change after 21 treatments. At the deeper dermis somewhere between 3 and 4 mm from the epidermis, ballooning degeneration of the dermal cells was observed in hematoxylin-eosin specimens. Ribophototherapy is hopeful for treating pigmented skin lesions.- - - - - - - - - - ranking = 0.25keywords = cell (Clic here for more details about this article) |
15/54. Combined nevi of the conjunctiva.PURPOSE: To report the clinical and histologic features of combined nevi of the conjunctiva, a type of nevus that is not uncommon in the skin but has rarely been reported in the conjunctiva. methods: Conjunctival nevi and melanomas from the files of the University of california, san francisco, eye pathology laboratory were reviewed from 1984 to 1999 for the presence of features of both standard nevocytic nevi and blue nevi. Clinical histories and, when available, clinical photographs were obtained. RESULTS: Thirty-one combined nevi were discovered during the 15-year period between 1984 and 1999. One case before 1984 had been incorrectly diagnosed as a junctional nevus. The dendritic and spindle-shaped blue nevus cells had been overlooked because they were not recognized as distinct from the standard nevocytic nevus cells. The recognition of a blue as well as a brown color, a deep as well as a superficial component in the lesion, or a history of pigmentation since birth may help to establish the correct clinical diagnosis and prevent an unnecessarily deep surgical resection. Although growth of the lesion or "satellites" in some patients may favor a clinical diagnosis of melanoma, none of the lesions in this series were malignant. CONCLUSION: Despite a paucity of reports of combined nevi of the conjunctiva in the medical literature, this type of nevus--a combination of a nevocytic and a blue nevus--is common and has been overlooked in the past.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
16/54. Epithelioid blue nevus: a rare variant of blue nevus not always associated with the carney complex.Epithelioid blue nevus is a rare variant of blue nevus that has been recently described in patients with carney complex. Some of the patients with carney complex have multiple epithelioid blue nevi and a familial history of similar lesions is often recorded. Epithelioid blue nevus consists of an intradermal melanocytic nevus composed of polygonal epithelioid cells laden with melanin. Neoplastic cells show no maturation at the base of the lesion and, in contrast with the usual stromal changes in blue nevi, epithelioid blue nevus exhibits no fibrosis of the dermis. We have studied three cases of epithelioid blue nevus in three patients with no evidence of carney complex. The lesions were solitary and there was no family history of similar lesions. Therefore, epithelioid blue nevus is a distinctive variant of blue nevus that may also appear as a sporadic lesion and is not always associated with carney complex.- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
17/54. Cellular blue naevus of the scalp with brain invasion.A case of a 28 year old woman with an intracranial cellular blue naevus (CBN) which was believed to be the extension from a pigmented skin/scalp lesion is reported. There was no similar pigmented skin lesion noted on other parts of her body. Radical intervention, including wide excision of the affected skin of the scalp, removal of the underlying pigmented skull bone and wide excision of the pigmented dura, together with wide excision of the intracranial mass, were performed. The skin defect was covered by rotation flap and free skin graft. The dura was closed by grafting with fascia lata. The skull defect was left open and would be repaired later at a second planned surgery.- - - - - - - - - - ranking = 361776.21019889keywords = naevus, cell (Clic here for more details about this article) |
18/54. Giant cellular blue nevus of the anterior chest wall mimicking metastatic melanoma to the breast: a case report.BACKGROUND AND OBJECTIVES: Blue nevi are benign pigmented dermal lesions that can mimic cutaneous melanoma in appearance. Cellular components may infiltrate subcutaneous tissue. We present a complex case of cellular blue nevus (CBN) to demonstrate the ambiguous clinical appearance of these lesions and to provide an approach for management of such cases. methods: We report an extraordinary case of CBN mimicking metastatic melanoma to the breast. A 53-year-old female with an acquired giant blue nevus of the chest wall was found to have two new breast nodules suspicious for malignancy on routine mammography. These were biopsied and interpreted as consistent with metastatic melanoma vs. CBN. The patient underwent complete excision of the chest wall nevus and modified radical mastectomy. RESULTS: Pathologic evaluation of the chest wall specimen revealed numerous collections of deeply pigmented melanocytes scattered throughout the breast parenchyma and embracing ductal structures. No mitoses or nuclear polymorphism were seen. The diagnosis of CBN involving the chest, breast tissue and axillary lymph nodes was made. CONCLUSION: Giant blue nevi overlying the breast can develop cellular components that infiltrate subcutaneous and breast tissue resulting in the appearance of breast nodules on mammography. A generous excision biopsy inclusive of the overlying nevus and breast component may be required to establish the dignity of the lesion.- - - - - - - - - - ranking = 1.5keywords = cell (Clic here for more details about this article) |
19/54. Malignant melanoma arising from unusual conjunctival blue nevus.Cellular blue nevus is an uncommon pigmented tumor in the conjunctiva, where it generally appears as a deep, circumscribed, pigmented conjunctival mass. We report a case of conjunctival blue nevus that clinically resembled primary acquired melanosis and gave rise to conjunctival melanoma. A 41-year-old man developed a diffuse pigmented mass in the inferior fornix of his left eye. Over a 20-year period, he noted slight progression of the pigment. Foci of epibulbar pigmentation were also present. The lesion resembled primary acquired melanosis. Excisional biopsy and adjuvant cryotherapy were performed. Histopathologic examination disclosed an intense infiltrate of heavily pigmented dendritic melanocytes with aggregates of less pigmented plump cells in the substantia propria. The conjunctival epithelium was normal. Malignant cellular features consistent with melanoma were observed in some foci. Cellular blue nevus of the conjunctiva can simulate primary acquired melanosis and can give rise to malignant melanoma. Arch Ophthalmol. 2000;118:1581-1584- - - - - - - - - - ranking = 0.5keywords = cell (Clic here for more details about this article) |
20/54. Pedunculated atypical cellular blue nevus.Atypical variants of cellular blue nevus are considered to have features intermediate between typical cellular blue nevus and rare malignant blue nevus; they usually show bizarre pleomorphic cells which have prominent nucleoli. We describe a 37-year-old-Korean woman who had had an asymptomatic pedunculated single mass on her right thigh for 17 years. A skin biopsy showed a tumor consisting of intensely pigmented dendritic cells and less or nonpigmented epitheloid cells in the dermis with striking atypia. There has been no evidence of recurrence for 3 years after surgery. The diagnosis of atypical cellular blue nevus was made on the basis of clinical features and skin biopsy findings.- - - - - - - - - - ranking = 2.5keywords = cell (Clic here for more details about this article) |
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