No abstract available.
Dysplastic Nevus Syndrome*

BACKGROUND: The role of the phosphatidylinositol-3 kinase signaling pathway in the development of acral melanoma has recently gained evidence. Phosphatase and tensin homologue (PTEN), one of the key molecules in the pathway, acts as a tumor suppressor through either an Akt-dependent or Akt-independent pathway. Akt accelerates degradation of p53. OBJECTIVE: We assessed the expression of PTEN, phospho-Akt (p-Akt), and p53 by immunohistochemistry in benign acral nevi, acral dysplastic nevi, and acral melanomas in the radial growth phase and with a vertical growth component. METHODS: Ten specimens in each group were included. Paraffin-embedded specimens were immunostained with antibodies for PTEN, p-Akt, and p53. We scored both the staining intensity and the proportion of positive cells. The final score was calculated by multiplying the intensity score by the proportion score. RESULTS: All specimens of benign acral nevi except one showed some degree of PTEN-negative cells. The numbers of p-Akt and p53-positive cells were higher in acral dysplastic nevi and melanoma than in benign nevi. P-Akt scores were 1.7, 1.8, 2.6, and 4.4, and p53 scores were 2.0, 2.1, 3.8, and 4.1 in each group. PTEN and p-Akt scores in advanced acral melanoma were higher than in the other neoplasms. CONCLUSION: The expression of PTEN was decreased and the expression of p-Akt was increased in acral melanoma, especially in advanced cases. The PTEN-induced pathway appears to affect the late stage of melanomagenesis. Altered expression of p-Akt is thought to be due to secondary changes following the loss of PTEN.
Antibodies ; Dysplastic Nevus Syndrome* ; Immunohistochemistry ; Melanoma ; Nevus* ; Phosphotransferases

BACKGROUND: Melanomas need to be differentiated from benign melanocytic lesions during diagnosis. However, it is difficult to differentiate them using histopathology alone, since both neoplasms have broad morphological spectrums and subtle differentiating features. OBJECTIVE: To evaluate the usefulness of Ki-67/Melan-A double staining for differentiating melanoma from benign melanocytic nevi. METHODS: We selected 20 cases of intradermal nevi, 20 cases of compound nevi, 5 cases of dysplastic nevi, and 25 cases of melanoma from clinicopathologically proven cases reviewed by the Department of Dermatology at our medical center. Ki-67/Melan-A double staining was performed, and the Melan-A verified Ki-67 index (Ki-67-M index) and Ki-67 index were measured. The immunopositivity was measured in the deepest third of the lesions. RESULTS: The Ki-67-M index of intradermal nevi, compound nevi, dysplastic nevi, and melanoma were 0.4+/-0.9%, 1.0+/-1.1%, 4.3+/-1.7%, and 24.1+/-10.9%, respectively. The best Ki-67/Melan-A cut-off point to distinguish melanomas from benign melanocytic nevi was 5%; the sensitivity and specificity were 100% and 97.7%, respectively. Immunopositivity in the deepest third of the intradermal nevi, compound nevi, and melanoma, were 10.5%, 20%, and 100%, respectively; the sensitivity and specificity for diagnosing melanoma were 100% and 84.6%, respectively. The sensitivity and specificity of combined Ki-67-M and immunopositivity in the deepest third for diagnosing melanoma were 100% and 97.7%, respectively. CONCLUSION: The Ki-67-M index and immunopositivity in the deepest third of melanoma were significantly higher than that of benign melanocytic nevi. Therefore, Ki-67/Melan-A double staining is a potentially valuable diagnostic tool for differentiating melanoma from benign melanocytic nevi.
Dermatology ; Diagnosis ; Dysplastic Nevus Syndrome ; MART-1 Antigen ; Melanoma* ; Nevus ; Nevus, Intradermal ; Nevus, Pigmented* ; Sensitivity and Specificity

No abstract available.
Dysplastic Nevus Syndrome* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

BACKGROUND: Congenital melanocytic nevi (CMN) are present at birth. It is well known that the presence of large-sized congenital nevus in early life could predict a major risk of developing melanoma. OBJECTIVE: To investigate the clinical and dermoscopic features of the CMN, to search for and highlight any differences between small-sized, medium-sized, large-sized CMN. METHODS: A nonrandomized observational study was performed. A total of 108 melanocytic nevi were analysed by clinical and dermoscopic examination. RESULTS: Of the subjects, 57.4% were aged less than 16 years, 42.6% were aged 16 and more. Of the nevi, 26 had reticular pattern (24.1%), 35 had globular pattern (32.4%), 13 had reticular-globular pattern (12.0%), 16 had homogeneous pattern (14.8%), 6 had reticular-homogeneous pattern (5.6%), 2 had globular-homogeneous pattern (1.9%), 7 had cobblestone pattern (6.5%), 3 had reticular patchy pattern (2.8%). Atypical dots and globules, focal hypopigmentation and perifollicular hypopigmentation are the most common dermoscopic features of CMN. The rarest dermoscopic feature is the blue-whitish veil. CONCLUSION: Most of the dermoscopic features related with dysplastic nevi up to the present, such as atypical dots and globules, focal hypopigmentation, perifollicular hypopigmentation were observed in CMN, in our study. Congenital nevus and dysplastic nevi may share the same dermoscopic features, therefore it is important to know it is found at birth or not.
Dermoscopy ; Dysplastic Nevus Syndrome ; Hypopigmentation ; Melanoma ; Nevus ; Nevus, Pigmented* ; Observational Study ; Parturition

BACKGROUND: Congenital melanocytic nevi (CMN) are present at birth. It is well known that the presence of large-sized congenital nevus in early life could predict a major risk of developing melanoma. OBJECTIVE: To investigate the clinical and dermoscopic features of the CMN, to search for and highlight any differences between small-sized, medium-sized, large-sized CMN. METHODS: A nonrandomized observational study was performed. A total of 108 melanocytic nevi were analysed by clinical and dermoscopic examination. RESULTS: Of the subjects, 57.4% were aged less than 16 years, 42.6% were aged 16 and more. Of the nevi, 26 had reticular pattern (24.1%), 35 had globular pattern (32.4%), 13 had reticular-globular pattern (12.0%), 16 had homogeneous pattern (14.8%), 6 had reticular-homogeneous pattern (5.6%), 2 had globular-homogeneous pattern (1.9%), 7 had cobblestone pattern (6.5%), 3 had reticular patchy pattern (2.8%). Atypical dots and globules, focal hypopigmentation and perifollicular hypopigmentation are the most common dermoscopic features of CMN. The rarest dermoscopic feature is the blue-whitish veil. CONCLUSION: Most of the dermoscopic features related with dysplastic nevi up to the present, such as atypical dots and globules, focal hypopigmentation, perifollicular hypopigmentation were observed in CMN, in our study. Congenital nevus and dysplastic nevi may share the same dermoscopic features, therefore it is important to know it is found at birth or not.
Dermoscopy ; Dysplastic Nevus Syndrome ; Hypopigmentation ; Melanoma ; Nevus ; Nevus, Pigmented* ; Observational Study ; Parturition

A nevus with cyst is defined as a single lesion of a melanocytic nevus, and this is commonly associated with an epidermal cyst. For the previously reported cases of a nevus with cyst, most of the melanocytic nevi were of the intradermal or compound type. There have been rare reported cases of dysplastic nevus, blue nevus, Spitz nevus, congenital melanocytic nevus and so forth. We report here on a rare case of congenital melanocytic nevus combined with an epidermal cyst in a 21-year-old woman.
Dysplastic Nevus Syndrome ; Epidermal Cyst ; Female ; Humans ; Nevus ; Nevus, Blue ; Nevus, Epithelioid and Spindle Cell ; Nevus, Pigmented ; Young Adult

BACKGROUND: Cutaneous melanoma is a malignant neoplasm that has the tendency to metastasize through lymphatic vessels. However, the mechanism of lymphatic spread in malignant melanoma is not fully understood due to lack of lymphatic-specific markers. OBJECTIVE: The purpose of this study was to determine the intra- and peritumoral lymphatic vessel density (LVD) using a novel monoclonal antibody D2-40, and whether increased expression of lymphatic vessel correlated with malignancy grading in a series of melanocytic lesions and prognosis of malignant melanoma. METHODS: The intra- and peritumoral LVD were examined by immunohistochemistry using D2-40 antibody in a series of melanocytic lesions. RESULTS: We found significantly higher intra- and peritumoral LVD in malignant melanoma as compared with either benign melanocytic nevus, dysplastic nevus, or melanoma in situ (p<0.05), and the intratumoral LVD was significantly related to Breslow depth (p<0.05) and the development of lymphatic metastasis (p<0.05). CONCLUSION: The higher intra- and peritumoral LVD in malignant melanomas suggests that melanoma cells might promote lymphangiogenesis. In addition, our data suggests that increased lymphatics in melanoma is an independent prognostic factor and important for the development of lymphatic metastasis.
Dysplastic Nevus Syndrome ; Immunohistochemistry ; Lymphangiogenesis ; Lymphatic Metastasis ; Lymphatic Vessels* ; Melanoma* ; Nevus, Pigmented ; Prognosis

BACKGROUND: The dysplastic nevus is a rare form of melanocytic nevus, but the clinical criteria and histopathologic finding are still debated. There are no studies of dysplastic nevus in korea except a few case reports. OBJECTIVE: This study was aimed to evaluate the clinical and histopathological characteristics of dysplastic nevus developed in korean. METHODS: We reviewed the clinical and histopathologic finding of 15 patients diagnosed as dysplastic nevus on the biopsy. RESULTS: The result were as follows ; 1. The incidence of dysplastic nevus in our study was 9.9 cases/100,000 population 2. The subjects consisted of 9 males and 6 females. 3. The common onset of age was 11-20. 4. The common site of dysplastic nevus was the trunk. 5. The common pattern of lesional change was asymmetry and color variegation. 6. The common clinical findings of the dysplastic nevus was multiple, 5-12mm size, multipapular surface, ill-demarcated margin and brown/black color. 7. The pathologic findings including shoulder phenomenon, melanocytic nest, patchy lymphohistiocytic infiltration, melanophage, scattered atypical epitheloid cell, random atypia, anisokaryosis and no mitosis was shown in all the patients, but eosinophilic hyperplasia was shown in 13 patients. 8. The mild atypia in the Duke grading system was the most common. There was significant positive correlation between architectural and cytologic scores(Pearson correlation test, P<0.05, r=0.97). CONCLUSION: Although the incidence of the dysplastic nevus in our study was much lower than that of the west, the clinicopathologic findings were not different.
Biopsy ; Dysplastic Nevus Syndrome* ; Eosinophils ; Female ; Humans ; Hyperplasia ; Incidence ; Korea ; Male ; Mitosis ; Nevus, Pigmented ; Shoulder

Halo congenital nevus is a condition in which halo formation is associated with congenital nevocellular nevus. Both humoral and cell-mediated immunity have been implicated to be involved in halo formation. We described a 8-year-old boy with halo congenital nevus characterized by the unique histologic location of inflammatory cells. He has no personal and familial history of vitiligo, dysplastic nevus, melanoma or autoimmune disease. Histologically, the present case of halo congenital nevus undergoing spontaneous regression showed a marked inflammatory infiltrate with remnants of original nevus cell nests in the upper dermis, whereas no inflammatory infiltrate was present in the deep dermis. Most of inflammatory cells were T-cells.
Autoimmune Diseases ; Child ; Dermis ; Dysplastic Nevus Syndrome ; Humans ; Immunity, Cellular ; Male ; Melanoma ; Nevus* ; T-Lymphocytes ; Vitiligo