Acquired Dermal Melanocytosis of the Nose Successfully Treated with Neodymium-doped Yttrium Aluminum Garnet 1064 nm Laser

( Ju Hee Han ),( Jun Young Lee,),( Young Min Park ),( Ji Hyun Lee ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.8

A 28-year-old woman presented with asymptomatic, diffuse, irregularly shaped, grayish patches on the nasal alae, septum, and nostrils (Fig. 1A). The patches had been growing for 5 years. No history of contact, prior inflammation, trauma, or significant sun exposure was found. Histological examination showed melanocytes dispersed in the upper and mid-dermis (Fig. 2A, B). Fontana-Masson and Melan-A staining showed increased dermal melanin pigment and dermal melanocytes, respectively (Fig. 2C, D). The lesion subsided significantly after six sessions of treatment with a 1,064 nm neodymiumdoped yttrium aluminum garnet (Nd:YAG) laser (each four sessions of 1,064 nm, 2 Hz, 2.0 J/cm2, and 5 Hz, 1.4 J/cm2; and each two sessions of 1,064 nm, 5 Hz, 2.0 J/cm2, and 10 Hz, 1.4 J/cm2), without complications (Fig. 1B). Dermal melanocytosis is defined as a broad group of congenital and acquired melanocytic lesions characterized by intradermal dendritic, variably pigmented, spindle-shaped melanocytes, with or without dermal melanophages. Clinically, this group may show several morphological forms, such as Mongolian spot, blue nevus, nevus of Ota, nevus of Ito, and Acquired, bilateral nevus of Ota-like macules (ABNOM). Acquired dermal melanocytosis (ADM) usually presents symmetrically, similar to ABNOM. In in cases where a definite diagnosis cannot be made, we can use the term “dermal melanocytosis”. Rarely, there are reports of localized and asymmetric ADM on the face, and other areas of the body1-3. Localized ADM on the nose, especially on the nasal alae, septum, and nostrils, as in our case, is a rare condition, but it is often found in Asians2. However, to the best of our knowledge, localized ADM of the nose has not been reported in the Korean literature. According to previous literature, cryotherapy and dermabrasion are known to be successful as treatment options4,5. However, these modalities are invasive and can lead to many complications. Therefore, Q-switched Nd:YAG lasers, known as “laser toning”, recently became a widely used treatment modality for dermal melanocytosis, especially ABNOM and nevus of Ota. The 1,064 nm Nd:YAG laser shows highly selective destruction of melanin within the aberrant dermal melanocytes, and its longer wavelength results in relatively deep penetration into the skin, bypassing the epidermis, to target the aberrant dermal melanocytes. At this wavelength, melanin preferentially absorbs laser energy more than other chromophores, and the surrounding normal skin sustains minimal injury5. Thus, reporting this rare clinical manifestation of ADM and a successful treatment outcome may offer several possible therapeutic options, and generate awareness about such a presentation.

Case Report : An Unusual Case of Congenital Dermal Melanocytosis

( Sang Hoon Lee ),( Dae Hyun Kim ),( Gun Hong Lee ),( Kyu Uang Whang ),( Jong Suk Lee ),( Young Lip Park ) 대한피부과학회 2010 Annals of Dermatology Vol.22 No.4

Dermal melanocytosis is characterized by the presence of ectopic melanocytes in the dermis. The most common forms include the Mongolian spot, blue nevus, nevus of Ota, and nevus of Ito. Some types of dermal melanocytosis do not fit into any of these morphologic categories, however. Our case demonstrated an extensive amount of uniform deep blue patches of nevi with unilateral distribution on the left face, neck, chest, shoulder, and back. On histopathologic examination, a number of elongated melanocytes scattered throughout the dermis were found. We herein report a case of congenital unilateral dermal melanocytosis. (Ann Dermatol 22(4) 460~462, 2010)

A case of imatinib mesylate induced acquired dermal melanocytosis

( Ju Wang Jang ),( You Jin Jung ),( Dong Uk Cheon ),( Won Seon Koh ),( Jeong Eun Kim ),( Joo Yeon Ko ),( Young Suck Ro ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Imatinib mesylate is a tyrosine kinase inhibitor used to treat various oncological conditions, such as chronic myeloid leukemia. It is generally well tolerated with some cutaneous side effects. The most frequent dermatological side effect is hypopigmentation, but paradoxical hyperpigmentation has been rarely reported. Especially, imatinib-induced acquired dermal melanocytosis has been reported very rarely in the English literature. A 48-year-old woman with chronic myeloid leukemia presented with bluish to brownish macules and patches at face, upper trunk, and buttock. She had been treated with imatinib for 9 years, and the facial lesion began to occur 3 months after treatment. During the recent 2 years, the lesions have been developed at trunk and buttock. Histological examination of the lesion revealed the presence of a dendritic and stellate-shaped dermal melanocytes. Immunohistochemically, these cells were positive for melan-A, fontana silver and S-100. Based on these clinicopathological findings, she was diagnosed with acquired dermal melanocytosis induced by imatinib mesylate. The exact mechanism of imatinib-induced paradoxical hyperpigmentation is unclear. It has been hypothesized that it could have different target effects on immature and mature melanocytes and KIT and its ligand stem cell factor (SCF) play a critical role in the pathogenesis. Herein, we report a rare case of imatinib-induced acquired dermal melanocytosis.

TS 1-4 : Efficacy and safety of 755-nm picosecond alexandrite laser for the treatment of dermal melanocytosis: A prospective clinical trial

( Gyoo Huh ),( Kyu Yeon Kim ),( Bo Bin Cha ),( Jin Seop Kim ),( Yeon Gu Choi ),( Hyeon Jeong Park ),( Heun Joo Lee ),( Young Jun Choi ),( Won-serk Kim ),( Ga-young Lee ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.-

Background: Laser treatment for dermal melanocytosis is often unsatisfactory. The picosecond-domain, 755-nm alexandrite laser has been proposed as a promising therapeutic option in Asian. Objectives: We aimed to evaluate the efficacy and safety of a 755-nm picosecond alexandrite laser for the treatment of dermal melanocytosis. Methods: This prospective open-labeled trial comprised 25 Korean subjects with dermal melanocytosis. Subjects received three laser treatments at 8-week intervals. Parameters were set at 700-picosecond pulse width, fluence of 3 J/㎠, 3-mm spot size, and 4 Hz repetition rate and modified to the extents of 10 % depending on the therapeutic response. All were evaluated at every visit and 3 months after the final treatment (28 weeks from the baseline). Melanin index (MI) was measured and two blinded dermatologists rated clinical improvement using physicians’ global assessment (PGA) based on standardized photographs. Patients’ self-assessment and adverse events were also recorded. Results: Mean MI showed significant improvement compared with baseline at week 28 (p<0.001; mean differences of -0.02). On PGA, 50 % (12/24) and 16.7 % (4/24) of subjects were reported at least moderate improvement and marked improvement at week 28, respectively. All the adverse reactions were mild and transient. Conclusion: The 755-nm picosecond alexandrite laser can be an effective and safe treatment option to treat dermal melanocytosis in Asian.

Efficacy and safety of 755-nm picosecond alexandrite laser for the treatment of dermal melanocytosis: A prospective clinical trial

( Gyoo Huh ),( Kyu Yeon Kim ),( Bo Bin Cha ),( Jin Seop Kim ),( Yeon Gu Choi ),( Hyeon Jeong Park ),( Heun Joo Lee ),( Young Jun Choi ),( Won-serk Kim ),( Ga-young Lee ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.1

Background: Laser treatment for dermal melanocytosis is often unsatisfactory. The picosecond-domain, 755-nm alexandrite laser has been proposed as a promising therapeutic option in Asian. Objectives: We aimed to evaluate the efficacy and safety of a 755-nm picosecond alexandrite laser for the treatment of dermal melanocytosis. Methods: This prospective open-labeled trial comprised 25 Korean subjects with dermal melanocytosis. Subjects received three laser treatments at 8-week intervals. Parameters were set at 700-picosecond pulse width, fluence of 3 J/㎠, 3-mm spot size, and 4 Hz repetition rate and modified to the extents of 10 % depending on the therapeutic response. All were evaluated at every visit and 3 months after the final treatment (28 weeks from the baseline). Melanin index (MI) was measured and two blinded dermatologists rated clinical improvement using physicians’ global assessment (PGA) based on standardized photographs. Patients’ self-assessment and adverse events were also recorded. Results: Mean MI showed significant improvement compared with baseline at week 28 (p<0.001; mean differences of -0.02). On PGA, 50 % (12/24) and 16.7 % (4/24) of subjects were reported at least moderate improvement and marked improvement at week 28, respectively. All the adverse reactions were mild and transient. Conclusion: The 755-nm picosecond alexandrite laser can be an effective and safe treatment option to treat dermal melanocytosis in Asian.

A case of incidentally found metastatic malignant melanoma with unknown primary site in congenital systemic dermal melanocytosis patient

( Won-oh Kim ),( Jin-woong Jung ),( Young-wook Ryoo ),( Sung-ae Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 42-year-old man presented with numerous gray-bluish hyperpigmented macules and patches on face, trunk and both extremities since birth. He was diagnosed of malignant melanoma of liver at Gastro-intestinology department and referred to our Dermatology department for skin biopsy to find the primary skin lesion of melanoma. Skin biopsy was done on 5 most suspicious lesions, but the results were all consistent with blue nevus. Through endoscopy and colonoscopy, multiple dark-bluish hyperpigmented macules were also found on stomach, ileum and rectum. The patient was referred to Hemato-oncology department and planning for chemotherapy. Dermal melanocytosis is characterized by the presence of ectopic melanocytes in the dermis. There are several morphologic forms, such as the blue nevus, the mongolian spot, the nevus of Ota, and the nevus of Ito. We define this case as the congenital systemic dermal melanocytosis. Herein, we report a extremely rare case of congenital systemic dermal melanocytosis patient with incidentally found metastatic malignant melanoma with unknown primary site.

A case of acquired dermal melanocytosis on the face and extremities

( Chong Won Choi ),( Bo Ri Kim ),( Kwang Hyun Cho ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Dermal melanocytosis includes various kinds of congenital and acquired hyperpigmentation, which is characterized by a presence of intradermal dendritic, pigmented melanocytes. Among the congenital dermal melanocytosis, Mongolian spots, nevi of Ota, and nevi of Ito are usually present at birth or appear in early childhood. However, there are several types of acquired dermal melanocytosis that usually appear during adult life. Acquired dermal melanocysosis usually appears in Asian women. A 22-year-old woman presented with asymptomatic, multiple, symmetric, brown colored macules on the nasal ala, both dorsums of hands and feet which had been for more than 10 years. A skin biopsy from her dorsum of foot showed some pigmented dendritic cells in superficial dermis. Immunostaining for Mart-1 revealed positivity for the pigmented dendritic cells. Based on the clinical and histopathological findings, she was diagnosed with acquired dermal melanocytosis on the face and extremities.

[P486] Aquired dermal melanocytosis of the upper back in the middle-aged woman with acquired bilateral nevus of Ota-like macules (ABNOM)

( Hak-jun Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Hyunju Jin ),( Hyang-suk You ),( Woo-haing Shim ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Dermal melanocytosis is pigmentary disorder histologically characterized by the presence of intradermal melanin-containing melanocytes. It is clinically devided into several subtypes according to onset and location of lesion. Most forms of dermal melanocytosis are present at birth. However, there have been some reports of adult-onset dermal melanocytosis called acquired dermal melanocytosis (ADM). ADM usually occurs on the face, including acquired bilateral nevus of Ota-like macules, and the acquired nevus of Ota. But, Non-facial ADM which is known to be extremely rare, mainly affect the trunk and extremity. Herein, we report a rare case of 39-year-old women with blue-grayish patches on her face, upper back for one year. These lesions occured at the same time. She denied any preceding trauma, metal contact, discoloration and prior inflammatory lesion. Histopathologic examination showed multiple spindleshaped dendritic melanocytes in the dermis. We diagnosed this patient as ADM based on clinical manifestations and histopathology. Though ABNOM is not rare, ADM of the upper back is rare, and furthermore simultaneous occurrence of ADM of the upper back and ABNOM in this case seems to be quite rare.

Dermal melanocyte hamartoma with nevus spilus

( Jaewook Jeon ),( Hongrim Kim ),( Hyunyi Suh ),( Kyungho Kim ),( Jiyoung Ahn ),( Miyoun Park ),( Jaiil Youn ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Dermal melanocyte hamartoma (dermal melanocytosis) is a very rare condition characterized by areas of diffuse gray-blue pigmentation or coalescing macular lesions, present at birth, and with similarities to the nevi of Ota and Ito. Differential diagnosis of these dermal melanocytic lesions include the Mongolian spot, the blue nevus, the nevus of Ota, the nevus of Ito and dermal melanocytic harmatoma. The 15-years-old girl visited our clinic for hyperpigmented patches on the left thigh. It present at birth, show multiple brownish macule on the diffuse gray-blue pigementation base. Nevus spilus is also known as speckled lentiginous nevus because it has spotted apperarance with background light brown discoloration. They are thougt to be a form of congenital nevi because they usually appear at birth or soon thereafter. Combined nevus of a nevus spilus and a dermal melanocytic lesion are unusual, to our knowledge, the combination of nevus spilus and an overlying dermal melanocyte hamartoma has not been previously reported.

Coincidence of Dermal Melanocyte Hamartoma and Becker’s Nevus in a Patient with Neurofibromatosis Type 1

( Young Jae Kim ),( Myoung Eun Choi ),( Mi Woo Lee ),( Jee Ho Choi ),( Sung Eun Chang ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.10

Dermal melanocytosis is characterized by an increased number of ovoid to elongated melanocytes situated between collagen fibers in the dermis, including blue nevus, Mongolian spots, nevus of Ota and Ito and dermal melanocyte hamartoma. Herein, we present a rare case of a 15-year-old boy presented with both dermal melanocyte hamartoma and Becker’s nevus in conjunction with neurofibromatosis. A shared pathophysiologic mechanism between neurofibromatosis and other nevi in the context of organoid hamartoma has been reviewed. (Korean J Dermatol 2019;57(10):632∼634)