A case of nevus spilus with congenital melanocytic nevus

( Wonjoo Kwon ),( Yosup Shin ),( Eunbyul Cho ),( Eunjoo Park ),( Kwangho Kim ),( Kwangjoong Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Nevus spilus is a relatively common skin lesion characterized by multiple pigmented macules or papules within a pigmented patch. It is controversial whether NS is congenital or acquired. Congenital melanocytic nevus is defined as a cutaneous lesion appeared at birth, containing melanocytic nevus cells. It is characterized by the diffuse infiltration of melanocytes in the deepest reticular dermis and subcutis, and by the presence of melanocytes around skin appendages. A 16-year-old female patient presented with a congenital pigmented skin lesion on the left upper arm. Speckled brownish to black colored macules with background light brown patch was noticed. Skin biopsy was performed on her left upper arm, and showed pigmentation over dermal-epidermal junction. It also showed mild elongated rete ridge over diffuse junctional nest and nevus cell of upper dermis, with proliferating melanocyte along elongated rete ridge. Nevus cells were also present around hair follicles, sweat glands and vessels in the deep dermis. Immunohistochemical staining showed melanocytes on upper dermis which is positive in HMB-45 staining and basal layer cells with positive in S-100 protein staining. Therefore, the lesion was diagnosed with a nevus spilus combined with congenital melanocytic nevus. This case presents the evidence for the congenital nature of nevus spilus. Herein, we report a case of nevus spilus with congenital melanocytic nevus.

P222 Study of serial (staged) excision of congenital melanocytic nevus

( Kyukwang Whang ),( Eunsun Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Serial excision of congenital melanocytic nevus is a important treatment option especially medium sized one. Study about the result of serial excision was not many, and not evaluated in detail. Objectives: For the statistical analysis of serial excision of congenital melanocytic nevus, and how to do efficiently and to reduce stages and the length of scar. Methods: 33 patients during 8 years are included among cases of serial excision of congenital melanocytic nevus patients. Results: Sex ratio is 7 male, and 26 female. Locations are 11 face, 6 arm, 11 lower extremity, and 5 body area. Mean of surgical stages was 2.24. Interval between surgery was 10.575 month. Mean size of CMN was 19.67cm2. 18 Er:YAG, 13 Nd:YAG, 27 pulsed dye laser and 9 CO2 fractional lasers were added for improving final results and scars. S shaped excision was preferred than straight design to reduce stages and scars. Conclusion: Serial(staged) excision was powerful option with higher satisfaction especially in medium sized and hairy congenital melanocytic nevus. S shape designed excision enabled to make less operation stage, showed better shape and result than the straight design. It had limitation around vital organ like eye, nose and mouth, and then combination treatment like Er:YAG ablation and Nd:YAG was necessary. During some of excision, change of axis of defect after underming was helpful to reduce length and scar.

Congenital melanocytic nevus: a clinicopathologic study and its association with nevus cell types (Type A, B, C)

( Jae Yun Lim ),( Jung Yup Kim ),( Sunmin Yim ),( Ju-yeon Choi ),( Han-saem Kim ),( Jung-in Kim ),( Jung Min ),( Joon Hong Min ),( Young Jun Choi ),( Jae Hui Nam ),( Seoung Wan Chae ),( Ga-young Lee ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Congenital melanocytic nevus may be defined as a lesion present at birth and containing nevus cells. Maturation in the melanocytic nevus means a conversion of pigment-producing large, clear type A cells to nerve-like type C cells through lymphocytoid type B cells. Objectives: This study was performed to investigate the clinical and pathologic characteristics of congenital melanocytic nevus and associated factors with nevus cell types in Korean population. Methods: This study was performed with patients histologically confirmed as congenital melanocytic nevus between 2007 and 2015. The proportion and region of interest (ROI) of type A, B and C cells were calculated using ‘image J’ program. Statistical differences were assessed using the Kruskal-Wallis test and Mann-Whitney test. Results: Mean size of nevus was 2.7±2.0 cm, and the most common location of the lesion was head and neck (n=20, 32.3%). Depth of the nevus cell and the nevus cell infiltration to the eccrine gland positively correlate with the proportion of the type C cell to the type A+B cell (p<0.05), and angioadnexocentric nevus was reported at 4 cases (4.84%). Conclusion: As the depth of the nevus cell and the nevus cell infiltration to the eccrine gland increase, the proportion of the type C cell to the type A+B cell markedly increases. Clinicopathologic features of angioadnexocentric nevus identified at this study are identical to previous studies.

[P171] Congenital melanocytic nevus with mucin deposition

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

Congenital melanocytic nevus is defined as a lesion present at birth and containing nevus cells. It is characterized by a diffuse infiltration of nevus cells in the deepest reticular dermis to subcutaneous layer and presence of nevus cells around skin appendages. Cutaneous mucin deposition can be observed in variety of cutaneous disorders. However, it is rare in association with congenital melanocytic nevus. A 9-year-old girl presented with a black colored nodule on the right areolar area. The lesion existed from birth and the size of the lesion increased proportionally as the patient grows up. No subjective symptom such as itching or pain was noted. There was no trauma or medication for nevus lesion on her past history. Skin biopsy was done from the black colored nodule on the right areolar area showed diffuse infiltrated cell nests composed of nevus cells with abundant mucin deposit in papillary and reticular dermis. Mucin deposition in congenital melanocytic nevus has been rarely reported. Aging process, trauma and medication have been suspected as trigger factors. Furthermore, the interaction between melanocytes and the extracellular matrix via various cytokines might be a possible mechanism, but the exact pathway remains to be identified. We report a rare case of congenital melanocytic nevus with mucin deposition, which is especially scarce in children.

4세 여아의 거대 선천멜라닌세포모반에서 발생한 악성흑색종

전재헌 ( Jae Hun Jun ),정한진 ( Han Jin Jung ),이석종 ( Seok Jong Lee ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),박진영 ( Jin Young Park ),김명화 ( Myung Hwa Kim ),박병철 ( Byung Cheol Park ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.12

Melanoma may arise from a very giant congenital melanocytic nevus even in the first several years of life. Therefore, excision of a giant congenital melanocytic nevus should be considered as early as possible. However considering surgical and anesthetic risks, the surgery can wait until after the first 6 months of life. Unfortunately, surgical treatment does not completely prevent occurrence of melanoma from a giant congenital melanocytic nevus. Besides, several cases of melanoma occurring after blunt trauma or laser therapy have been reported. We report a case of malignant melanoma associated with a giant congenital melanocytic nevus in a 4-year-old female. The malignant melanoma occurred at the boundaries of the previous surgical excision and laser therapy sites for a giant congenital melanocytic nevus. This is the youngest case of malignant melanoma developed from a congenital melanocytic nevus in the Korean dermatological literature. (Korean J Dermatol 2011;49(12):1102~1106)

A case of congenital melanocytic nevus with halo phenomenon accompanied by vitiligo

( Youngil Kim ),( Hyunjung Kwon ),( Hyungrok Kim ),( Inyong Kim ),( Kyungduck Park ),( Joonsoo Park ),( Hyun Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Halo nevus is a round to oval shaped hypopigmented patch around a pigmented nevus. Only 4.7% of halo nevus is being reported around congenital nevus and much rarer with vitiligo. The pathogenesis of congenital halo nevus and vitiligo is still unclear, but considering that the CD 8 positive T lymphocyte infiltrate around the melanocyte and autoantibody to melanocyte is found in both diseases, same autoimmune process may participate in both diseases.A 6-year-old boy presented with whitish depigmentation around a brownish pigmented patch on right neck. The brownish pigmented patch appeared since birth and the depigmented lesion appreared 3 years ago. Since then hypopigmented patches were occurred at both periocular area and knee area. Koebner phenomenon was also observed. Histologically, nevus cells and inflammatory cell infiltration was observed at the brownish pigmented area. On the other hand, at depigmented area, there was significant decrease in melanocyte melanin in epidermis and dermis. The patient was diagnosed with congenitaal melanocytic nevus with halo phenomenon accompanied by vitiligo and excision was planned but the patient was transferred to other dermatologic clinic. Herein, we describe a 6-year-old boy with congenital melanocytic nevus with halo phenomenon accompanied by vitiligo.

A case of simultaneous onset of congenital melanocytic nevus with halo phenomenon and vitiligo

( Byeong Hak Seo ),( Ji Hyun Kim ),( Yong Woo Oh ),( Dong Hee Kim ),( Yu Sung Choi ),( Ho Seok Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Halo nevus is a benign melanocytic nevus surrounded by a round, well-demarcated area of depigmentation. Halo phenomenon often occurs around acquired melanocytic lesions, including intradermal and compound nevi, Spitz nevus, malignant melanoma and congenital melanocytic nevus (CMN). Vitiligo is an acquired, autoimmune, depigmenting disorder of the skin and mucous membrane, resulting from a selective loss of melanocyte. The pathogenesis of halo nevus and vitiligo is still unclear, but a similar autoimmune mechanism of cytotoxic T-lymphocytes and autoantibodies to melanocytes has been suggested in both diseases. However, so far, simultaneous onset of CMN with halo phenomenon and vitiligo is rarely reported. A 6-year old boy presented with an annular whitish hypopigmented patch around a hairy pigmented plaque on the left knee and a coin-sized hypopigmented patch on the upper back. The hairy pigmented plaque appeared since birth and the depigmented patches appeared 6 months ago. Histopathologic findings from the central pigmented plaque showed nests of nevus cell, surrounded by lymphohistiocytic infiltrates in the dermis. The patient was diagnosed with CMN with halo phenomenon accompanied by vitiligo. Herein, we report a case of simultaneous onset of CMN with halo phenomenon and vitiligo.

선천성 멜라닌세포 모반의 병리조직학적 고찰

조광현(Kwang Hyun Cho),전호수(Ho Su Chun),김선훈(Seon Hoon Kim),박경찬(Kyung Chan Park),김규한(Kyu Han Kim),이승철(Seung Chul Lee),지제근(Je Geun Chil) 대한피부과학회 1993 大韓皮膚科學會誌 Vol.31 No.4

Background : since congenital nevi may not always be identified clirically, it remains a challange for histologists to separate an acquired from a congehital nevus. The camparative histologic feature of congenital and acquired lesions have been described by several authors. Objective : In an attempt to establish reliable microscopic recognition of congenital nevi, the histologic features of 52 congenital melanocytic nevi were studied. Material and methods By reviewing HMB slides, histologic paterns were observed depending on the extent of nevus cell infiltration. An immunohistochemical study wi h anti S-100 protein and HMB-45 antibody was also performed. Results : Diffuse infiltratien of upper and lower dermis with nevu. cells was observed in 21 cases (40.0%). Nevus cell infiltration of appendages and neurovascular structures was observed in 29 cases (55.8%). Indian filing of dermal nevus cells was observed in 33 casesl(64.7%). Epidermis showed elongation of rete ridges in 36 ca.es(69.2%). Immunohistochemical staining with HMB 45 showed a positive raction in 9 cases out of 51 having dermal nevus cells, and epidemal melanocytes showed positive reaction in 20 cases. Conclusion : Congenital melanocytie nevi can be classified by histolcgic appearance into several patterns. Nevus cells had a trend to infiltrate into the deeper dermis as the clinieal size increrased. Nevus cell infiltration of appendages and neurovascular structure was a common finding in congenital melanocytic nevi. (Kor J Dermatol 1993;31(4):523-531)

Vitiligo vulgaris in a patient with giant congenital melanocytic nevus

( Min Young Lee ),( Jee-bum Lee ),( Seung-chul Lee ),( Young Ho Won ),( Sook Jung Yun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 46-year-old women presented with giant congenital melanocytic nevus on back and abdomen including many satellite lesions on legs since birth. From last 3 years, whitish patches occurred on face, hands, feet and back. The depigmented patches also spread even on nevus lesion. She had no remarkable past history, family history or any drug history. The wood lamp examination showed sharp demarcation with accentuation on whitish patches. The biopsy from depigmented patch showed absent melanocytes, and excisional biopsy from depigmented nevus lesion revealed compound nevus with decreased melanocyte on epidermis. The abdomino-pelvic CT and brain MRI had no other abnormal finding, and laboratory examination including thyroid function test was within normal limit. Vitiligo vulgaris is an acquired hypopigmentary disorder results from melanocyte destruction. The exact etiological factor is still not known, but the autoimmune mechanism medicated by T cells is well accepted. The halo formation or vitiligo with cognenital melanocytic nevus lesion may also indicate immunologic reaction about nevus cells. This case shows rare vitiligo vulgaris developing in giant congenital melanocytic nevus.

Laser treatment of congenital melanocytic nevus: the additive effect of hydrogen peroxide along with the conventional laser treatment

( Young In Lee ),( Jihee Kim ),( Jemin Kim ),( Ju Hee Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Although total excision is the current treatment of choice for congenital melanocytic nevus (CMN), a surgical intervention may have unacceptable outcomes and therefore is not always feasible. There has been increasing interest in the efficacy of laser treatment for CMN, but multiple treatment session should be anticipated. Moreover, due to the persistence of dermal nevus cells as well as melanocyte stem cell niche located in the bulge area of hair follicles, a lifelong follow-up is required. A 33 year-old female with CMN on her right thigh visited our clinic. A 2-staged excision and multiple 1064nm Nd:YAG laser treatments in combination with fractional ablative CO₂ laser were performed, but several peri-follicular repigmentations were observed along the treatment. We additionally applied hydrogen peroxide, which is a known genotoxic reagent, to the lesion after each treatment session, with a satisfactory outcome. We hypothesized that the local administration of hydrogen peroxide induced differentiation of melanocytic stem cells from the bulge, resulting in the depletion of the stem cell reservoir. Moreover, destructive oxidation of melanin pigments as a result of treatment by hydrogen peroxide may have caused a bleaching effect on the nevus as shown in the hair graying process. Further laboratory study is required to confirm the effect of local administration of hydrogen peroxide on CMN treated with multiple laser treatments.