Blue Nevus Hidden within the Nevus of Ota.

A 3-year-old boy presented with bluish patch and scattered blue spots on the left side of his face. After several sessions of laser treatment, the azury patch in the periorbital area became even darker. Histopathology showed many bipolar, pigment-laden dendritic cells scattered in the papillary and upper reticular dermis. Immunohistochemically, these cells were positive for S100, SOX-10, melan-A, P16, and HMB-45. The positive rate of Ki-67 was less than 5%. Finally, the lesion was diagnosed with nevus of Ota concurrent with common blue nevus. Therefore, for cases of the nevus of Ota with poor response to laser treatment, the possible coexisting diseases should be suspected.

An update on ophthalmological perspectives in oculodermal melanocytosis (Nevus of Ota).

PURPOSE: To provide a review of the literature on oculodermal melanocytosis (ODM) with a focus on the diagnostic and therapeutic implications of multimodal imaging techniques in the management of ophthalmic complications. METHODS: The authors carried out a literature search on PubMed, Medline, and Scopus of English language articles published on ODM through August 2021. This review presents traditional and novel diagnostic methods in the diagnosis and follow-up of patients with particular emphasis on addressing the role of imaging in the management of the ophthalmic complications of the condition towards improving current practice patterns. RESULTS: ODM is a rare, prevalently unilateral, congenital condition that presents with brown or blue/gray flat asymptomatic lesions of the skin, mucosae, episclera/sclera, and uvea localized within the territory of distribution of the ophthalmic and mandibular branches of the trigeminal nerve. Glaucoma and predisposition to uveal melanoma are the main ophthalmic complications. Diagnosis and management are through comprehensive opthalmological examination and traditional imaging methods such as ultrasonography and fluorescein/indocyanine green angiography as pigmentation of the fundus can conceal subtle retinal and choroidal alterations. Anterior segment optical coherence tomography and ultrasound biomicroscopy are used to evaluate the anterior segment and the ciliary body in the presence of glaucoma or melanoma of the anterior uveal tract. Fundus autofluorescence and retinal pigment epithelium (RPE) alterations are of aid in the differential diagnosis between choroidal nevi and melanoma. Enhanced depth imaging spectral domain optical coherence tomography offers outstanding in vivo evaluation of the dimensions and details of tumors or nevi and surrounding choroidal tissues and small choroidal melanomas may show distortions of the retinal and sub-retinal profile, presence of intra and sub-retinal fluid, abnormalities of the RPE, and compression of the choriocapillaris. CONCLUSIONS: Novel multimodal imaging techniques are significant in the diagnosis and management of the ophthalmic complications of ODM. Fundus autofluorescence and enhanced depth spectral domain optical coherence tomography have adjunctive value in the detection of early-stage melanoma and differential diagnosis between nevi and melanoma. Awareness of current and emerging imaging techniques can propagate improved standardized definition and assessment of the complications of ODM.

Ocular manifestations of facial port-wine stain, nevus of Ota, and phakomatosis pigmentovascularis in Asian patients.

BACKGROUND: Heightened intraocular pressure resulting in glaucoma and impaired vision is treatable if detected early. It is therefore necessary to identify populations at risk for glaucoma for regular screening visits. OBJECTIVE: To investigate the prevalence of glaucoma in patients with facial port-wine stains (PWSs), nevus of Ota, and phakomatosis pigmentovascularis (PPV) and to establish the association between facial vascular birthmarks and ocular complications. METHODS: This study is a retrospective chart review of 166 patients with facial PWS, PPV, and nevus of Ota over a 10-year period. RESULTS: Of the 166 cases, 76 patients were diagnosed with PWS, 83 with nevus of Ota, and 7 with PPV. The mean age of patients was 12.8 years, ranging from newborn to 63 years old. Fifteen patients were diagnosed with glaucoma. Of 15 patients, 11 presented with PWS, and 4 presented with both PWS and PPV. Of 83 patients with nevus of Ota, only 2 (2.4%) presented with increased ocular pressure. LIMITATIONS: The relatively short follow-up period is a limiting factor in this study. CONCLUSIONS: Early and periodic ophthalmic examinations in patients with PWS, PPV, and nevus of Ota are essential to minimizing the risk of developing glaucoma in these groups of patients.

[Treatment of nevus of Ota and Ito and epidermal nevus syndrome]. / Behandlung des Naevus Ota und Ito und des Pigmentnävussyndroms.

Nevus of Ota, nevus of Ito and nevus of Hori are special melanocytic nevi that have a slate-brown or blue/grey coloring. They are pigmented disorders characterized by its heterotopic melanocytic dermal location and by blue/brown unilateral and sometimes bilateral facial patch in case of nevus of Ota, and in the supraclavicular, scapular, and deltoid region in case of nevus of Ito. It is more common in patients with Asian and dark-skinned ethnic backgrounds. Histologically, elongated, dendritic melanocytes are seen scattered mainly throughout the upper third of reticular dermis. An acquired variant is called Hori's nevus with more bilateral facial distribution, similar to melasma. Dermal melanocytosis can also occur elsewhere on the body, including inside the mouth. Despite its benign nature, patients frequently seek therapy because of its facial involvement. QS lasers are used effectively to treat these lesions. The number of treatment sessions correlates with clinical improvement. Post laser hypo- and hyperpigmentation are common side effects mainly affecting patients with darker skin.

A Prospective, Split-Face, Randomized Study Comparing Picosecond to Q-Switched Nd: YAG Laser for Treatment of Epidermal and Dermal Pigmented Lesions in Asians.

BACKGROUND: Whether picosecond lasers outperform Q-switched lasers in treating pigmented lesions has not been clearly evaluated. OBJECTIVE: To compare the efficacy and safety of picosecond and Q-switched lasers in treating epidermal and dermal pigmented lesions in Asians. METHODS: Eight subjects with lentigines and 6 subjects with acquired bilateral nevus of Ota-like macules were enrolled. Subjects was randomly treated with a picosecond laser on one side of the face and a Q-switched laser on the other side. Subjective assessments on pigment clearance, and adverse effect were obtained at Weeks 0, 4, 12, and 24 after the final treatment. RESULTS: Clinical improvement differed between the 2 laser systems at Week 4 (p = .034), Week 12 (p = .039), and Week 24 (p = .027), with 85.7% of picosecond and 57.2% of Q-switched laser sites showing >50% improvement at 6 months. There was no significant difference in the incidence of side effect and healing time, but picosecond laser was significantly associated with a lower treatment discomfort (p = .05). CONCLUSION: The picosecond laser seems to be more effective and better tolerated than Q-switched laser for the treatment of pigmented lesions in Asians.

Treatment of Laser-Responsive Dermal Pigmentary Conditions in Type III-IV Asian Skin With a 755-nm Picosecond Pulse Duration Laser: A Retrospective Review of Its Efficacy and Safety.

BACKGROUND: Picosecond lasers have become very popular in the treatment of hyperpigmentation. OBJECTIVE: Evaluating the efficacy and safety of picosecond 755-nm laser in treatment of nevi of Ota (NO) and Hori's nevi (HN) in Asians with Fitzpatrick skin Types III/IV. METHODS: A retrospective review of patient records at the National Skin Center, Singapore, from 2015 to 2017. Three independent blinded dermatologists assessed pre-and-post treatment photographs using the physician's global assessment (PGA) score (0-clear, 1-almost clear, 2-mild, 3-moderate, and 4-severe). RESULTS: There were 18 cases of NO and 11 cases of HN. Mean treatment sessions were 2.22 (NO; range 1-6) and 3.82 (HN; range 1-6). In the NO group, mean pre-and-post treatment PGA scores were 3.1 and 1.3, respectively (1.8 point change, p-value 0.0002), and average fluence used was 2.02 J/cm (range: 1.02-2.38). In the HN group, mean pre-and-post treatment PGA scores were 2.6 and 1.1, respectively (1.5 point change, p-value 0.004), and average fluence was 2.08 J/cm (range: 1.98-3.40). Eleven patients (37.9%) experienced postlaser erythema, and 1 (3.4%) patient developed transient postlaser hypopigmentation. No permanent hyper/hypopigmentation was seen. CONCLUSION: The picosecond 755-nm laser is effective in the treatment of dermal pigmentary conditions in Asians with Fitzpatrick skin Types III/IV, with minimal risk of postlaser complications, and compared with the center's past experience with the Q-switched nanosecond 1064-nm laser, results in faster and more effective pigment clearance.

Comparison of a picosecond alexandrite laser versus a Q-switched alexandrite laser for the treatment of nevus of Ota: A randomized, split-lesion, controlled trial.

BACKGROUND: Novel picosecond lasers have been available for various pigmentary disorders. However, there are limited data directly comparing picosecond lasers and Q-switched lasers for treatment of nevus of Ota. OBJECTIVE: To compare the efficacy and safety of a picosecond alexandrite laser (PSAL) with a Q-switched alexandrite laser (QSAL) for the treatment of nevus of Ota. METHODS: Each lesion of 56 enrolled participants was split into 2 parts and randomly assigned to either the PSAL or QSAL treatment arm. Each lesion was treated in up to 6 sessions in 12-week intervals. Efficacy and safety were determined using blinded visual evaluation and self-report at each follow-up visit. RESULTS: The PSAL arm achieved a significantly better clearance (5-point scale, PSAL 4.53 vs QSAL 4.0) with fewer sessions (PSAL 5.26 vs QSAL 5.87) and less severe pain (Visual Analog Scale, PSAL 5.61 vs QSAL 6.40). Patients were more satisfied with PSAL than QSAL (Likert scale, 4.5 vs 4.0). Occurrences of postinflammatory hyperpigmentation (PSAL 26% vs QSAL 34%) and hypopigmentation (PSAL 21% vs QSAL 47%) were also lower in PSAL than QSAL arm. LIMITATIONS: Lack of objective assessments and outcome measures. CONCLUSION: PSAL demonstrated better clinical results and fewer adverse events than QSAL for the treatment of nevus of Ota.

Clinical characteristics and treatment of 52 cases of phakomatosis pigmentovascularis.

Phakomatosis pigmentovascularis is a rare syndrome characterized by widespread capillary malformation and pigmented nevus. The objective of this study was to evaluate its characteristics and treatment. Fifty-two patients presenting between 2003 and 2017 were retrospectively reviewed. Type IIa (port-wine stain and dermal melanocytosis with oculocutaneous involvement) was most common. Systemic involvement was observed in 17.3% and it was not significantly correlated to extent of capillary malformation or pigmented nevus. However, systemic involvement was significantly frequent in patients with nevus of Ota and in patients with pigmented nevus located on the head and neck (P = 0.004 and 0.035, respectively). Capillary malformation was almost cleared in 28.6% of patients using pulsed dye laser, whereas pigmented nevus was almost cleared in 23.7% and completely cleared in 42.1% of patients using Q-switched neodymium:yttrium-aluminum-garnet laser. Treatment outcome score showed significant inverse correlation with the extent of port-wine stain or pigmented nevus (P = 0.047, ρ = -0.308 and P = 0.011, ρ = -0.410, respectively). Pigmented nevus demonstrated better treatment response to lasers than did capillary malformation. Smaller lesions tended to show better treatment outcomes for both capillary malformation and pigmented nevus.

Nevus of Ota, a classic presentation / Nevus de Ota de presentación clásica

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Nevus of Ota - an intraoral presentation: a case report.

BACKGROUND: Nevus of Ota or "oculodermal melanocytosis" is a rare congenital hamartoma of dermal melanocytes causing a blue-gray hyperpigmentation of the eye and surrounding structures. The condition, originally described by Ota and Tanino in 1939, mainly affects the ophthalmic and maxillary divisions of the trigeminal nerve. We describe the first reported case of unilateral oculodermal melanocytosis in a Caucasian woman with oral buccal mucosal involvement. Oral involvement of nevus of Ota is very rare. CASE PRESENTATION: A 48-year-old Caucasian woman was referred by the dermatology division to the oral medicine department at the University of Liverpool School of Dentistry with new-onset oral pigmentation to the left buccal mucosa. The patient had a previous diagnosis of oculodermal nevus. CONCLUSION: An incisional biopsy of the left buccal mucosa was completed. The report stated that histological and immunohistochemical features were in keeping with a blue nevus, but within the context of the preexisting occulodermal pigmentation, a diagnosis of oculodermal melanocytosis, also known as "nevus of Ota," was made. The patient will be kept under review in the oral medicine department because the progression of the lesion on the left buccal mucosa requires active monitoring owing to the potential for malignant change. The patient also requires regular review in the dermatology and ophthalmology divisions.

Glaucoma in Phacomatosis Pigmentovascularis in a Young African Adolescent Boy: A Case Report.

BACKGROUND: Phacomatosis pigmentovascularis (PPV) has previously almost exclusively been reported in Asians and in dermatological journals. In this report, we present a case of a young black South African adolescent boy referred to our eye clinic. CASE REPORT: A 15-year-old male patient presented with gradual, painless loss of vision in his right eye. Clinical examination revealed a port-wine stain with ocular involvement on the right as well as a nevus of Ota. Fundoscopy on the right revealed an advanced glaucomatous optic disc and raised intraocular pressure. A diagnosis of glaucoma associated with PPV was made. CONCLUSION: We present the first case of PPV in an African male individual with associated glaucoma seen at our tertiary hospital.

Meningeal Melanocytoma Associated with Nevus of Ota: Analysis of Twelve Reported Cases.

BACKGROUND: Primary melanocytic neoplasms (PMNs) are rare neoplasms, especially within the central nervous system. Meningeal melanocytomas, a subtype of PMN, are even rarer. Nevus of Ota results from the incomplete migration of melanocytes from the neural crest. Synchronous nevus of Ota and meningeal melanocytoma are infrequently encountered in clinical practice. OBJECTIVE: To evaluate and elucidate 12 cases of synchronous meningeal melanocytoma and nevus of Ota, thereby improving the understanding of the relationship between these 2 diseases. METHODS: We reviewed cases and searched the English-language literature from the PubMed database and collected clinical parameters of 12 cases of synchronously occurring nevus of Ota and meningeal melanocytoma. RESULTS: Among the 12 cases, 90.90% and 91.66% of the lesions were located ipsilaterally and supratentorially, respectively. CONCLUSIONS: Our findings indicated a trend for both types of lesion to be located ipsilaterally and supratentorially. When a patient with nevus of Ota is found to harbor an intracranial neoplasm, the most likely diagnosis is PMN.

Oculodermal Melanocytosis: Nevus of Ota in a Dog.

This report describes the clinical presentation, diagnosis, and histopathologic features of oculodermal melanocytosis in a young dog. A 3-year-old male neutered Labrador Retriever presented with conjunctival and scleral hyperpigmentation of the right eye, with concurrent ipsilateral cutaneous hyperpigmentation involving the right side of the face. Initial skin and conjunctival biopsies revealed an accumulation of histologically benign melanocytes within the dermis and conjunctival stroma, respectively. Enucleation was elected 19 months later by the referring veterinarian due to the progression of ocular pigmentation with concurrent marked corneal lipidosis and the suspicion of a scleral mass. On gross and histopathologic examination of the globe, there was marked panuveal melanocytosis with extension into the sclera, bulbar conjunctiva, and connective tissue surrounding the optic nerve, as well as sharply demarcated ipsilateral hyperpigmentation of the facial skin. The findings are characteristic of oculodermal melanocytosis (nevus of Ota), a dermal melanocytic hamartoma presenting as cutaneous facial hyperpigmentation that corresponds to the distribution of the ophthalmic and maxillary branches of the trigeminal nerve, often with ipsilateral ocular involvement.