A rare cutis verticis gyrata secondary to cerebriform intradermal nevus: case report and literature review.

BACKGROUND: Cutis verticis gyrate (CVG) is a rare morphologic syndrome that presents with hypertrophy and folding of the scalp. CVG can be classified into three forms: primary essential, primary non-essential, and secondary. Cerebriform intradermal nevus (CIN) is a rare cause of secondary CVG. We are here to report a rare case of CVG with an underlying CIN and discuss the clinical course, treatment options, and critical screening guidelines for these patients. CASE PRESENTATION: A 25 year-old male patient presented with a chief complaint of generalized hair loss in the scalp parietaloccipital region for a duration of 1 year and the hair loss area was occasionally accompanied by mild itching. The hair loss started gradually and worsened over time. In addition, he had scalp skin folds resembling the ridge and furrow of the cerebral cortex in the parietaloccipital region since birth. Physical examination revealed hypertrophy and formation of folds in the parietal-occipital area, forming 5 to 6 furrows and ridges. The size of the cerebriform mass was about 12.0 cm × 8.5 cm, without other skin lesions. Diffuse non-scarring hair loss was distributed on the posterior-parietal scalp, mid-parietal scalp and superior-occipital scalp. The diseased tissue of the patient's parietaloccipital area was excised under general anesthesia. The postoperative pathological examination of the tissue excised showed that there were dense intradermal melanocytic nevus, so the patient was diagnosed with secondary CVG caused by CIN. At the 2 year follow-up, there were no obvious changes in the lesions. CONCLUSIONS: CIN must be differentiated from other conditions that manifest as CVG, including primary essential or non-essential CVG and secondary CVG caused by other reasons. Each CIN patient requires a specific decision of whether to excise the lesion surgically or follow a wait-and-see policy, depending on the patient's will and specific condition. Surgical treatment may be performed when there is an aesthetic demand. However, clinical observation and close follow-up is also a good treatment choice for patients with stable disease or mild symptoms.

Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes.

BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.

Scalp expansion for giant cutis verticis gyrata secondary to cerebriform intradermal nevus.

Cutis verticis gyrata (CVG) is characterized by extensive formation of scalp skin that mirrors the folds of the cerebral gyri. Giant CVG secondary to cerebriform intradermal nevus (CIN) has been rarely reported, and its management mainly involves surgical excision. In certain cases of giant CVG, however, surgical excision is dilemmatic. This case report describes a giant CVG secondary to CIN that was successfully managed with scalp expansion and surgical excision. Previously published studies are also reviewed.

Dermoscopic patterns of intradermal naevi.

BACKGROUND: Intradermal naevi represent a benign histopathological variant of common melanocytic naevi. Studies describing dermoscopic criteria of dermal naevi are very limited. OBJECTIVES: To identify dermoscopic features of dermal naevi in order to facilitate differential diagnosis from malignant lesions. METHODS: A 15-year retrospective study was performed to evaluate the dermoscopic characteristics of 202 dermal naevi, histopathologically diagnosed through the analysis of digital dermoscopic images performed with polarised light dermoscopy. For each lesion, vascular pattern, pigment pattern and other dermoscopic clues were evaluated. RESULTS: 147 Unna naevi and 55 Miescher naevi were included in the study. Brown pigment (37.1%) was the pigment pattern most frequently observed in both Unna and Miescher naevi, followed by cobblestone pattern (30.6%) in Unna naevi and white areas (23.6%) and dotted/globule pattern (20%) in Miescher naevi. As regards the vascular patterns, the polymorphic one was the most frequently observed (34.6%). The combination between comma-shaped and arborising vessels was the most common among all naevi. CONCLUSIONS: Our study describes the dermoscopic features of dermal naevi that may help to differentiate them from malignant lesions such as basal cell carcinoma, amelanotic melanoma and Spitz naevi.

Osteonevus of Nanta: a case report in a combined melanocytic nevus

Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.

Adult-onset porokeratotic eccrine ostial and dermal duct nevus:dermatoscopic findings and treatment with tazarotene.

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare dermatosis initially described as 'comedo nevus' and renamed 'PEODDN'; it has also been referred to as linear eccrine nevus with comedones, porokeratotic eccrine ostial and hair follicle nevus, and porokeratotic adnexal ostial nevus. PEODDN is usually present at birth or develops early in life. Rarely, PEODDN can develop in adults. The treatment of this puzzling condition is not standardized. We report herein a new case of adultonset PEODDN with dermatoscopic images. Our patient responded favorably to topical tazarotene.

Osteonevus of Nanta: a case report in a combined melanocytic nevus.

Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.

Nodular skin lesions: correlation of reflectance confocal microscopy and optical coherence tomography features.

BACKGROUND: Nodular lesions have common clinical appearance but different prognoses. Differential diagnosis between melanoma (MM), basal cell carcinoma (BCC) and dermal naevus (DN) poses a challenge in clinical practice. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are promising non-invasive imaging techniques, potentially able to decrease redundant biopsies. RCM allows in vivo visualization of skin down to the papillary dermis at almost histological resolution, while OCT, particularly dynamic OCT (D-OCT), provides images deeper within the dermis and reveals the vascular pattern. OBJECTIVES: To identify correlating features observed with RCM and OCT associated with the different nodular lesion diagnoses. METHODS: We retrospectively assessed 68 nodular lesions (30 MM, 20 BCC and 18 DN) with RCM and subsequently OCT. At the end of the study, evaluations were matched with histopathological diagnosis and statistical analysis was performed. RESULTS: In MM, 57% (17/30) evidenced both cerebriform nests at RCM and icicle-shaped structures at OCT, with higher average Breslow index. In 80% of BCCs with basaloid islands at RCM, OCT showed ovoid structures. More than half of DN (56%) showed hyporeflective nests at OCT and either dense nests or dense and sparse nests at RCM. CONCLUSIONS: The combined use of RCM and OCT offers a better understanding of the morphological architecture of nodular lesions, correlating RCM parameters with OCT and vice versa, assisting in turn with early differential diagnosis of malignant and benign nodular lesions. The correlation between icicle-shaped structures and cerebriform nests in MM and their association with Breslow index requires future research.

Juvenile melanocytic acral nevus: A comparative study between MANIAC and non-MANIAC nevus and its clinicopathological characteristics.

BACKGROUND: Melanocytic acral nevi have a series of distinguishing features, including their location, patient age at onset, clinical progression, and histological findings. In particular, histopathological analysis often reveals a melanocytic acral nevus with intraepidermal ascent of cells (MANIAC nevus), which in some cases can be mistaken for atypia or malignancy. AIM: This study describes the clinicopathological characteristics of acral nevi in patients under 18 years old and contrasts the clinical and histological features between MANIAC vs non-MANIAC nevi. METHODS: This was a retrospective observational study, performed in our department in the decade between January 2007 and January 2017. We included patients younger than 18 years of age who were subjected to the removal of melanocytic acral nevi. RESULTS: A total of 70 patients were studied. 54.2% (38/70) were females and 45.8% (32/70) were males. With regard to the type of nevus, 34 were compound, 27 were junctional, and 9 were predominantly intradermal lesions. We identified a total of 41 MANIAC nevi and 29 non-MANIAC nevi. Statistically significant differences between these two groups were identified in nevus size (larger in MANIAC) and the frequency of compound nevi (higher in the MANIAC group), but not in the remainder of the histological parameters studied.

An Atypical Fibroxanthoma and Intradermal Nevus Collision Tumor-Potential for Misdiagnosis.

Atypical fibroxanthomas (AFX) are rare cutaneous tumors, which typically present as a solitary ulcerated papule or nodule on sun-damaged skin. Despite malignant-appearing features on histology, AFX typically pursue a benign clinical course. In rare instances, AFX can form collision tumors with other lesions. However, to the best of our knowledge, AFX in collision with a nevus has never been previously reported. In this study, we describe such a lesion for its novelty and challenge in diagnosis, as this case was originally considered to be melanoma arising in a nevus. On histologic examination, there were 2 distinct populations of cells; one composed of markedly atypical and pleomorphic epithelioid and oval to spindled cells, consistent with AFX, and the other, a bland-appearing intradermal nevus with congenital features. The AFX population stained positive with smooth muscle actin, CD10, and CD68 and was negative for S100, SOX10, Melan-A, desmin, pancytokeratin, CK5/6, and p63. Deep to this was a second population of small, bland-appearing melanocytes in a broad, band-like distribution. This unusual collision tumor between AFX and an intradermal nevus highlights the important role immunohistochemistry plays in avoiding the misdiagnosis and potential overtreatment of benign or low-grade lesions, and in identifying potential mimickers.