Case and Research Letter
Sclerosing Nevus With Pseudomelanomatous Features: A Case Report
Nevus esclerosante con rasgos seudomelanomatosos
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Floristán Muruzábal, F.J. Pinedo Moraleda, R. Gamo Villegas, J.L. López Estebaranz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "U." "apellidos" => "Floristán Muruzábal" "email" => array:1 [ 0 => "uxuafloristan@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F.J." "apellidos" => "Pinedo Moraleda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Gamo Villegas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "López Estebaranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus esclerosante con rasgos seudomelanomatosos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1201 "Ancho" => 1600 "Tamanyo" => 819979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Lesion with a 3-zone pattern. Hematoxylin and eosin (H&E), low-power view. B and C, Proliferation of atypical melanocytes at the dermoepidermal junction with an area of scarring, nests of atypical melanocytes, and a congenital-type residual nevus both peripheral and deep to the scar. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×100. D, Scattered areas of pagetoid spread of melanocytic cells in other areas of the epidermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2008, Giuseppe Fabrizi et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> were the first to describe a subgroup of lesions with distinct histopathologic characteristics among all the melanocytic nevi excised for clinical regression; these lesions were given the name of sclerosing nevus with pseudomelanomatous features (SNPF).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 44-year-old woman who was seen for persistent pruritus in the area of a nevus on her back. The variegate maculopapular lesion measured approximately 1<span class="elsevierStyleHsp" style=""></span>cm in diameter and had irregular borders. On dermoscopy, an atypical globular pattern and a negative network were observed, with red, white, and occasional bluish areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was evaluated using reflectance confocal microscopy (RCM), which showed marked destructuring of the epidermis, with irregularly shaped keratinocytes instead of the typical honeycomb or cobbled appearance, the presence of pagetoid cells with a multifocal distribution and dendritic morphology, a loss of bright rings, the absence of a defined pattern at the dermoepidermal junction, the presence of atypical cells forming junctional and dermal nests, and a dense inflammatory infiltrate with fibrosis and abundant melanophages (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). With a suspected diagnosis of melanoma, the lesion was excised.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology revealed an atypical proliferation of melanocytes at the dermoepidermal junction, with occasional pagetoid spread in the epidermis, an area of scar tissue, melanocytic nests with a morphology similar to that described at the dermoepidermal junction, and a residual nevus with a congenital pattern, both peripherally and deep to the scar tissue. The cells were not frankly atypical and, after detailed examination, no mitotic figures were identified (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The proliferation index was very low and was limited practically to the junctional component. The cells of the irregular nests and of the residual nevus component expressed Melan-A and p16, with a loss of expression of HMB-45 in the dermal component. The lesion did not reach the borders of resection. This histologic image was consistent with a sclerosing nevus with pseudomelanomatous features. With this diagnosis, no additional treatment was performed, and the patient remains on follow-up.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">SNPF, a recently described clinical and pathologic entity, is also known as nevus with florid fibroplasia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> It is considered to mimic melanoma both clinically and histologically.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Etiologically, this lesion appears to be a benign melanocytic nevus that becomes involved in a process of fibrosis combined with a pseudomelanomatous proliferation. It typically arises in young individuals, mainly on the back, particularly in the area of the scapula. This site is thought to be affected because of almost imperceptible microtrauma or inflammatory changes in the region, such as the chronic friction of clothing, sunburn, seborrheic eczema, or acne. However, other authors consider that this type of fibrosis may be something intrinsic to the maturation process of a dysplastic nevus.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopically it is characterized by signs of regression, affecting 10% to 50% of the lesion, in the form of white and blue scars, and an absence of other specific signs of melanoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">RCM is a noninvasive technique with a resolution very similar to conventional histology. It provides horizontal images and can be considered an intermediate diagnostic method between dermoscopy and histopathology, frequently avoiding unnecessary surgical excisions. However, the presence of cellular atypia on RCM study in these cases means that a diagnosis of melanoma cannot be ruled out. As is to be expected, abundant melanophages and collagen bundles are also observed.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically there are 3 zones: an atypical proliferation of melanocytes at the dermoepidermal junction, with lentiginous hyperplasia, and confluent junctional nests with occasional pagetoid spread; a significant area of dermal sclerosis that contains irregular nests of atypical melanocytes; and a congenital-type residual nevus adjacent to the deep surface of the scar.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The low level of cellular atypia and the absence of mitoses, cell necrosis, or spreading dermal nodules differentiates this lesion from regressing melanoma. In addition, SNPF usually has an “ordered” pattern of fibrosis, with homogeneous bundles of parallel eosinophilic collagen fibers closely related to the epidermis. In contrast, a regressing melanoma is characterized by fibrosis that is often paler (perhaps because of edema), formed of more irregular collagen bundles, and the presence of melanophages. The diagnostic criteria of Fabrizi et al. probably make it possible to differentiate SNPF from a regressing melanoma. However, atypia in the junctional region associated with pagetoid spread makes diagnosis of this entity a question of the quantitative presence of morphological criteria, and a degree of interobserver variability between pathologists should therefore be expected.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Taking into account the benign biological behavior of this entity, some authors consider that a more conservative approach could be warranted in melanocytic lesions showing regression on the convex area of the back.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Those authors propose observation. However, other authors recommend surgical excision, as SNPF mimics melanoma clinically, dermoscopically, and on RCM.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Only histology can give us the definitive diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Floristán Muruzábal U, Pinedo Moraleda FJ, Gamo Villegas R, López Estebaranz JL. Nevus esclerosante con rasgos seudomelanomatosos. Actas Dermosifiliogr. 2016;107:691–694.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1630 "Ancho" => 978 "Tamanyo" => 187442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic appearance. A, Variegate pigmented lesion with irregular borders measuring approximately 1<span class="elsevierStyleHsp" style=""></span>cm in diameter. B, Atypical globular pattern, with a red, white, and blue negative network.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 692 "Ancho" => 1400 "Tamanyo" => 267319 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Confocal microscopy. A, Focus of abundant dendritic cells in the epidermis (red arrow). B, Areas of poorly defined papillas, with atypical junctional and dermal nests (blue arrows), areas of fibrosis, and an inflammatory infiltrate (asterisk).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1201 "Ancho" => 1600 "Tamanyo" => 819979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Lesion with a 3-zone pattern. Hematoxylin and eosin (H&E), low-power view. B and C, Proliferation of atypical melanocytes at the dermoepidermal junction with an area of scarring, nests of atypical melanocytes, and a congenital-type residual nevus both peripheral and deep to the scar. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×100. D, Scattered areas of pagetoid spread of melanocytic cells in other areas of the epidermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerosing nevus with pseudomelanomatous features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Fabrizi" 1 => "I. Pennacchia" 2 => "C. Pagliarello" 3 => "G. Massi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2007.00941.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "995" "paginaFinal" => "1002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18537860" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clark/dysplastic nevi with florid fibroplasia associated with pseudomelanomatous features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J. Ko" 1 => "J.L. Bolognia" 2 => "E.J. Glusac" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.02.046" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" "volumen" => "64" "paginaInicial" => "346" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21238828" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283808006647" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerosing nevus with pseudomelanomatous features and regressing melanoma with nevoid features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Ferrara" 1 => "A. Amantea" 2 => "G. Argenziano" 3 => "P. Broganelli" 4 => "A.M. Cesinaro" 5 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 137 | 63 | 200 |
| 2024 September | 135 | 52 | 187 |
| 2024 August | 152 | 75 | 227 |
| 2024 July | 130 | 57 | 187 |
| 2024 June | 148 | 43 | 191 |
| 2024 May | 110 | 56 | 166 |
| 2024 April | 105 | 28 | 133 |
| 2024 March | 117 | 36 | 153 |
| 2024 February | 135 | 40 | 175 |
| 2024 January | 90 | 25 | 115 |
| 2023 December | 100 | 26 | 126 |
| 2023 November | 85 | 34 | 119 |
| 2023 October | 110 | 18 | 128 |
| 2023 September | 108 | 26 | 134 |
| 2023 August | 75 | 25 | 100 |
| 2023 July | 98 | 48 | 146 |
| 2023 June | 80 | 35 | 115 |
| 2023 May | 135 | 36 | 171 |
| 2023 April | 102 | 34 | 136 |
| 2023 March | 120 | 25 | 145 |
| 2023 February | 74 | 17 | 91 |
| 2023 January | 67 | 22 | 89 |
| 2022 December | 87 | 37 | 124 |
| 2022 November | 63 | 28 | 91 |
| 2022 October | 58 | 22 | 80 |
| 2022 September | 50 | 47 | 97 |
| 2022 August | 72 | 42 | 114 |
| 2022 July | 77 | 39 | 116 |
| 2022 June | 89 | 37 | 126 |
| 2022 May | 96 | 45 | 141 |
| 2022 April | 75 | 26 | 101 |
| 2022 March | 63 | 46 | 109 |
| 2022 February | 49 | 25 | 74 |
| 2022 January | 65 | 41 | 106 |
| 2021 December | 56 | 39 | 95 |
| 2021 November | 60 | 40 | 100 |
| 2021 October | 85 | 49 | 134 |
| 2021 September | 56 | 46 | 102 |
| 2021 August | 63 | 33 | 96 |
| 2021 July | 46 | 29 | 75 |
| 2021 June | 47 | 30 | 77 |
| 2021 May | 63 | 35 | 98 |
| 2021 April | 128 | 42 | 170 |
| 2021 March | 54 | 24 | 78 |
| 2021 February | 56 | 25 | 81 |
| 2021 January | 28 | 21 | 49 |
| 2020 December | 33 | 19 | 52 |
| 2020 November | 27 | 27 | 54 |
| 2020 October | 29 | 19 | 48 |
| 2020 September | 37 | 13 | 50 |
| 2020 August | 36 | 16 | 52 |
| 2020 July | 22 | 12 | 34 |
| 2020 June | 33 | 24 | 57 |
| 2020 May | 22 | 22 | 44 |
| 2020 April | 22 | 16 | 38 |
| 2020 March | 30 | 25 | 55 |
| 2020 February | 5 | 0 | 5 |
| 2019 December | 2 | 0 | 2 |
| 2019 September | 6 | 0 | 6 |
| 2019 August | 2 | 0 | 2 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 1 | 0 | 1 |
| 2019 April | 2 | 6 | 8 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 3 | 0 | 3 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 2 | 0 | 2 |
| 2018 February | 28 | 2 | 30 |
| 2018 January | 45 | 8 | 53 |
| 2017 December | 50 | 6 | 56 |
| 2017 November | 45 | 4 | 49 |
| 2017 October | 48 | 6 | 54 |
| 2017 September | 28 | 7 | 35 |
| 2017 August | 31 | 11 | 42 |
| 2017 July | 26 | 4 | 30 |
| 2017 June | 37 | 11 | 48 |
| 2017 May | 52 | 16 | 68 |
| 2017 April | 32 | 8 | 40 |
| 2017 March | 15 | 8 | 23 |
| 2017 February | 35 | 16 | 51 |
| 2017 January | 14 | 10 | 24 |
| 2016 December | 23 | 21 | 44 |
| 2016 November | 32 | 20 | 52 |
| 2016 October | 86 | 27 | 113 |
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