Case And Research Letter
Not as Good as it Looks
No es bueno todo lo que lo parece
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Focal area with a pigment network on the left and a white patch in the lower right area of the image.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Monteagudo, O. Figueroa-Silva, O. Suárez-Amor, J.C. Álvarez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Monteagudo" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Figueroa-Silva" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Suárez-Amor" ] 3 => array:2 [ "nombre" => "J.C." 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Salgüero Fernández, M.M. Sigüenza Sanz, L. Nájera Botello, G. Roustan Gullón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I. Salgüero" "apellidos" => "Fernández" "email" => array:1 [ 0 => "irenebsf@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" => "M.M. Sigüenza" "apellidos" => "Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L. Nájera" "apellidos" => "Botello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "G. Roustan" "apellidos" => "Gullón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anatomía patológica, Hospital Puerta de Hierro, Majadahonda, 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" => "No es bueno todo lo que lo parece" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1224 "Ancho" => 1626 "Tamanyo" => 287534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous nodule on the auricle of the ear.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 50-year-old man, skin phototype <span class="elsevierStyleSmallCaps">iii</span>, with no past medical history of interest and with no personal or family history of melanoma, was seen in dermatology outpatients for a lesion that had arisen a year earlier on the auricle of his right ear. After treatment with salicylic acid as if it were a wart, the lesion initially disappeared, but subsequently returned. Dermatologic examination revealed an erythematous nodular lesion measuring 0.5<span class="elsevierStyleHsp" style=""></span>cm in diameter on the lower third of the auricle of the right ear (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy did not suggest a melanocytic lesion, and there were no palpable regional cervical lymph nodes. The lesion was excised and histopathology reported a well-defined polypoid lesion that, at low magnification, appeared to be a benign lesion; however, at higher magnification, a melanocytic lesion with cytologic atypia and mitoses was observed, with a lack of deep maturation. Pagetoid spread and lymphatic invasion were also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for S100 and melan A and negative for HMB45 and p16, and a high Ki-67 cell proliferation index was also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Based on these findings, the patient was diagnosed with nevoid melanoma of 0.7<span class="elsevierStyleHsp" style=""></span>cm diameter, Clark level <span class="elsevierStyleSmallCaps">v</span> and a Breslow thickness of 6.11<span class="elsevierStyleHsp" style=""></span>mm, with up to 3 mitoses per mm.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> No ulceration, lymphocytic response, signs of regression, or perineural invasion were present.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Positron emission tomography-computed tomography was performed, showing no viable tumor tissue with affinity for 18F-FDG. Widening of the surgical margins to 2<span class="elsevierStyleHsp" style=""></span>cm and selective sentinel lymph node biopsy (SLNB) were performed. After widening, the margins were free of tumor and the SLNB was negative. The patient was therefore diagnosed with melanoma stage T4b, N0, M0.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevoid melanoma, described by Schmoeckel et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> in 1985, is a lesion with characteristics similar to a benign nevus (symmetrical, dome-shaped lesion with cells that apparently mature). The main differential diagnosis is with intradermal melanocytic nevus (IDMN), and up to 50% of cases are referred for a suspected benign lesion.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Histologically, nevoid melanoma is differentiated from IDMN because IDMN does not present cytologic atypia, mitoses, pagetoid spread, lymphovascular invasion, or lack of deep maturation. Immunohistochemistry is very similar and cannot be used to differentiate between these 2 diseases. HMB-45 is positive in 80% to 86% of melanomas, but was negative in our patient. Loss of p16, as was found in our patient, correlates with aggressiveness and metastases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding malignant lesions, nodular melanoma is a densely cellular, nodular tumor, with intense cytologic atypia, mitoses, and an absence of the radial growth phase. Signs of IDMN are almost always present in melanoma on nevus, and immunohistochemistry can help in such cases, as the expression of HMB-45 and Ki-67, which characterize the superficial region of IDMN, is lost in nevoid melanoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In minimal deviation melanoma, cell organization in the dermis facilitates differentiation, as the growth pattern is expansive and displaces adjacent structures, and remnants of the preexisting nevus, whether a Spitz nevus, congenital nevus, or blue nevus, almost always persist.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Nevoid melanoma is very rare, accounting for between 0.5%<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> and 2.3% of cases. It is more common in men, with a mean age at presentation of 57 years, and tends to arise on the back and limbs.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The largest series, with 43 patients, was published in 2015 by Idriss et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Those authors described 2 architectural patterns (plaque and polypoid) and stated that 81% of cases of nevoid melanoma presented nests arranged in a parallel theque pattern in the basal layer of the tumor, which could aid diagnosis. Genetic techniques including fluorescent in situ hybridization and comparative genomic hybridization (CGH) have been shown to be useful in the differentiation between melanoma and melanocytic nevus. In that study, CGH detected genetic changes in 7 of the 8 cases in which the test was performed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nevoid melanomas appear to carry a poorer prognosis than other types described in the different series, with metastasis rates of 15% to 37.5% and a mortality of between 25% and 37.5% (series by Schmoeckel et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> and series by Idriss et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a>). In our patient, SLNB was performed despite the site being on the head and neck, which can make the technique more difficult, and, in accordance with the melanoma committee, local radiotherapy was administered.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" 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: Fernándezirenebsf@hotmail.com IS, Sanz MMS, Botello LN, Gullón GR. No es bueno todo lo que lo parece. Actas Dermosifiliogr. 2017;108:876–878.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1224 "Ancho" => 1626 "Tamanyo" => 287534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous nodule on the auricle of the ear.</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" => 2114 "Ancho" => 3167 "Tamanyo" => 947281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nevoid malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 14 | 23 |
| 2024 October | 101 | 45 | 146 |
| 2024 September | 144 | 61 | 205 |
| 2024 August | 166 | 87 | 253 |
| 2024 July | 155 | 36 | 191 |
| 2024 June | 162 | 40 | 202 |
| 2024 May | 108 | 36 | 144 |
| 2024 April | 101 | 34 | 135 |
| 2024 March | 112 | 21 | 133 |
| 2024 February | 105 | 29 | 134 |
| 2024 January | 85 | 31 | 116 |
| 2023 December | 94 | 26 | 120 |
| 2023 November | 108 | 20 | 128 |
| 2023 October | 97 | 30 | 127 |
| 2023 September | 61 | 24 | 85 |
| 2023 August | 50 | 13 | 63 |
| 2023 July | 72 | 35 | 107 |
| 2023 June | 74 | 19 | 93 |
| 2023 May | 46 | 25 | 71 |
| 2023 April | 58 | 15 | 73 |
| 2023 March | 59 | 23 | 82 |
| 2023 February | 58 | 11 | 69 |
| 2023 January | 49 | 29 | 78 |
| 2022 December | 70 | 27 | 97 |
| 2022 November | 30 | 19 | 49 |
| 2022 October | 43 | 30 | 73 |
| 2022 September | 23 | 26 | 49 |
| 2022 August | 28 | 54 | 82 |
| 2022 July | 30 | 47 | 77 |
| 2022 June | 21 | 25 | 46 |
| 2022 May | 47 | 45 | 92 |
| 2022 April | 71 | 26 | 97 |
| 2022 March | 56 | 52 | 108 |
| 2022 February | 50 | 25 | 75 |
| 2022 January | 87 | 31 | 118 |
| 2021 December | 45 | 38 | 83 |
| 2021 November | 53 | 46 | 99 |
| 2021 October | 46 | 50 | 96 |
| 2021 September | 42 | 30 | 72 |
| 2021 August | 39 | 32 | 71 |
| 2021 July | 47 | 16 | 63 |
| 2021 June | 46 | 27 | 73 |
| 2021 May | 35 | 45 | 80 |
| 2021 April | 81 | 71 | 152 |
| 2021 March | 47 | 27 | 74 |
| 2021 February | 47 | 25 | 72 |
| 2021 January | 17 | 19 | 36 |
| 2020 December | 37 | 23 | 60 |
| 2020 November | 32 | 17 | 49 |
| 2020 October | 34 | 11 | 45 |
| 2020 September | 31 | 13 | 44 |
| 2020 August | 30 | 19 | 49 |
| 2020 July | 19 | 15 | 34 |
| 2020 June | 26 | 19 | 45 |
| 2020 May | 17 | 11 | 28 |
| 2020 April | 20 | 15 | 35 |
| 2020 March | 26 | 14 | 40 |
| 2020 February | 5 | 0 | 5 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 0 | 7 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 5 | 0 | 5 |
| 2018 February | 26 | 7 | 33 |
| 2018 January | 62 | 4 | 66 |
| 2017 December | 26 | 15 | 41 |
| 2017 November | 59 | 37 | 96 |
| 2017 October | 1 | 4 | 5 |
| 2017 September | 5 | 6 | 11 |
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