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such as Melanoma Antigen Recognized by T-cells 1 &#40;MART-1&#41; or&#44; a related stain&#44; Melan-A&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The literature cautions MART-1&#47;Melan-A positivity can be misleading&#44; because MART-1&#47;Melan-A&#39;s cytoplasmic antigen in the melanosome can be transferred between cells during inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a patient thought to have a malignant melanoma in situ &#40;MMIS&#41; with marked regression upon initial biopsy&#44; but was more consistent with lichen striatus upon subsequent biopsy and clinical correlation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 32-year-old male presented with a changing lesion on his anterior shoulder&#46; The lesion was partially biopsied with a clinical differential diagnosis of an atypical melanocytic lesion vs Becker&#39;s nevus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Initial histological review showed single and atypical cells at the dermoepidermal junction &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; MART-1 mildly highlighted cell aggregates &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; Atypical lentiginous junctional cells were suspicious for MMIS with marked regression&#46; The patient was referred to oncology&#44; who consulted the pathologist&#44; and sampled the lesion again&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Additional samples showed fewer pseudonests&#44; and SRY-related HMG-box Gene 10 &#40;SOX10&#41; did not show a melanocytic neoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; After examination of the subsequent biopsies and clinical image&#44; the lesion was felt to represent a lichenoid process with marked pigment incontinence&#44; most consistent with lichen striatus with melanocyte pseudonests&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights a diagnostic pitfall in lichenoid processes with pseudonests&#44; for which misdiagnosis has repercussions in treatment and management&#46; The clinical and histological findings point to a lichenoid process and are not consistent with MMIS&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">After pseudonests were initially described&#44; other studies cautioned using MART-1&#47;Melan-A in pigmented lesions with chronic sun damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a> Despite studies suggesting pseudonests were rare&#44; Silva et al&#46; cautioned against excluding it from the differential diagnosis and heeded prior warnings to use multiple stains&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microphthalmia-associated transcription factor &#40;MITF&#41;&#44; a nuclear epitope&#44; and SOX10&#44; a regulator for MITF&#44; are more specific due to nuclear epitopes not readily transferring between cells in inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Therefore&#44; other studies used supplementary stains&#44; such as SOX10 or MITF&#44; to verify true melanocytic components with benign reorganization&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;4&#44;7</span></a> MITF differentiated pseudonests from true melanocytic lesions after labeling cells consistently with other stains&#44; such as S-100 or SOX10&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;5</span></a> S-100 is considered one of the most sensitive stains for melanocytic lesions and specific against pseudomelanocytic nests due to a lack of aberrant staining in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Thus&#44; MITF&#39;s efficacy was challenged after MITF positive&#47;S-100 negative nests were found in 30 cases of cutaneous lupus erythematosus with lichenoid interface dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Authors hypothesized MITF stains similarly to MART-1&#47;Melan-A and insisted on clinical correlation and S-100 staining when both MART-1&#47;Melan-A and MITF are positive&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The term &#8220;melanocytic pseudonests&#8221; was suggested for benign lesions with positive nest staining beyond MART-1&#47;Melan-A in greater than 1-2 cells and not clinically thought to be MMIS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A summary of studies and nest stain positivity can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Alternative compositions of nests&#44; such as cells or cellular debris from melanocytes&#44; melanophages&#44; lymphocytes&#44; or keratinocytes&#44; are speculated to cause the aberrant MART-1&#47;Melan-A staining&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;7</span></a> Silva et al&#46; hypothesized pseudonests originate during lichenoid inflammation due to either recruitment or benign reorganization of true melanocytes&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and Hall et al&#46; used soluble adenylyl cyclase &#40;sAC&#41; and CD1a to differentiate S-100 and sAC positive junctional melanocytes from superficial S-100 and CD1a positive epidermal Langerhans cells&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Other causes for discrepancies include differing staining protocols&#44; study types&#44; or disease processes&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the controversy&#44; several histologic features are important when differentiating lesions beyond stains&#46; For instance&#44; the lack of pagetoid spread or surrounding lentiginous melanocytic proliferation makes MMIS unlikely&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> while non-staining nuclei in MITF positive nests hint to non-melanocytic origins&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Conversely&#44; features suggestive of atypical melanocytic lesions include an abundance of positive staining junctional nests&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> confluent non-nested melanocytes&#44; solar elastosis&#44; effaced rete ridges&#44; and &#8216;starburst&#8217; giant cells&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dermatologists&#8217; awareness of pseudomelanocytic nests is critical in avoiding a severe diagnostic pitfall&#46; Clinicians should be cognizant of the possibility for pseudomelanocytes if the clinical differential diagnosis includes a lichenoid process and a pathology report describes an atypical melanocytic neoplasm&#46; In the presence of Melan-A&#47;MART-1 positivity&#44; panels of multiple melanocytic markers&#44; such as S-100 and&#47;or MITF &#40;or SOX10&#41;&#44; markers of keratinocytic origin&#44; and histologic correlation with the clinical context are essential for correct diagnosis&#46; More studies are needed to determine the true nature of pseudonests and the sensitivity&#47;specificity of stains in evaluating pseudonests&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; McClanahan D&#44; Choudhary S&#44; Zahniser J&#44; Ho J&#46; Trampas diagn&#243;sticas&#58; nidos seudomelanoc&#237;ticos en el contexto de la inflamaci&#243;n liquenoide&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;321&#8211;325&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior shoulder lesion with speckled brown appearance and areas of erythema&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Initial biopsy showed diminished rete ridges and atypical cells in nests and as single cells with an underlying lymphohistiocytic infiltrate on hematoxylin and eosin &#40;H&#38;E&#41; on low &#40;A&#41; and high &#40;B&#41; magnification&#46; MART-1 showed weak staining of the lesional cells &#40;C&#41;&#46; Subsequent biopsies showed less nesting on H&#38;E on low &#40;D&#41; and high &#40;E&#41; magnification and did not show a melanocytic neoplasm with SOX10 stains &#40;F&#41;&#46; Pankeratin and S100 were only focally positive &#40;not pictured&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#43;&#58; positive staining nests&#59; &#8722;&#58; negative staining nests&#59; O&#58; occasional cells in nests&#59; R&#58; rare cell in nests&#59; UK&#58; unknown&#59; &#42;&#58; some cells exhibit non-staining nuclei&#59; M&#58; normal distribution of melanocytes at dermal-epidermal junction&#59; LEN&#58; Langerhans cells in epidermis and nests&#59; LE&#58; Langerhans cells in epidermis&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#47;sex&#44; location&#44; clinical presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&#47;negative nest stains</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Maize et al&#46;&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">35&#47;M&#44; left temple&#44; blue-gray macules</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Discoid Lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>&#44; S100<span class="elsevierStyleSup">M</span>&#44; Tyrosinase<span class="elsevierStyleSup">M</span>&#44; and BCL2<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">El Shabrawi-Caelen et al&#46;&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 10 cases of pigmented actinic keratosis</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Pigmented actinic keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>&#44; S100<span class="elsevierStyleSup">M&#44; LE</span>&#44; and Tyrosinase<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">60&#47;M&#44; both cheeks&#44; brown grayish pigmentation&#44; ill circumscribed</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Lichenoid phototoxic reaction</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">59&#47;M&#44; upper head&#44; irregular&#44; partly confluent reticulated pigmentation</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Lichen planus pigmentosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">52&#47;F&#44; infraorbital area&#44; small scaly plaque</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Pigmented lichenoid keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Nicholson and Gerami&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">39&#47;F&#44; forehead&#44; ill-defined hyperpigmented macules</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&#44; CD68 and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Nicholson and Gerami&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">76&#47;F&#44; right periocular&#44; well-demarcated hyperpigmented patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span>&#44; HMB45&#44; S100&#44; and CD68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Silva et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">48&#47;M&#44; submandibular area of left neck&#44; well-circumscribed&#44; violaceous to hyperpigmented&#44; nonblanching&#44; polygonal patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; MITF&#44; SOX10&#44; and S100 focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichen planus pigmentosus&#47; Erythema dyschromicum perstans</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Gavino et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 70 cases of lichen planus-like keratosis</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and MIFT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Benign melanocytic nevi with lichenoid inflammation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Abuzeid et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">1 UK case of positive staining nests in 53 cases of cutaneous lupus erythematosus &#40;five UK negative staining nests&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and MIFT&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Cutaneous lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Hall et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">48&#47;M&#44; central chest&#44; irregular brown to violaceous patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; MIFT&#44; SOX10&#44; S100&#42;&#44; and CD1a<span class="elsevierStyleSup">LEN</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichen planus actinicus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">sAC<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chung et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#47;M&#44; back&#44; ankles&#44; and feet&#44; violaceous&#44; polygonal&#44; flat-topped&#44; mildly pruritic papules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and SOX10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lichen planus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Caso actual</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">32&#47;M&#44; anterior shoulder&#44; mammilated multifocal brown plaque</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; focal S100&#44; and focal CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichenoid process with marked pigment incontinence and melanocytic pseudonests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SOX10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Case and Research Letters
Diagnostic Pitfalls: Pseudomelanocytic Nests in the Setting of Lichenoid Inflammation
Trampas diagnósticas: nidos seudomelanocíticos en el contexto de la inflamación liquenoide
D. McClanahana,
Corresponding author
drm92@pitt.edu

Corresponding author.
, S. Choudharya, J. Zahniserb, J. Hoa
a Department of Dermatology, University of Pittsburgh, Pittsburgh, USA
b Horizon Dermatology – UPMC, Hermitage, USA
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such as Melanoma Antigen Recognized by T-cells 1 &#40;MART-1&#41; or&#44; a related stain&#44; Melan-A&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The literature cautions MART-1&#47;Melan-A positivity can be misleading&#44; because MART-1&#47;Melan-A&#39;s cytoplasmic antigen in the melanosome can be transferred between cells during inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a patient thought to have a malignant melanoma in situ &#40;MMIS&#41; with marked regression upon initial biopsy&#44; but was more consistent with lichen striatus upon subsequent biopsy and clinical correlation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 32-year-old male presented with a changing lesion on his anterior shoulder&#46; The lesion was partially biopsied with a clinical differential diagnosis of an atypical melanocytic lesion vs Becker&#39;s nevus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Initial histological review showed single and atypical cells at the dermoepidermal junction &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; MART-1 mildly highlighted cell aggregates &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; Atypical lentiginous junctional cells were suspicious for MMIS with marked regression&#46; The patient was referred to oncology&#44; who consulted the pathologist&#44; and sampled the lesion again&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Additional samples showed fewer pseudonests&#44; and SRY-related HMG-box Gene 10 &#40;SOX10&#41; did not show a melanocytic neoplasm &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; After examination of the subsequent biopsies and clinical image&#44; the lesion was felt to represent a lichenoid process with marked pigment incontinence&#44; most consistent with lichen striatus with melanocyte pseudonests&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights a diagnostic pitfall in lichenoid processes with pseudonests&#44; for which misdiagnosis has repercussions in treatment and management&#46; The clinical and histological findings point to a lichenoid process and are not consistent with MMIS&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">After pseudonests were initially described&#44; other studies cautioned using MART-1&#47;Melan-A in pigmented lesions with chronic sun damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3&#44;6</span></a> Despite studies suggesting pseudonests were rare&#44; Silva et al&#46; cautioned against excluding it from the differential diagnosis and heeded prior warnings to use multiple stains&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microphthalmia-associated transcription factor &#40;MITF&#41;&#44; a nuclear epitope&#44; and SOX10&#44; a regulator for MITF&#44; are more specific due to nuclear epitopes not readily transferring between cells in inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Therefore&#44; other studies used supplementary stains&#44; such as SOX10 or MITF&#44; to verify true melanocytic components with benign reorganization&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;4&#44;7</span></a> MITF differentiated pseudonests from true melanocytic lesions after labeling cells consistently with other stains&#44; such as S-100 or SOX10&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;5</span></a> S-100 is considered one of the most sensitive stains for melanocytic lesions and specific against pseudomelanocytic nests due to a lack of aberrant staining in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Thus&#44; MITF&#39;s efficacy was challenged after MITF positive&#47;S-100 negative nests were found in 30 cases of cutaneous lupus erythematosus with lichenoid interface dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Authors hypothesized MITF stains similarly to MART-1&#47;Melan-A and insisted on clinical correlation and S-100 staining when both MART-1&#47;Melan-A and MITF are positive&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The term &#8220;melanocytic pseudonests&#8221; was suggested for benign lesions with positive nest staining beyond MART-1&#47;Melan-A in greater than 1-2 cells and not clinically thought to be MMIS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A summary of studies and nest stain positivity can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Alternative compositions of nests&#44; such as cells or cellular debris from melanocytes&#44; melanophages&#44; lymphocytes&#44; or keratinocytes&#44; are speculated to cause the aberrant MART-1&#47;Melan-A staining&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;7</span></a> Silva et al&#46; hypothesized pseudonests originate during lichenoid inflammation due to either recruitment or benign reorganization of true melanocytes&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and Hall et al&#46; used soluble adenylyl cyclase &#40;sAC&#41; and CD1a to differentiate S-100 and sAC positive junctional melanocytes from superficial S-100 and CD1a positive epidermal Langerhans cells&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Other causes for discrepancies include differing staining protocols&#44; study types&#44; or disease processes&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the controversy&#44; several histologic features are important when differentiating lesions beyond stains&#46; For instance&#44; the lack of pagetoid spread or surrounding lentiginous melanocytic proliferation makes MMIS unlikely&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> while non-staining nuclei in MITF positive nests hint to non-melanocytic origins&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Conversely&#44; features suggestive of atypical melanocytic lesions include an abundance of positive staining junctional nests&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> confluent non-nested melanocytes&#44; solar elastosis&#44; effaced rete ridges&#44; and &#8216;starburst&#8217; giant cells&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dermatologists&#8217; awareness of pseudomelanocytic nests is critical in avoiding a severe diagnostic pitfall&#46; Clinicians should be cognizant of the possibility for pseudomelanocytes if the clinical differential diagnosis includes a lichenoid process and a pathology report describes an atypical melanocytic neoplasm&#46; In the presence of Melan-A&#47;MART-1 positivity&#44; panels of multiple melanocytic markers&#44; such as S-100 and&#47;or MITF &#40;or SOX10&#41;&#44; markers of keratinocytic origin&#44; and histologic correlation with the clinical context are essential for correct diagnosis&#46; More studies are needed to determine the true nature of pseudonests and the sensitivity&#47;specificity of stains in evaluating pseudonests&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; McClanahan D&#44; Choudhary S&#44; Zahniser J&#44; Ho J&#46; Trampas diagn&#243;sticas&#58; nidos seudomelanoc&#237;ticos en el contexto de la inflamaci&#243;n liquenoide&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;321&#8211;325&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior shoulder lesion with speckled brown appearance and areas of erythema&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Initial biopsy showed diminished rete ridges and atypical cells in nests and as single cells with an underlying lymphohistiocytic infiltrate on hematoxylin and eosin &#40;H&#38;E&#41; on low &#40;A&#41; and high &#40;B&#41; magnification&#46; MART-1 showed weak staining of the lesional cells &#40;C&#41;&#46; Subsequent biopsies showed less nesting on H&#38;E on low &#40;D&#41; and high &#40;E&#41; magnification and did not show a melanocytic neoplasm with SOX10 stains &#40;F&#41;&#46; Pankeratin and S100 were only focally positive &#40;not pictured&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#43;&#58; positive staining nests&#59; &#8722;&#58; negative staining nests&#59; O&#58; occasional cells in nests&#59; R&#58; rare cell in nests&#59; UK&#58; unknown&#59; &#42;&#58; some cells exhibit non-staining nuclei&#59; M&#58; normal distribution of melanocytes at dermal-epidermal junction&#59; LEN&#58; Langerhans cells in epidermis and nests&#59; LE&#58; Langerhans cells in epidermis&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#47;sex&#44; location&#44; clinical presentation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&#47;negative nest stains</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Maize et al&#46;&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">35&#47;M&#44; left temple&#44; blue-gray macules</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Discoid Lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>&#44; S100<span class="elsevierStyleSup">M</span>&#44; Tyrosinase<span class="elsevierStyleSup">M</span>&#44; and BCL2<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">El Shabrawi-Caelen et al&#46;&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 10 cases of pigmented actinic keratosis</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Pigmented actinic keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>&#44; S100<span class="elsevierStyleSup">M&#44; LE</span>&#44; and Tyrosinase<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">60&#47;M&#44; both cheeks&#44; brown grayish pigmentation&#44; ill circumscribed</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Lichenoid phototoxic reaction</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">59&#47;M&#44; upper head&#44; irregular&#44; partly confluent reticulated pigmentation</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Lichen planus pigmentosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Beltraminelli et al&#46;&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">52&#47;F&#44; infraorbital area&#44; small scaly plaque</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Pigmented lichenoid keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Nicholson and Gerami&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">39&#47;F&#44; forehead&#44; ill-defined hyperpigmented macules</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&#44; CD68 and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Nicholson and Gerami&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">76&#47;F&#44; right periocular&#44; well-demarcated hyperpigmented patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span>&#44; HMB45&#44; S100&#44; and CD68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Silva et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">48&#47;M&#44; submandibular area of left neck&#44; well-circumscribed&#44; violaceous to hyperpigmented&#44; nonblanching&#44; polygonal patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; MITF&#44; SOX10&#44; and S100 focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichen planus pigmentosus&#47; Erythema dyschromicum perstans</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Gavino et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 70 cases of lichen planus-like keratosis</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and MIFT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Benign melanocytic nevi with lichenoid inflammation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CK and CD3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Abuzeid et al&#46;&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">1 UK case of positive staining nests in 53 cases of cutaneous lupus erythematosus &#40;five UK negative staining nests&#41;</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and MIFT&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Cutaneous lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Hall et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">48&#47;M&#44; central chest&#44; irregular brown to violaceous patch</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; MIFT&#44; SOX10&#44; S100&#42;&#44; and CD1a<span class="elsevierStyleSup">LEN</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichen planus actinicus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">sAC<span class="elsevierStyleSup">M</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chung et al&#46;&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#47;M&#44; back&#44; ankles&#44; and feet&#44; violaceous&#44; polygonal&#44; flat-topped&#44; mildly pruritic papules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1 and SOX10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lichen planus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Caso actual</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">32&#47;M&#44; anterior shoulder&#44; mammilated multifocal brown plaque</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Melan-A&#47;MART-1&#44; focal S100&#44; and focal CK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Lichenoid process with marked pigment incontinence and melanocytic pseudonests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SOX10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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