Case and Research Letters
Simultaneous Disappearance of Various Nevi in a Patient with Autoimmune Disorders
Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados
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Álvarez-Chinchilla, I. Poveda Montoyo, B. Encabo-Durán, J. Bañuls Roca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P.J." "apellidos" => "Álvarez-Chinchilla" "email" => array:1 [ 0 => "pedroalvarezchinchilla@gmail.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" => "I." "apellidos" => "Poveda Montoyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Encabo-Durán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Bañuls Roca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d’Alacant, Alicante, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados" ] ] "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" => 1050 "Ancho" => 1400 "Tamanyo" => 179741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images showing changes in the patient's nevi.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During digital follow-up of a 42-year-old woman with atypical nevi using a MoleMax II video dermoscopy system (Derma Medical, London, UK), the patient's melanocytic lesions progressively disappeared and were practically absent by the end of a 3-year period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She presented with several autoimmune processes, including HLA-B27-positive sacroiliitis, ANA-positive peripheral arthritis, and autoimmune hypothyroidism that was treated with supplemental L-tyrosine. She had no personal or family history of melanoma. There was no evidence of a halo phenomenon or any other reaction around the nevi at any time. Several potential explanations can account for the disappearance of melanocytic nevi. Progressive disappearance in adulthood is a described feature of acquired melanocytic nevi (AMN).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">However, the rapid disappearance of AMN in young adults, as in the present case, is unusual. This involution can be caused by certain specific reactions. The halo or Sutton nevus can progressively fade and ultimately disappear, leaving a depigmented halo surrounding the site of the original nevus. Histologically, the condition is characterized by the presence of lymphocytic infiltrate with predominance of CD8<span class="elsevierStyleSup">+</span> T lymphocytes. This infiltrate results in progressive destruction of the melanocytes via a mechanism similar to that observed in vitiligo. This is the most common mechanism by which nevi disappear.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Isolated reports have also described the disappearance of congenital melanocytic nevi, with or without a halo. In some cases histology has revealed the persistence of melanocytes despite apparent clinical disappearance.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A completely different form of nevus disappearance involves an eccematoid reaction around the nevus (Meyerson nevus) followed by nevus involution, and is characterized by eczema-like histological findings.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Because AMN and melanoma induce the expression of similar antigens, AMN can disappear in melanoma patients, a consequence of an immune system reaction that occurs spontaneously or is induced by immunotherapy with anti-CTL01A4 and anti-PD-1 agents.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Although less common, the disappearance of nevi in patients with neither eczema nor halo nevi has been described, although few of those cases involved involution of practically all nevi, as occurred in our patient.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The literature describes 3 dermoscopic patterns associated with the disappearance of melanocytic nevi: halo phenomena; blue regression (peppering), caused by the action of melanophages, and white regression, characterized by a white fibrotic area with a pseudo-cicatricial appearance; and lesion disappearance with neither halo nor regression. In the case of the third pattern, which was observed in our patient, the lesions undergo a progressive loss of pigment and the dermoscopic pattern fades until lesion disappearance.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given our patient's history of autoimmune diseases, the mechanism underlying nevus disappearance in this case was most likely immune in nature, although this was not histologically verified.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to be familiar with the different ways in which melanocytic lesions can evolve, since clinical lesion disappearance does not always imply histological disappearance, and to remember that digital dermoscopy is a useful method by which to monitor these patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" 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: Álvarez-Chinchilla PJ, Poveda Montoyo I, Encabo-Durán B, Bañuls Roca J. Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados. Actas Dermosifiliogr. 2018;109:927–928.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 1400 "Tamanyo" => 179741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images showing changes in the patient's nevi.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Bologna" 1 => "J.L. Jorizzo" 2 => "J.V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 9 | 30 |
| 2024 October | 137 | 48 | 185 |
| 2024 September | 120 | 31 | 151 |
| 2024 August | 144 | 72 | 216 |
| 2024 July | 130 | 41 | 171 |
| 2024 June | 143 | 57 | 200 |
| 2024 May | 92 | 52 | 144 |
| 2024 April | 110 | 43 | 153 |
| 2024 March | 114 | 41 | 155 |
| 2024 February | 124 | 39 | 163 |
| 2024 January | 115 | 37 | 152 |
| 2023 December | 99 | 30 | 129 |
| 2023 November | 143 | 25 | 168 |
| 2023 October | 145 | 33 | 178 |
| 2023 September | 141 | 36 | 177 |
| 2023 August | 122 | 16 | 138 |
| 2023 July | 154 | 35 | 189 |
| 2023 June | 146 | 28 | 174 |
| 2023 May | 186 | 22 | 208 |
| 2023 April | 133 | 23 | 156 |
| 2023 March | 120 | 27 | 147 |
| 2023 February | 118 | 33 | 151 |
| 2023 January | 148 | 36 | 184 |
| 2022 December | 109 | 44 | 153 |
| 2022 November | 43 | 24 | 67 |
| 2022 October | 54 | 24 | 78 |
| 2022 September | 52 | 30 | 82 |
| 2022 August | 61 | 41 | 102 |
| 2022 July | 57 | 59 | 116 |
| 2022 June | 38 | 33 | 71 |
| 2022 May | 132 | 48 | 180 |
| 2022 April | 127 | 39 | 166 |
| 2022 March | 117 | 52 | 169 |
| 2022 February | 107 | 35 | 142 |
| 2022 January | 141 | 49 | 190 |
| 2021 December | 72 | 39 | 111 |
| 2021 November | 98 | 42 | 140 |
| 2021 October | 103 | 56 | 159 |
| 2021 September | 79 | 44 | 123 |
| 2021 August | 122 | 36 | 158 |
| 2021 July | 86 | 34 | 120 |
| 2021 June | 82 | 28 | 110 |
| 2021 May | 69 | 57 | 126 |
| 2021 April | 136 | 98 | 234 |
| 2021 March | 89 | 41 | 130 |
| 2021 February | 65 | 28 | 93 |
| 2021 January | 57 | 25 | 82 |
| 2020 December | 40 | 36 | 76 |
| 2020 November | 30 | 41 | 71 |
| 2020 October | 14 | 27 | 41 |
| 2020 September | 26 | 24 | 50 |
| 2020 August | 20 | 20 | 40 |
| 2020 July | 12 | 15 | 27 |
| 2020 June | 25 | 28 | 53 |
| 2020 May | 8 | 9 | 17 |
| 2020 April | 12 | 12 | 24 |
| 2020 March | 12 | 11 | 23 |
| 2020 February | 1 | 0 | 1 |
| 2019 May | 0 | 1 | 1 |
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