Case and Research Letters
Acquired Facial Dermal Melanocytosis of the Sun's Nevus Type: A Case Report
Melanocitosis dérmica facial adquirida tipo nevo de Sun. Reporte de un caso
E. Marín Hernándeza,
, Y. Calderón Ponce de Leónb, V. Bautista Piñac, L. Sánchez Rodríguezd
Corresponding author
a Servicio de Dermatología Pediátrica, Centro Médico Nacional Siglo XXI, Ciudad de México, CDMX, Mexico
b Dermatología, Centro Dermatológico Dr. Ladislao de la Pascua, Ciudad de México, CDMX, Mexico
c Anatomía Patológica, Fundación del Cáncer de Mama (FUCAM), Ciudad de México, Mexico
d Neumología, Instituto Nacional de Enfermedades Respiratorias (INER), Ciudad de México, CDMX, Mexico
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Reporte de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 679 "Ancho" => 905 "Tamanyo" => 97407 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermal spindle melanocytes located between collagen and perivascular fibers (S100 staining, original magnification ×20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermal melanocytosis is a group of congenital or acquired entities, characterized clinically by bluish-gray discoloration of the skin, and histologically by the presence in the dermis of pigmented spindle and dendritic melanocytes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The etiology and pathogenesis are unclear.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Facial forms of dermal melanocytosis have been described, including nevus of Hori, nevus of Ota, nevus of Hidano, periorbital melanosis (as proposed by Watanabe), and nevus of Sun.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Sun et al. reported 110 cases of nevus fusco-caeruleus zygomaticus in Chinese patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This lesion consists of small speckled patches of skin ranging in color from brown to gray to blue, principally affects the zygomatic region, appears gradually between the second and third decades of life, and is 12.8 times more prevalent in women than men. Familial cases with an autosomal dominant inheritance pattern have been described.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> There is no known association with other dermatoses.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Histology shows dispersed elongated melanocytes in the upper dermis, as visualized with Fontana-Masson and 3,4-dihydroxyphenylalanine (DOPA) staining or by immunohistochemistry for S100 and HMB-45.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Here, we describe a case of acquired dermal melanocytosis corresponding to nevus of Sun.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 27-year-old woman presented with asymptomatic hyperpigmented patches in the zygomatic region that had appeared 3 years earlier. Since the appearance of the lesions, she had been evaluated by 4 dermatologists, all of whom had established a diagnosis of melasma. The patient had undergone treatment with hydroquinone, high- and medium-potency steroids, kojic acid, intralesional tranexamic acid, and chemical and physical photoprotection, without improvement. Physical examination revealed dermatosis in the bilateral zygomatic region, below the lower palpebral border, consisting of well defined, speckled, grayish-brown macules of less than 4<span class="elsevierStyleHsp" style=""></span>mm diameter that showed a tendency to coalesce (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). A clinical diagnosis of acquired facial dermal melanocytosis was established, and a biopsy was taken. Histology (hematoxylin-eosin staining) revealed the presence of pigmented spindle cells distributed in the upper, perivascular, and periadnexal dermis. These cells, which were positive for S100 protein, were identified as dermal melanocytes (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Based on these findings, the diagnosis of nevus-of-Sun-type acquired facial dermal melanocytosis was confirmed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The main differential diagnosis is melasma, owing to its prevalence in the Spanish population. Clinically, melasma manifests as brown or grayish patches on the face that are usually uniform in color, rarely mottled, and never affect the periorbital area.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Histology shows hyperpigmentation of the basal layer, rupture of the basement membrane, melanophages in the dermis, an increase in the number of vessels, mast cells, and solar elastosis.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> By contrast, nevus of Sun affects the zygomatic area and is characterized by hyperpigmented, speckled, brown or gray-blue macules. Histology shows elongated, pigmented spindle cells in the upper dermis that correspond to dermal melanocytes positive for S100 protein.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Other conditions that should be ruled out include ephelides, Riehl melanosis, ashy dermatosis, ochronosis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> agminated dermal melanocytosis,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and other forms of acquired facial dermal melanocytosis.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Treatment consists of physical and chemical photoprotection, although some cases have been treated with Q-switched Alexandrite laser.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,10</span></a> On the American continent, a case of nevus of Hori was described in an Argentine woman of Japanese descent.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Based on a review of the literature and the shared clinical and histopathological similarities, we propose grouping these pigmentary dermatoses within a single category; acquired facial dermal melanocytosis. It is highly likely that this type of facial hyperpigmentation is underdiagnosed due to confusion with other more common dermatoses, as occurred in the present case.</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: Marín Hernández E, Calderón Ponce de León Y, Bautista Piña V, Sánchez Rodríguez L. Melanocitosis dérmica facial adquirida tipo nevo de Sun. Reporte de un caso. Actas Dermosifiliogr. 2020;111:337–338.</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" => 881 "Ancho" => 1305 "Tamanyo" => 198079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Bilateral, symmetrical lesions in the infraorbital region. B, Higher-magnification image showing speckled, grayish-brown macules coalescing to form a plaque.</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" => 679 "Ancho" => 905 "Tamanyo" => 97407 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermal spindle melanocytes located between collagen and perivascular fibers (S100 staining, original magnification ×20).</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" => "Nevo de Hori Presentación de un caso y revisión de las melanocitosis dérmicas faciales névicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 12 | 35 |
| 2024 October | 162 | 70 | 232 |
| 2024 September | 170 | 74 | 244 |
| 2024 August | 149 | 90 | 239 |
| 2024 July | 122 | 50 | 172 |
| 2024 June | 111 | 48 | 159 |
| 2024 May | 110 | 40 | 150 |
| 2024 April | 100 | 25 | 125 |
| 2024 March | 100 | 44 | 144 |
| 2024 February | 87 | 32 | 119 |
| 2024 January | 115 | 33 | 148 |
| 2023 December | 82 | 23 | 105 |
| 2023 November | 119 | 33 | 152 |
| 2023 October | 88 | 49 | 137 |
| 2023 September | 109 | 46 | 155 |
| 2023 August | 51 | 43 | 94 |
| 2023 July | 92 | 74 | 166 |
| 2023 June | 65 | 44 | 109 |
| 2023 May | 96 | 82 | 178 |
| 2023 April | 72 | 30 | 102 |
| 2023 March | 104 | 60 | 164 |
| 2023 February | 71 | 32 | 103 |
| 2023 January | 59 | 43 | 102 |
| 2022 December | 73 | 56 | 129 |
| 2022 November | 50 | 36 | 86 |
| 2022 October | 50 | 30 | 80 |
| 2022 September | 40 | 37 | 77 |
| 2022 August | 29 | 31 | 60 |
| 2022 July | 35 | 49 | 84 |
| 2022 June | 22 | 25 | 47 |
| 2022 May | 95 | 47 | 142 |
| 2022 April | 96 | 30 | 126 |
| 2022 March | 99 | 50 | 149 |
| 2022 February | 89 | 32 | 121 |
| 2022 January | 123 | 39 | 162 |
| 2021 December | 106 | 43 | 149 |
| 2021 November | 85 | 45 | 130 |
| 2021 October | 94 | 40 | 134 |
| 2021 September | 79 | 32 | 111 |
| 2021 August | 67 | 26 | 93 |
| 2021 July | 76 | 22 | 98 |
| 2021 June | 59 | 28 | 87 |
| 2021 May | 58 | 43 | 101 |
| 2021 April | 144 | 53 | 197 |
| 2021 March | 91 | 26 | 117 |
| 2021 February | 47 | 16 | 63 |
| 2021 January | 45 | 17 | 62 |
| 2020 December | 50 | 17 | 67 |
| 2020 November | 47 | 17 | 64 |
| 2020 October | 55 | 13 | 68 |
| 2020 September | 64 | 26 | 90 |
| 2020 August | 49 | 17 | 66 |
| 2020 July | 55 | 15 | 70 |
| 2020 June | 74 | 34 | 108 |
| 2020 May | 31 | 29 | 60 |
| 2020 April | 15 | 6 | 21 |
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