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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 70-year-old woman with a history of bilateral breast carcinoma was seen for a bluish lesion on the dorsum of the right foot that had appeared during adolescence&#46; The patient reported the recent appearance of a more pigmented area in the distal portion of the lesion&#46; She experienced no pain&#44; itching&#44; or other accompanying symptoms&#46; She reported no trauma or any personal or family history of melanoma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Examination revealed a linear plaque of 10&#160;cm in diameter on the dorsum of the right foot consisting of multiple well-defined&#44; bluish&#44; rounded papules&#44; one of which&#44; located in the distal area of the lesion&#44; measured 5&#160;mm and had a blacker coloration &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Dermoscopy revealed multiple grouped areas of dark blue&#8211;gray pigmentation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Neither the inguinal nor axillary lymph nodes were palpable&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology showed a dermal proliferation of spindle-shaped melanocytes without cytological or architectural atypia&#44; with marked pigmentation&#46; These cells were accompanied by melanophages and penetrated the dermal collagen&#46; The observed lesion exclusively affected the dermis&#46; There was no evidence of nevic proliferation at the dermoepidermal junction&#44; either in the form of theca cells or lentiginous proliferation&#46; No mitotic figures were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">What is your diagnosis&#63;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Agminated or plaque-type blue nevus&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Given the extension of the lesion and the absence of criteria indicating malignancy&#44; it was decided to carry out regular monitoring&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Blue nevi are dermal melanocytic proliferations that generally appear as small&#44; dark-blue&#44; solitary macules or papules&#46; When these lesions group together&#44; they tend to do so linearly&#44; following a Blaschkoid or segmental distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The Latin term agmen means &#8220;army&#8221; and refers to this rare group of smooth or raised nevi clustered in a well-circumscribed area&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> independent of their linear or segmental distribution&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In general&#44; dermal melanocytes disappear during the second half of gestation&#44; but some remain in the dermis of the scalp&#44; the sacral region&#44; and the dorsal aspect of the distal extremities&#44; locations at which blue nevi occur more frequently&#46; The blue coloration of these nevi is the result of the Tyndall effect&#44; caused by the refraction of light striking the dermal melanocytes&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although the pathogenesis of agminated or plaque-type blue nevus is unknown&#44; isolated cases have been described after skin trauma or sunburn&#44; suggesting that these factors may stimulate melanocyte proliferation&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Moreover&#44; somatic activating mutations have been recently detected in <span class="elsevierStyleItalic">GNAQ</span> and <span class="elsevierStyleItalic">GNA11</span>&#44; genes in which mutations have been previously identified in non-agminated blue nevi&#46; Although similar mutations in <span class="elsevierStyleItalic">GNAQ</span> and <span class="elsevierStyleItalic">GNA11</span> have been detected in mucosal melanoma&#44; such mutations are not by themselves sufficient to trigger degeneration to melanoma&#44; and a second mutational event is required to induce malignancy&#46; The presence of other mutations has also been described in other pigmented lesions with an agminated distribution &#40;e&#46;g&#46; nevus spilus&#44; intradermal nevus&#41;&#44; reflecting post-zygotic expression of mosaic mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Four histological forms of blue nevus are described&#58; common&#59; cellular&#59; combined&#59; and epithelioid&#44; which is associated with Carney syndrome<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The differential diagnosis should include melanoma on blue nevus &#40;malignant blue nevus&#41;&#44; metastatic melanoma&#44; argyria&#44; and vascular malformations&#44; and the diagnosis should be based on clinical and histological findings&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Agminated blue nevus usually follows an indolent course&#46; However&#44; increases in size and the development of new local lesions are common&#44; and require regular monitoring&#46; Cases associated with other pigmented lesions &#40;nevus spilus&#44; lentigos&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> dermatomyositis&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and Carney complex<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> have been described&#44; without establishing clinical significance&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Given the benign nature of this lesion&#44; treatment is not required in the absence of changes&#44; and clinical monitoring is sufficient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This work has not received any type of funding&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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