CASE AND RESEARCH LETTERS
Intradermal Melanoma Associated With an Intradermal Melanocytic Nevus
Melanoma intradérmico asociado a nevo melanocítico intradérmico
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Arjona-Aguilera, C. Gil-Jassogne, D. Jiménez-Gallo, C. Albarrán-Planelles" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Arjona-Aguilera" "email" => array:1 [ 0 => "cintiaarjona@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" => "C." "apellidos" => "Gil-Jassogne" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "Jiménez-Gallo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Albarrán-Planelles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Puerta del Mar, Servicio Andaluz de Salud, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma intradérmico asociado a nevo melanocítico intradérmico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 487 "Ancho" => 1299 "Tamanyo" => 281476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Cell pleomorphism in the area corresponding to the melanoma; note the mitotic figure in the center (hematoxylin-eosin, original magnification ×60). B, Intense and diffuse positive cytoplasmic expression of MelanA (×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intradermal melanoma on a pre-existing intradermal nevus is an exceptional finding. Since 1961, a total of 11 cases have been published<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–8</span></a>; none of these were in the Spanish medical literature (PubMed, December 27, 2014).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 42-year-old man who underwent treatment at his health center for a lesion in the center of his forehead. In the clinical history, the lesion was described as a fibroelastic nodule measuring 7<span class="elsevierStyleHsp" style=""></span>mm in diameter. The patient reported that the lesion had been present since childhood and that it had grown progressively during the last year. The patient's personal history contained no record of relevant disease, previous removal of cutaneous lesions, or family history of neoplasm.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology revealed a nodular lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) composed of an intradermal melanocytic nevus in contact with the surgical margins (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) at the center of which was a nodule whose larger diameter measured 5<span class="elsevierStyleHsp" style=""></span>mm. The nodule was composed of atypical melanocytes. Additional histopathologic findings included cell pleomorphism, aberrant nucleoli, absence of maturation, isolated cellular necrosis, and 3 mitotic figures per square millimeter (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). No significant lymphocytic or junctional components were observed. The atypical cells showed intense cytoplasmic expression of S-100 and MelanA (diffuse) and HMB-45 (focal) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed no further atypical pigmented lesions or enlarged lymph nodes. Extending the margins with a lateral 1-cm excision that reached the fascia only revealed scar fibrosis. Selective biopsy of the sentinel node was performed, and staining of several sections with hematoxylin-eosin, S-100, and HMB-45 revealed absence of tumor cells.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, the extension study ruled out metastasis of primary melanoma from another site. No significant findings were revealed by ultrasound scan (eyes, neck, and abdomen) or positron emission tomography with computed tomography. The results of the laboratory analysis were also unremarkable, with a normal S-100 protein concentration (0.05<span class="elsevierStyleHsp" style=""></span>μg/L). The clinical, laboratory, and histopathology findings confirmed the diagnosis of melanoma developing from an intradermal nevus.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The risk of progression to malignancy in benign melanocytic lesions was recently studied in a meta-analysis,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> which revealed a 2% incidence for melanoma, especially for congenital nevi ><span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>cm located on the trunk.</p><p id="par0035" class="elsevierStylePara elsevierViewall">However, very few epidemiological data are available on intradermal melanoma arising from an intradermal nevus, which constitutes both a diagnostic and a therapeutic challenge. The 11 published cases reveal common characteristics: onset in adulthood, nodular appearance, nodular histopathologic pattern, and variable degrees of deep invasion. In more than half of the cases, melanoma was located in deeper planes of the nevus. In the case we present, the melanoma was situated within the nevus. No intraepidermal or junctional melanocytic activity was detected in any of the above-mentioned patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Cytology facilitates diagnosis. Melanoma cells often contain mitotic figures and nuclear atypia. The immunohistochemistry study showed that positivity for S-100 was more intense in atypical melanocytes. In addition, intradermal nevi are usually negative for immunostaining with HMB-45, which is generally positive in junctional nevi and in melanoma. All of the above findings were observed in the case we present.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis should be with long-standing melanocytic nevus, malignant blue nevus, and primary intradermal melanoma. Long-standing nevus appears as a nodular lesion on the face of patients older than 60 years. It contains small, monomorphic melanocytes exhibiting maturation, together with large solitary melanocytes with a hyperchromatic nucleus but no pleomorphism or mitosis. Occasionally, it is associated with degenerative signs such as thrombosis, hemorrhage, fibrosis, and sclerosis. Malignant blue nevus develops over a pre-existing blue nevus, it is easily distinguished in histopathology, and its prognosis is generally poor. Primary intradermal melanoma contains no nevus cells in histopathology and is a diagnosis of exclusion after primary disease has been ruled out at other levels.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The histopathologic differential diagnosis includes other nodular melanocytic lesions. Noticeably common is melanocytic nevus with large nests at the junctional and intradermal levels, with no cellular atypia, pleomorphism, mitosis, or necrosis. Intradermal expansive nodules and proliferative nodules (more often the large cell variety) can present in the setting of a conventional melanoma. Congenital nevus contains large but isomorphic undifferentiated melanocytes exhibiting maturation and few or no mitotic figures.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Finally, the prognosis of this disease is unclear, and the few published cases prevent a suitable prognosis from being proposed. Distance metastasis was observed in only 1 case.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Progression was associated mainly with the intradermal location and the diagnostic delay.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Given that primary intradermal melanoma associated with intradermal nevus is an exceptional finding, we must bear in mind the possibility of metastasis from a melanoma at another anatomic level. The first step is a detailed history, which should include previous excisions and regression of previous lesions. This should be followed by a meticulous physical examination including the mucosa and eyeballs. Finally, additional tests should include a complete blood count, biochemistry with lactate dehydrogenase, sentinel node study, and positron emission tomography with computed tomography or whole-body computed tomography. Histopathology of the lesion removed is also important and should take into account the differential diagnoses mentioned above. These data enable the tumor to be staged and treatment tailored to the individual patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arjona-Aguilera C, Gil-Jassogne C, Jiménez-Gallo D, Albarrán-Planelles C. Melanoma intradérmico asociado a nevo melanocítico intradérmico. Actas Dermosifiliogr. 2015;106:776–777.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 628 "Ancho" => 975 "Tamanyo" => 199823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histopathology of the melanoma nodule removed (hematoxylin-eosin, original magnification ×1).</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" => 732 "Ancho" => 976 "Tamanyo" => 407712 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Portion corresponding to the intradermal melanocytic nevus, with typical melanocytic nests and melanin pigmentation in the superficial dermis (hematoxylin-eosin, original magnification ×10).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 487 "Ancho" => 1299 "Tamanyo" => 281476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Cell pleomorphism in the area corresponding to the melanoma; note the mitotic figure in the center (hematoxylin-eosin, original magnification ×60). 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 13 | 25 |
| 2024 Octubre | 260 | 56 | 316 |
| 2024 Septiembre | 253 | 62 | 315 |
| 2024 Agosto | 295 | 77 | 372 |
| 2024 Julio | 279 | 56 | 335 |
| 2024 Junio | 238 | 55 | 293 |
| 2024 Mayo | 173 | 57 | 230 |
| 2024 Abril | 146 | 34 | 180 |
| 2024 Marzo | 199 | 45 | 244 |
| 2024 Febrero | 194 | 39 | 233 |
| 2024 Enero | 171 | 42 | 213 |
| 2023 Diciembre | 181 | 22 | 203 |
| 2023 Noviembre | 202 | 45 | 247 |
| 2023 Octubre | 191 | 48 | 239 |
| 2023 Septiembre | 201 | 36 | 237 |
| 2023 Agosto | 154 | 31 | 185 |
| 2023 Julio | 188 | 44 | 232 |
| 2023 Junio | 150 | 36 | 186 |
| 2023 Mayo | 148 | 68 | 216 |
| 2023 Abril | 105 | 52 | 157 |
| 2023 Marzo | 126 | 21 | 147 |
| 2023 Febrero | 133 | 42 | 175 |
| 2023 Enero | 114 | 49 | 163 |
| 2022 Diciembre | 124 | 58 | 182 |
| 2022 Noviembre | 76 | 31 | 107 |
| 2022 Octubre | 61 | 34 | 95 |
| 2022 Septiembre | 58 | 40 | 98 |
| 2022 Agosto | 61 | 52 | 113 |
| 2022 Julio | 50 | 62 | 112 |
| 2022 Junio | 44 | 41 | 85 |
| 2022 Mayo | 150 | 51 | 201 |
| 2022 Abril | 195 | 44 | 239 |
| 2022 Marzo | 167 | 62 | 229 |
| 2022 Febrero | 159 | 53 | 212 |
| 2022 Enero | 142 | 71 | 213 |
| 2021 Diciembre | 130 | 53 | 183 |
| 2021 Noviembre | 156 | 67 | 223 |
| 2021 Octubre | 175 | 57 | 232 |
| 2021 Septiembre | 178 | 61 | 239 |
| 2021 Agosto | 158 | 83 | 241 |
| 2021 Julio | 143 | 56 | 199 |
| 2021 Junio | 159 | 88 | 247 |
| 2021 Mayo | 107 | 62 | 169 |
| 2021 Abril | 211 | 141 | 352 |
| 2021 Marzo | 146 | 74 | 220 |
| 2021 Febrero | 143 | 64 | 207 |
| 2021 Enero | 69 | 69 | 138 |
| 2020 Diciembre | 60 | 66 | 126 |
| 2020 Noviembre | 38 | 50 | 88 |
| 2020 Octubre | 50 | 57 | 107 |
| 2020 Septiembre | 58 | 60 | 118 |
| 2020 Agosto | 57 | 48 | 105 |
| 2020 Julio | 44 | 69 | 113 |
| 2020 Junio | 53 | 61 | 114 |
| 2020 Mayo | 32 | 56 | 88 |
| 2020 Abril | 38 | 45 | 83 |
| 2020 Marzo | 33 | 27 | 60 |
| 2020 Febrero | 5 | 24 | 29 |
| 2020 Enero | 4 | 36 | 40 |
| 2019 Diciembre | 2 | 17 | 19 |
| 2019 Noviembre | 4 | 20 | 24 |
| 2019 Octubre | 0 | 14 | 14 |
| 2019 Septiembre | 0 | 22 | 22 |
| 2019 Agosto | 4 | 9 | 13 |
| 2019 Julio | 4 | 17 | 21 |
| 2019 Junio | 4 | 13 | 17 |
| 2019 Mayo | 7 | 32 | 39 |
| 2019 Abril | 6 | 26 | 32 |
| 2019 Marzo | 2 | 15 | 17 |
| 2019 Febrero | 3 | 5 | 8 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 7 | 0 | 7 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 5 | 2 | 7 |
| 2018 Julio | 0 | 2 | 2 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Abril | 0 | 11 | 11 |
| 2018 Marzo | 3 | 12 | 15 |
| 2018 Febrero | 51 | 10 | 61 |
| 2018 Enero | 49 | 19 | 68 |
| 2017 Diciembre | 60 | 18 | 78 |
| 2017 Noviembre | 37 | 13 | 50 |
| 2017 Octubre | 47 | 13 | 60 |
| 2017 Septiembre | 37 | 17 | 54 |
| 2017 Agosto | 42 | 20 | 62 |
| 2017 Julio | 31 | 21 | 52 |
| 2017 Junio | 33 | 28 | 61 |
| 2017 Mayo | 32 | 18 | 50 |
| 2017 Abril | 20 | 16 | 36 |
| 2017 Marzo | 18 | 72 | 90 |
| 2017 Febrero | 23 | 8 | 31 |
| 2017 Enero | 20 | 6 | 26 |
| 2016 Diciembre | 22 | 11 | 33 |
| 2016 Noviembre | 41 | 21 | 62 |
| 2016 Octubre | 24 | 10 | 34 |
| 2016 Septiembre | 0 | 9 | 9 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 1 | 2 | 3 |
| 2016 Junio | 1 | 3 | 4 |
| 2016 Mayo | 3 | 7 | 10 |
| 2016 Abril | 0 | 2 | 2 |
| 2016 Marzo | 0 | 2 | 2 |
| 2016 Febrero | 0 | 5 | 5 |
| 2015 Noviembre | 0 | 4 | 4 |
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