Case and Research Letters
Melanoma With Meyerson's Phenomenon: Clinical and Dermoscopic Features
Melanoma con fenómeno de Meyerson: características clínicas y dermatoscópicas
L.A. Bollea-Garlatti
, L.M. Molinari, G.N. Galimberti, R.L. Galimberti
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Servicio de Dermatología, Centro de Cáncer de Piel y Cirugía Micrográfica de Mohs, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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B) Células atípicas con núcleos grandes e irregulares, nucléolos evidentes y ocasionales vacuolas intranucleares (H&E ×10). C) Epidermis adyacente con acantosis, espongiosis moderada y exocitosis de linfocitos, junto a un infiltrado inflamatorio mononuclear dispuesto en forma perivascular en la dermis (H&E ×10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.A. Bollea-Garlatti, L.M. Molinari, G.N. Galimberti, R.L. Galimberti" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.A." "apellidos" => "Bollea-Garlatti" ] 1 => array:2 [ "nombre" => "L.M." "apellidos" => "Molinari" ] 2 => array:2 [ "nombre" => "G.N." "apellidos" => "Galimberti" ] 3 => array:2 [ "nombre" => "R.L." 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There is no central vascularization.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martínez-López, G. Blasco-Morente, I. Pérez-López, E. García-Durá" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-López" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Blasco-Morente" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Pérez-López" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "García-Durá" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004299" "doi" => "10.1016/j.ad.2015.08.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015004299?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901600024X?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S157821901600024X/v2_201704010117/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016000305" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.01.026" "estado" => "S300" "fechaPublicacion" => "2016-04-01" "aid" => "1297" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:253-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1953 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 1651 "PDF" => 258 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Acropigmentation of the Dorsum of the Hands From Preparing Mojitos: A Lime-Induced Phytophotodermatosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "255" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acropigmentación dorsal por elaboración de mojitos: una fitofotodermatosis por lima" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 911 "Ancho" => 1000 "Tamanyo" => 194235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Asymptomatic, homogeneous hyperpigmentation that developed on the dorsum of the thumbs of both hands of a patient several days after preparing mojitos at a beach party.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.I. 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"apellidos" => "Galvañ-Pozo" "sufijo" => "Jr." ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015004937" "doi" => "10.1016/j.ad.2015.06.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015004937?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000305?idApp=UINPBA000044" "url" => "/15782190/0000010700000003/v2_201704010117/S1578219016000305/v2_201704010117/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Melanoma With Meyerson's Phenomenon: Clinical and Dermoscopic Features" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "255" "paginaFinal" => "257" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.A. Bollea-Garlatti, L.M. Molinari, G.N. Galimberti, R.L. Galimberti" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L.A." "apellidos" => "Bollea-Garlatti" "email" => array:2 [ 0 => "agubollea@hotmail.com" 1 => "agubollea@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.M." "apellidos" => "Molinari" ] 2 => array:2 [ "nombre" => "G.N." "apellidos" => "Galimberti" ] 3 => array:2 [ "nombre" => "R.L." "apellidos" => "Galimberti" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Centro de Cáncer de Piel y Cirugía Micrográfica de Mohs, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma con fenómeno de Meyerson: características clínicas y dermatoscópicas" ] ] "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" => 2290 "Ancho" => 2501 "Tamanyo" => 1182265 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology: A, Proliferation of atypical melanocytes with radial and vertical growth phases, intraepidermal migration of melanocytes, and nests and irregular plaques that infiltrate the papillary dermis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×4. B, Atypical cells with large and irregular nuclei, prominent nucleoli, and occasional intranuclear vacuoles. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×10.<span class="elsevierStyleHsp" style=""></span>C, Adjacent epidermis with acanthosis, moderate spongiosis, and lymphocyte exocytosis, associated with a mononuclear inflammatory infiltrate in a perivascular distribution in the dermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 75 year-old woman with a history of venous insufficiency of the lower extremities. She consulted for a lesion that had arisen on her left ankle a year earlier and that had become erythematous and pruritic during the week prior to consultation. Physical examination revealed a slightly elevated, dark blue and brown lesion that was asymmetric and had poorly defined borders. It measured 1<span class="elsevierStyleHsp" style=""></span>cm in diameter. The lesion was surrounded by a halo of eczema and desquamation, and the region was edematous and presented varicose blood vessel dilatations (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The provisional diagnoses included an ecchymotic lesion associated with dermatitis secondary to venous stasis or a melanocytic lesion with halo eczema (Meyerson phenomenon).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A blue-whitish veil was observed on dermoscopy and there were irregularly distributed, structureless brown and black areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Patches of glomerular vessels and dotted vessels and fine whitish desquamation were observed in the area of the halo (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The dermoscopic findings elevated our suspicion of a melanocytic lesion, specifically malignant melanoma with halo eczema, and excision biopsy was therefore performed. Histology of the lesion revealed a proliferation of atypical melanocytes with a radial and vertical growth phases, intraepidermal melanocyte migration, and nests and irregular plaques that infiltrated the papillary dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). These atypical cells had large and irregular nuclei, with prominent nucleoli and occasional intranuclear vacuoles (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). The adjacent epidermis presented acanthosis with moderate spongiosis, lymphocyte exocytosis, and hyperkeratosis, associated with a perivascular mononuclear inflammatory infiltrate in the dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>C). This confirmed the diagnosis of superficial spreading melanoma with Meyerson phenomenon and a Breslow depth of 1.12<span class="elsevierStyleHsp" style=""></span>mm. No ulceration, regression, blood or lymph vessel invasion, or neurotropism were observed, and the mitotic index was low.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Halo eczema or Meyerson phenomenon is a symmetric area of erythema and desquamation that surrounds a central lesion; it can be pruritic or asymptomatic. A number of hypotheses have been proposed regarding the etiology and pathogenesis of this phenomenon, the main one of which suggests an immune response with a predominance of CD4<span class="elsevierStyleSup">+</span> lymphocytes over CD8<span class="elsevierStyleSup">+</span> lymphocytes.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The phenomenon was first described in acquired melanocytic nevi, but there have since been reports in all types of melanocytic nevi (congenital, dysplastic) and even in nonmelanocytic lesions such as basal cell carcinoma, squamous cell carcinoma, and seborrheic keratosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Rodins et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> were the first to report a Meyerson phenomenon in an in situ melanoma, and later Ferneiny et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> described the finding in a superficial spreading melanoma with a Breslow depth of 0.75<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The few studies that have been performed on the dermoscopy of melanocytic lesions with halo eczema suggest that the inflammatory phenomenon does not affect or mask visualization of dermoscopic structures and criteria, and thus does not interfere with correct identification of these signs.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4</span></a> In our case, the presence of a blue-whitish veil and of structureless areas suggested the diagnosis of melanoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Dotted vessels, distributed in patches, and yellowish scale crusts, similar to the findings of halo eczema in our case, are observed on dermoscopy in all types of dermatitis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Ecchymoses present a homogeneous pattern of structureless purpuric areas on dermoscopy,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> allowing us to exclude this diagnosis in our patient.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After reviewing the literature, we believe this is the first case in which the dermoscopic features of an invasive melanoma with Meyerson phenomenon are described. We agree with the authors cited above<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a> that this phenomenon is a sign that must not be undervalued, as it is not exclusive to nevi; the dermoscopic features of the pigmented lesion must be evaluated to determine whether it is benign or malignant, and the appropriate action taken.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest and that they have not received funding for this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:2 [ "identificador" => "xack276186" "titulo" => "Acknowledgments" ] 2 => 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: Bollea-Garlatti LA, Molinari LM, Galimberti GN, Galimberti RL. Melanoma con fenómeno de Meyerson: características clínicas y dermatoscópicas. Actas Dermosifiliogr. 2016;107:255–257.</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" => 946 "Ancho" => 1659 "Tamanyo" => 192052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation. Elevated, asymmetric, dark blue and brown lesion with poorly defined borders and a diameter of 1<span class="elsevierStyleHsp" style=""></span>cm; the lesion is surrounded by halo eczema with desquamation. Background of edema and varicose blood vessel dilatation.</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" => 1234 "Ancho" => 2501 "Tamanyo" => 484754 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy. A, Blue-whitish veil and structureless brown and black areas in an irregular distribution. B, Glomerular and dotted vessels and fine whitish desquamation in the area of halo eczema.</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" => 2290 "Ancho" => 2501 "Tamanyo" => 1182265 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histopathology: A, Proliferation of atypical melanocytes with radial and vertical growth phases, intraepidermal migration of melanocytes, and nests and irregular plaques that infiltrate the papillary dermis. Hematoxylin and eosin (H&E), original magnification<span class="elsevierStyleHsp" style=""></span>×4. B, Atypical cells with large and irregular nuclei, prominent nucleoli, and occasional intranuclear vacuoles. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×10.<span class="elsevierStyleHsp" style=""></span>C, Adjacent epidermis with acanthosis, moderate spongiosis, and lymphocyte exocytosis, associated with a mononuclear inflammatory infiltrate in a perivascular distribution in the dermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early melanoma with halo eczema (Meyerson's phenomenon)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Rodins" 1 => "L. Byrom" 2 => "J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 7 | 16 |
| 2024 Octubre | 119 | 41 | 160 |
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| 2021 Diciembre | 56 | 35 | 91 |
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| 2021 Octubre | 61 | 47 | 108 |
| 2021 Septiembre | 54 | 42 | 96 |
| 2021 Agosto | 38 | 36 | 74 |
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| 2020 Octubre | 53 | 15 | 68 |
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| 2020 Junio | 50 | 29 | 79 |
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| 2018 Febrero | 20 | 4 | 24 |
| 2018 Enero | 29 | 5 | 34 |
| 2017 Diciembre | 40 | 8 | 48 |
| 2017 Noviembre | 26 | 9 | 35 |
| 2017 Octubre | 27 | 11 | 38 |
| 2017 Septiembre | 20 | 22 | 42 |
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| 2017 Marzo | 16 | 24 | 40 |
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| 2017 Enero | 24 | 11 | 35 |
| 2016 Diciembre | 21 | 18 | 39 |
| 2016 Noviembre | 25 | 16 | 41 |
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| 2016 Agosto | 1 | 1 | 2 |
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