Case and Research Letter
Sclerosing Nevus With Pseudomelanomatous Features: A Case Report
Nevus esclerosante con rasgos seudomelanomatosos
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A) Lesión pigmentada de aproximadamente 1<span class="elsevierStyleHsp" style=""></span>cm, bordes irregulares y heterocroma. B) Patrón globular atípico, con retículo negativo, color rojo, blanco y azul.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "U. Floristán Muruzábal, F.J. Pinedo Moraleda, R. Gamo Villegas, J.L. López Estebaranz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "U." "apellidos" => "Floristán Muruzábal" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Pinedo Moraleda" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Gamo Villegas" ] 3 => array:2 [ "nombre" => "J.L." 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Floristán Muruzábal, F.J. Pinedo Moraleda, R. Gamo Villegas, J.L. López Estebaranz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "U." "apellidos" => "Floristán Muruzábal" "email" => array:1 [ 0 => "uxuafloristan@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" => "F.J." "apellidos" => "Pinedo Moraleda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Gamo Villegas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.L." "apellidos" => "López Estebaranz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nevus esclerosante con rasgos seudomelanomatosos" ] ] "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" => 1201 "Ancho" => 1600 "Tamanyo" => 819979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Lesion with a 3-zone pattern. Hematoxylin and eosin (H&E), low-power view. B and C, Proliferation of atypical melanocytes at the dermoepidermal junction with an area of scarring, nests of atypical melanocytes, and a congenital-type residual nevus both peripheral and deep to the scar. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×100. D, Scattered areas of pagetoid spread of melanocytic cells in other areas of the epidermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2008, Giuseppe Fabrizi et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> were the first to describe a subgroup of lesions with distinct histopathologic characteristics among all the melanocytic nevi excised for clinical regression; these lesions were given the name of sclerosing nevus with pseudomelanomatous features (SNPF).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 44-year-old woman who was seen for persistent pruritus in the area of a nevus on her back. The variegate maculopapular lesion measured approximately 1<span class="elsevierStyleHsp" style=""></span>cm in diameter and had irregular borders. On dermoscopy, an atypical globular pattern and a negative network were observed, with red, white, and occasional bluish areas (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was evaluated using reflectance confocal microscopy (RCM), which showed marked destructuring of the epidermis, with irregularly shaped keratinocytes instead of the typical honeycomb or cobbled appearance, the presence of pagetoid cells with a multifocal distribution and dendritic morphology, a loss of bright rings, the absence of a defined pattern at the dermoepidermal junction, the presence of atypical cells forming junctional and dermal nests, and a dense inflammatory infiltrate with fibrosis and abundant melanophages (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). With a suspected diagnosis of melanoma, the lesion was excised.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology revealed an atypical proliferation of melanocytes at the dermoepidermal junction, with occasional pagetoid spread in the epidermis, an area of scar tissue, melanocytic nests with a morphology similar to that described at the dermoepidermal junction, and a residual nevus with a congenital pattern, both peripherally and deep to the scar tissue. The cells were not frankly atypical and, after detailed examination, no mitotic figures were identified (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The proliferation index was very low and was limited practically to the junctional component. The cells of the irregular nests and of the residual nevus component expressed Melan-A and p16, with a loss of expression of HMB-45 in the dermal component. The lesion did not reach the borders of resection. This histologic image was consistent with a sclerosing nevus with pseudomelanomatous features. With this diagnosis, no additional treatment was performed, and the patient remains on follow-up.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">SNPF, a recently described clinical and pathologic entity, is also known as nevus with florid fibroplasia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> It is considered to mimic melanoma both clinically and histologically.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Etiologically, this lesion appears to be a benign melanocytic nevus that becomes involved in a process of fibrosis combined with a pseudomelanomatous proliferation. It typically arises in young individuals, mainly on the back, particularly in the area of the scapula. This site is thought to be affected because of almost imperceptible microtrauma or inflammatory changes in the region, such as the chronic friction of clothing, sunburn, seborrheic eczema, or acne. However, other authors consider that this type of fibrosis may be something intrinsic to the maturation process of a dysplastic nevus.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dermoscopically it is characterized by signs of regression, affecting 10% to 50% of the lesion, in the form of white and blue scars, and an absence of other specific signs of melanoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">RCM is a noninvasive technique with a resolution very similar to conventional histology. It provides horizontal images and can be considered an intermediate diagnostic method between dermoscopy and histopathology, frequently avoiding unnecessary surgical excisions. However, the presence of cellular atypia on RCM study in these cases means that a diagnosis of melanoma cannot be ruled out. As is to be expected, abundant melanophages and collagen bundles are also observed.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically there are 3 zones: an atypical proliferation of melanocytes at the dermoepidermal junction, with lentiginous hyperplasia, and confluent junctional nests with occasional pagetoid spread; a significant area of dermal sclerosis that contains irregular nests of atypical melanocytes; and a congenital-type residual nevus adjacent to the deep surface of the scar.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The low level of cellular atypia and the absence of mitoses, cell necrosis, or spreading dermal nodules differentiates this lesion from regressing melanoma. In addition, SNPF usually has an “ordered” pattern of fibrosis, with homogeneous bundles of parallel eosinophilic collagen fibers closely related to the epidermis. In contrast, a regressing melanoma is characterized by fibrosis that is often paler (perhaps because of edema), formed of more irregular collagen bundles, and the presence of melanophages. The diagnostic criteria of Fabrizi et al. probably make it possible to differentiate SNPF from a regressing melanoma. However, atypia in the junctional region associated with pagetoid spread makes diagnosis of this entity a question of the quantitative presence of morphological criteria, and a degree of interobserver variability between pathologists should therefore be expected.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Taking into account the benign biological behavior of this entity, some authors consider that a more conservative approach could be warranted in melanocytic lesions showing regression on the convex area of the back.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Those authors propose observation. However, other authors recommend surgical excision, as SNPF mimics melanoma clinically, dermoscopically, and on RCM.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Only histology can give us the definitive diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0050" 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: Floristán Muruzábal U, Pinedo Moraleda FJ, Gamo Villegas R, López Estebaranz JL. Nevus esclerosante con rasgos seudomelanomatosos. Actas Dermosifiliogr. 2016;107:691–694.</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" => 1630 "Ancho" => 978 "Tamanyo" => 187442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic appearance. A, Variegate pigmented lesion with irregular borders measuring approximately 1<span class="elsevierStyleHsp" style=""></span>cm in diameter. B, Atypical globular pattern, with a red, white, and blue negative network.</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" => 692 "Ancho" => 1400 "Tamanyo" => 267319 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Confocal microscopy. A, Focus of abundant dendritic cells in the epidermis (red arrow). B, Areas of poorly defined papillas, with atypical junctional and dermal nests (blue arrows), areas of fibrosis, and an inflammatory infiltrate (asterisk).</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" => 1201 "Ancho" => 1600 "Tamanyo" => 819979 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histology. A, Lesion with a 3-zone pattern. Hematoxylin and eosin (H&E), low-power view. B and C, Proliferation of atypical melanocytes at the dermoepidermal junction with an area of scarring, nests of atypical melanocytes, and a congenital-type residual nevus both peripheral and deep to the scar. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×100. D, Scattered areas of pagetoid spread of melanocytic cells in other areas of the epidermis. H&E, original magnification<span class="elsevierStyleHsp" style=""></span>×400.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerosing nevus with pseudomelanomatous features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Fabrizi" 1 => "I. Pennacchia" 2 => "C. Pagliarello" 3 => "G. Massi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0560.2007.00941.x" "Revista" => array:6 [ "tituloSerie" => "J Cutan Pathol" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "995" "paginaFinal" => "1002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18537860" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clark/dysplastic nevi with florid fibroplasia associated with pseudomelanomatous features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.J. Ko" 1 => "J.L. Bolognia" 2 => "E.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 8 | 16 |
| 2024 Octubre | 137 | 63 | 200 |
| 2024 Septiembre | 135 | 52 | 187 |
| 2024 Agosto | 152 | 75 | 227 |
| 2024 Julio | 130 | 57 | 187 |
| 2024 Junio | 148 | 43 | 191 |
| 2024 Mayo | 110 | 56 | 166 |
| 2024 Abril | 105 | 28 | 133 |
| 2024 Marzo | 117 | 36 | 153 |
| 2024 Febrero | 135 | 40 | 175 |
| 2024 Enero | 90 | 25 | 115 |
| 2023 Diciembre | 100 | 26 | 126 |
| 2023 Noviembre | 85 | 34 | 119 |
| 2023 Octubre | 110 | 18 | 128 |
| 2023 Septiembre | 108 | 26 | 134 |
| 2023 Agosto | 75 | 25 | 100 |
| 2023 Julio | 98 | 48 | 146 |
| 2023 Junio | 80 | 35 | 115 |
| 2023 Mayo | 135 | 36 | 171 |
| 2023 Abril | 102 | 34 | 136 |
| 2023 Marzo | 120 | 25 | 145 |
| 2023 Febrero | 74 | 17 | 91 |
| 2023 Enero | 67 | 22 | 89 |
| 2022 Diciembre | 87 | 37 | 124 |
| 2022 Noviembre | 63 | 28 | 91 |
| 2022 Octubre | 58 | 22 | 80 |
| 2022 Septiembre | 50 | 47 | 97 |
| 2022 Agosto | 72 | 42 | 114 |
| 2022 Julio | 77 | 39 | 116 |
| 2022 Junio | 89 | 37 | 126 |
| 2022 Mayo | 96 | 45 | 141 |
| 2022 Abril | 75 | 26 | 101 |
| 2022 Marzo | 63 | 46 | 109 |
| 2022 Febrero | 49 | 25 | 74 |
| 2022 Enero | 65 | 41 | 106 |
| 2021 Diciembre | 56 | 39 | 95 |
| 2021 Noviembre | 60 | 40 | 100 |
| 2021 Octubre | 85 | 49 | 134 |
| 2021 Septiembre | 56 | 46 | 102 |
| 2021 Agosto | 63 | 33 | 96 |
| 2021 Julio | 46 | 29 | 75 |
| 2021 Junio | 47 | 30 | 77 |
| 2021 Mayo | 63 | 35 | 98 |
| 2021 Abril | 128 | 42 | 170 |
| 2021 Marzo | 54 | 24 | 78 |
| 2021 Febrero | 56 | 25 | 81 |
| 2021 Enero | 28 | 21 | 49 |
| 2020 Diciembre | 33 | 19 | 52 |
| 2020 Noviembre | 27 | 27 | 54 |
| 2020 Octubre | 29 | 19 | 48 |
| 2020 Septiembre | 37 | 13 | 50 |
| 2020 Agosto | 36 | 16 | 52 |
| 2020 Julio | 22 | 12 | 34 |
| 2020 Junio | 33 | 24 | 57 |
| 2020 Mayo | 22 | 22 | 44 |
| 2020 Abril | 22 | 16 | 38 |
| 2020 Marzo | 30 | 25 | 55 |
| 2020 Febrero | 5 | 0 | 5 |
| 2019 Diciembre | 2 | 0 | 2 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Agosto | 2 | 0 | 2 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 1 | 0 | 1 |
| 2019 Abril | 2 | 6 | 8 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 28 | 2 | 30 |
| 2018 Enero | 45 | 8 | 53 |
| 2017 Diciembre | 50 | 6 | 56 |
| 2017 Noviembre | 45 | 4 | 49 |
| 2017 Octubre | 48 | 6 | 54 |
| 2017 Septiembre | 28 | 7 | 35 |
| 2017 Agosto | 31 | 11 | 42 |
| 2017 Julio | 26 | 4 | 30 |
| 2017 Junio | 37 | 11 | 48 |
| 2017 Mayo | 52 | 16 | 68 |
| 2017 Abril | 32 | 8 | 40 |
| 2017 Marzo | 15 | 8 | 23 |
| 2017 Febrero | 35 | 16 | 51 |
| 2017 Enero | 14 | 10 | 24 |
| 2016 Diciembre | 23 | 21 | 44 |
| 2016 Noviembre | 32 | 20 | 52 |
| 2016 Octubre | 86 | 27 | 113 |
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