Case And Research Letter
Not as Good as it Looks
No es bueno todo lo que lo parece
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Focal area with a pigment network on the left and a white patch in the lower right area of the image.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Monteagudo, O. Figueroa-Silva, O. Suárez-Amor, J.C. Álvarez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Monteagudo" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Figueroa-Silva" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Suárez-Amor" ] 3 => array:2 [ "nombre" => "J.C." 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Salgüero Fernández, M.M. Sigüenza Sanz, L. Nájera Botello, G. Roustan Gullón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I. Salgüero" "apellidos" => "Fernández" "email" => array:1 [ 0 => "irenebsf@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" => "M.M. Sigüenza" "apellidos" => "Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L. Nájera" "apellidos" => "Botello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "G. Roustan" "apellidos" => "Gullón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dermatología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anatomía patológica, Hospital Puerta de Hierro, Majadahonda, 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" => "No es bueno todo lo que lo parece" ] ] "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" => 1224 "Ancho" => 1626 "Tamanyo" => 287534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous nodule on the auricle of the ear.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 50-year-old man, skin phototype <span class="elsevierStyleSmallCaps">iii</span>, with no past medical history of interest and with no personal or family history of melanoma, was seen in dermatology outpatients for a lesion that had arisen a year earlier on the auricle of his right ear. After treatment with salicylic acid as if it were a wart, the lesion initially disappeared, but subsequently returned. Dermatologic examination revealed an erythematous nodular lesion measuring 0.5<span class="elsevierStyleHsp" style=""></span>cm in diameter on the lower third of the auricle of the right ear (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy did not suggest a melanocytic lesion, and there were no palpable regional cervical lymph nodes. The lesion was excised and histopathology reported a well-defined polypoid lesion that, at low magnification, appeared to be a benign lesion; however, at higher magnification, a melanocytic lesion with cytologic atypia and mitoses was observed, with a lack of deep maturation. Pagetoid spread and lymphatic invasion were also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for S100 and melan A and negative for HMB45 and p16, and a high Ki-67 cell proliferation index was also observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Based on these findings, the patient was diagnosed with nevoid melanoma of 0.7<span class="elsevierStyleHsp" style=""></span>cm diameter, Clark level <span class="elsevierStyleSmallCaps">v</span> and a Breslow thickness of 6.11<span class="elsevierStyleHsp" style=""></span>mm, with up to 3 mitoses per mm.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> No ulceration, lymphocytic response, signs of regression, or perineural invasion were present.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Positron emission tomography-computed tomography was performed, showing no viable tumor tissue with affinity for 18F-FDG. Widening of the surgical margins to 2<span class="elsevierStyleHsp" style=""></span>cm and selective sentinel lymph node biopsy (SLNB) were performed. After widening, the margins were free of tumor and the SLNB was negative. The patient was therefore diagnosed with melanoma stage T4b, N0, M0.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevoid melanoma, described by Schmoeckel et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> in 1985, is a lesion with characteristics similar to a benign nevus (symmetrical, dome-shaped lesion with cells that apparently mature). The main differential diagnosis is with intradermal melanocytic nevus (IDMN), and up to 50% of cases are referred for a suspected benign lesion.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Histologically, nevoid melanoma is differentiated from IDMN because IDMN does not present cytologic atypia, mitoses, pagetoid spread, lymphovascular invasion, or lack of deep maturation. Immunohistochemistry is very similar and cannot be used to differentiate between these 2 diseases. HMB-45 is positive in 80% to 86% of melanomas, but was negative in our patient. Loss of p16, as was found in our patient, correlates with aggressiveness and metastases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding malignant lesions, nodular melanoma is a densely cellular, nodular tumor, with intense cytologic atypia, mitoses, and an absence of the radial growth phase. Signs of IDMN are almost always present in melanoma on nevus, and immunohistochemistry can help in such cases, as the expression of HMB-45 and Ki-67, which characterize the superficial region of IDMN, is lost in nevoid melanoma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In minimal deviation melanoma, cell organization in the dermis facilitates differentiation, as the growth pattern is expansive and displaces adjacent structures, and remnants of the preexisting nevus, whether a Spitz nevus, congenital nevus, or blue nevus, almost always persist.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Nevoid melanoma is very rare, accounting for between 0.5%<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> and 2.3% of cases. It is more common in men, with a mean age at presentation of 57 years, and tends to arise on the back and limbs.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The largest series, with 43 patients, was published in 2015 by Idriss et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Those authors described 2 architectural patterns (plaque and polypoid) and stated that 81% of cases of nevoid melanoma presented nests arranged in a parallel theque pattern in the basal layer of the tumor, which could aid diagnosis. Genetic techniques including fluorescent in situ hybridization and comparative genomic hybridization (CGH) have been shown to be useful in the differentiation between melanoma and melanocytic nevus. In that study, CGH detected genetic changes in 7 of the 8 cases in which the test was performed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nevoid melanomas appear to carry a poorer prognosis than other types described in the different series, with metastasis rates of 15% to 37.5% and a mortality of between 25% and 37.5% (series by Schmoeckel et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> and series by Idriss et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a>). In our patient, SLNB was performed despite the site being on the head and neck, which can make the technique more difficult, and, in accordance with the melanoma committee, local radiotherapy was administered.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" 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: Fernándezirenebsf@hotmail.com IS, Sanz MMS, Botello LN, Gullón GR. No es bueno todo lo que lo parece. Actas Dermosifiliogr. 2017;108:876–878.</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" => 1224 "Ancho" => 1626 "Tamanyo" => 287534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous nodule on the auricle of the ear.</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" => 2114 "Ancho" => 3167 "Tamanyo" => 947281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nevoid malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 14 | 24 |
| 2024 Octubre | 101 | 45 | 146 |
| 2024 Septiembre | 144 | 61 | 205 |
| 2024 Agosto | 166 | 87 | 253 |
| 2024 Julio | 155 | 36 | 191 |
| 2024 Junio | 162 | 40 | 202 |
| 2024 Mayo | 108 | 36 | 144 |
| 2024 Abril | 101 | 34 | 135 |
| 2024 Marzo | 112 | 21 | 133 |
| 2024 Febrero | 105 | 29 | 134 |
| 2024 Enero | 85 | 31 | 116 |
| 2023 Diciembre | 94 | 26 | 120 |
| 2023 Noviembre | 108 | 20 | 128 |
| 2023 Octubre | 97 | 30 | 127 |
| 2023 Septiembre | 61 | 24 | 85 |
| 2023 Agosto | 50 | 13 | 63 |
| 2023 Julio | 72 | 35 | 107 |
| 2023 Junio | 74 | 19 | 93 |
| 2023 Mayo | 46 | 25 | 71 |
| 2023 Abril | 58 | 15 | 73 |
| 2023 Marzo | 59 | 23 | 82 |
| 2023 Febrero | 58 | 11 | 69 |
| 2023 Enero | 49 | 29 | 78 |
| 2022 Diciembre | 70 | 27 | 97 |
| 2022 Noviembre | 30 | 19 | 49 |
| 2022 Octubre | 43 | 30 | 73 |
| 2022 Septiembre | 23 | 26 | 49 |
| 2022 Agosto | 28 | 54 | 82 |
| 2022 Julio | 30 | 47 | 77 |
| 2022 Junio | 21 | 25 | 46 |
| 2022 Mayo | 47 | 45 | 92 |
| 2022 Abril | 71 | 26 | 97 |
| 2022 Marzo | 56 | 52 | 108 |
| 2022 Febrero | 50 | 25 | 75 |
| 2022 Enero | 87 | 31 | 118 |
| 2021 Diciembre | 45 | 38 | 83 |
| 2021 Noviembre | 53 | 46 | 99 |
| 2021 Octubre | 46 | 50 | 96 |
| 2021 Septiembre | 42 | 30 | 72 |
| 2021 Agosto | 39 | 32 | 71 |
| 2021 Julio | 47 | 16 | 63 |
| 2021 Junio | 46 | 27 | 73 |
| 2021 Mayo | 35 | 45 | 80 |
| 2021 Abril | 81 | 71 | 152 |
| 2021 Marzo | 47 | 27 | 74 |
| 2021 Febrero | 47 | 25 | 72 |
| 2021 Enero | 17 | 19 | 36 |
| 2020 Diciembre | 37 | 23 | 60 |
| 2020 Noviembre | 32 | 17 | 49 |
| 2020 Octubre | 34 | 11 | 45 |
| 2020 Septiembre | 31 | 13 | 44 |
| 2020 Agosto | 30 | 19 | 49 |
| 2020 Julio | 19 | 15 | 34 |
| 2020 Junio | 26 | 19 | 45 |
| 2020 Mayo | 17 | 11 | 28 |
| 2020 Abril | 20 | 15 | 35 |
| 2020 Marzo | 26 | 14 | 40 |
| 2020 Febrero | 5 | 0 | 5 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 7 | 0 | 7 |
| 2019 Abril | 2 | 0 | 2 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Febrero | 26 | 7 | 33 |
| 2018 Enero | 62 | 4 | 66 |
| 2017 Diciembre | 26 | 15 | 41 |
| 2017 Noviembre | 59 | 37 | 96 |
| 2017 Octubre | 1 | 4 | 5 |
| 2017 Septiembre | 5 | 6 | 11 |
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