Case and Research Letters
Diagnostic Pitfalls: Pseudomelanocytic Nests in the Setting of Lichenoid Inflammation
Trampas diagnósticas: nidos seudomelanocíticos en el contexto de la inflamación liquenoide
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Bajo (A) y elevado aumento (B). MART-1 mostró una tinción débil de las células lesionales (C). Las biopsias sucesivas mostraron menos anidamientos con H&E. Bajo (D) y elevado aumento (E). Con la tinción SOX10 no mostraron una neoplasia melanocítica (F). La panqueratina y la S100 fueron positivas únicamente de manera focalizada (sin imagen).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. McClanahan, S. Choudhary, J. Zahniser, J. Ho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "McClanahan" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Choudhary" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Zahniser" ] 3 => array:2 [ "nombre" => "J." 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C, Spindle cells showing positive staining for human herpes virus 8 (monoclonal antibody, ORF73/HHV-8; original magnification ×20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Franco-Muñoz, M. García-Arpa, B. Lozano-Masdemont, I. Lara-Simón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Franco-Muñoz" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "García-Arpa" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Lara-Simón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018302862" "doi" => "10.1016/j.ad.2018.02.021" "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/S0001731018302862?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019301027?idApp=UINPBA000044" "url" => "/15782190/0000011000000004/v1_201905070820/S1578219019301027/v1_201905070820/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Diagnostic Pitfalls: Pseudomelanocytic Nests in the Setting of Lichenoid Inflammation" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "325" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. McClanahan, S. Choudhary, J. Zahniser, J. Ho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "McClanahan" "email" => array:1 [ 0 => "drm92@pitt.edu" ] "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" => "S." "apellidos" => "Choudhary" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Zahniser" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Ho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, University of Pittsburgh, Pittsburgh, USA" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Horizon Dermatology – UPMC, Hermitage, USA" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trampas diagnósticas: nidos seudomelanocíticos en el contexto de la inflamación liquenoide" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1036 "Ancho" => 3084 "Tamanyo" => 602415 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Initial biopsy showed diminished rete ridges and atypical cells in nests and as single cells with an underlying lymphohistiocytic infiltrate on hematoxylin and eosin (H&E) on low (A) and high (B) magnification. MART-1 showed weak staining of the lesional cells (C). Subsequent biopsies showed less nesting on H&E on low (D) and high (E) magnification and did not show a melanocytic neoplasm with SOX10 stains (F). Pankeratin and S100 were only focally positive (not pictured).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">“Pseudomelanocytic nests,” a more precise term than the commonly used “pseudonests,” are described in the literature as a diagnostic pitfall for pathologists.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> They are nests that stain with some melanocytic markers, but on further investigation, a melanocytic etiology is discordant with the clinical picture and further immunohistochemistry. Pseudonests have been described in lesions ultimately diagnosed as discoid lupus erythematosus, lichenoid phototoxic reactions, lichen planus pigmentosus, fixed drug eruptions, and lichen planus.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4</span></a> They create a diagnostic pitfall when mistaken for a melanocytic process, especially if using a single stain, such as Melanoma Antigen Recognized by T-cells 1 (MART-1) or, a related stain, Melan-A.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The literature cautions MART-1/Melan-A positivity can be misleading, because MART-1/Melan-A's cytoplasmic antigen in the melanosome can be transferred between cells during inflammation.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a patient thought to have a malignant melanoma in situ (MMIS) with marked regression upon initial biopsy, but was more consistent with lichen striatus upon subsequent biopsy and clinical correlation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 32-year-old male presented with a changing lesion on his anterior shoulder. The lesion was partially biopsied with a clinical differential diagnosis of an atypical melanocytic lesion vs Becker's nevus (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Initial histological review showed single and atypical cells at the dermoepidermal junction (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). MART-1 mildly highlighted cell aggregates (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Atypical lentiginous junctional cells were suspicious for MMIS with marked regression. The patient was referred to oncology, who consulted the pathologist, and sampled the lesion again.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Additional samples showed fewer pseudonests, and SRY-related HMG-box Gene 10 (SOX10) did not show a melanocytic neoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). After examination of the subsequent biopsies and clinical image, the lesion was felt to represent a lichenoid process with marked pigment incontinence, most consistent with lichen striatus with melanocyte pseudonests.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights a diagnostic pitfall in lichenoid processes with pseudonests, for which misdiagnosis has repercussions in treatment and management. The clinical and histological findings point to a lichenoid process and are not consistent with MMIS.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After pseudonests were initially described, other studies cautioned using MART-1/Melan-A in pigmented lesions with chronic sun damage.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,6</span></a> Despite studies suggesting pseudonests were rare, Silva et al. cautioned against excluding it from the differential diagnosis and heeded prior warnings to use multiple stains.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Microphthalmia-associated transcription factor (MITF), a nuclear epitope, and SOX10, a regulator for MITF, are more specific due to nuclear epitopes not readily transferring between cells in inflammation.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Therefore, other studies used supplementary stains, such as SOX10 or MITF, to verify true melanocytic components with benign reorganization.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4,7</span></a> MITF differentiated pseudonests from true melanocytic lesions after labeling cells consistently with other stains, such as S-100 or SOX10.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5</span></a> S-100 is considered one of the most sensitive stains for melanocytic lesions and specific against pseudomelanocytic nests due to a lack of aberrant staining in the literature.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> Thus, MITF's efficacy was challenged after MITF positive/S-100 negative nests were found in 30 cases of cutaneous lupus erythematosus with lichenoid interface dermatitis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Authors hypothesized MITF stains similarly to MART-1/Melan-A and insisted on clinical correlation and S-100 staining when both MART-1/Melan-A and MITF are positive.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The term “melanocytic pseudonests” was suggested for benign lesions with positive nest staining beyond MART-1/Melan-A in greater than 1-2 cells and not clinically thought to be MMIS.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A summary of studies and nest stain positivity can be found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Alternative compositions of nests, such as cells or cellular debris from melanocytes, melanophages, lymphocytes, or keratinocytes, are speculated to cause the aberrant MART-1/Melan-A staining.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> Silva et al. hypothesized pseudonests originate during lichenoid inflammation due to either recruitment or benign reorganization of true melanocytes,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and Hall et al. used soluble adenylyl cyclase (sAC) and CD1a to differentiate S-100 and sAC positive junctional melanocytes from superficial S-100 and CD1a positive epidermal Langerhans cells.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Other causes for discrepancies include differing staining protocols, study types, or disease processes.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the controversy, several histologic features are important when differentiating lesions beyond stains. For instance, the lack of pagetoid spread or surrounding lentiginous melanocytic proliferation makes MMIS unlikely,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> while non-staining nuclei in MITF positive nests hint to non-melanocytic origins.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Conversely, features suggestive of atypical melanocytic lesions include an abundance of positive staining junctional nests,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> confluent non-nested melanocytes, solar elastosis, effaced rete ridges, and ‘starburst’ giant cells.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dermatologists’ awareness of pseudomelanocytic nests is critical in avoiding a severe diagnostic pitfall. Clinicians should be cognizant of the possibility for pseudomelanocytes if the clinical differential diagnosis includes a lichenoid process and a pathology report describes an atypical melanocytic neoplasm. In the presence of Melan-A/MART-1 positivity, panels of multiple melanocytic markers, such as S-100 and/or MITF (or SOX10), markers of keratinocytic origin, and histologic correlation with the clinical context are essential for correct diagnosis. More studies are needed to determine the true nature of pseudonests and the sensitivity/specificity of stains in evaluating pseudonests.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => 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: McClanahan D, Choudhary S, Zahniser J, Ho J. Trampas diagnósticas: nidos seudomelanocíticos en el contexto de la inflamación liquenoide. Actas Dermosifiliogr. 2019;110:321–325.</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" => 1597 "Ancho" => 1200 "Tamanyo" => 239576 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anterior shoulder lesion with speckled brown appearance and areas of erythema.</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" => 1036 "Ancho" => 3084 "Tamanyo" => 602415 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Initial biopsy showed diminished rete ridges and atypical cells in nests and as single cells with an underlying lymphohistiocytic infiltrate on hematoxylin and eosin (H&E) on low (A) and high (B) magnification. MART-1 showed weak staining of the lesional cells (C). Subsequent biopsies showed less nesting on H&E on low (D) and high (E) magnification and did not show a melanocytic neoplasm with SOX10 stains (F). Pankeratin and S100 were only focally positive (not pictured).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">+: positive staining nests; −: negative staining nests; O: occasional cells in nests; R: rare cell in nests; UK: unknown; *: some cells exhibit non-staining nuclei; M: normal distribution of melanocytes at dermal-epidermal junction; LEN: Langerhans cells in epidermis and nests; LE: Langerhans cells in epidermis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age/sex, location, clinical presentation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive/negative nest stains</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final diagnosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Maize et al., 2003<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">35/M, left temple, blue-gray macules</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Discoid Lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>, S100<span class="elsevierStyleSup">M</span>, Tyrosinase<span class="elsevierStyleSup">M</span>, and BCL2<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">El Shabrawi-Caelen et al., 2004<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 10 cases of pigmented actinic keratosis</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Pigmented actinic keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span>, S100<span class="elsevierStyleSup">M, LE</span>, and Tyrosinase<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Beltraminelli et al., 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">60/M, both cheeks, brown grayish pigmentation, ill circumscribed</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Lichenoid phototoxic reaction</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Beltraminelli et al., 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">59/M, upper head, irregular, partly confluent reticulated pigmentation</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Lichen planus pigmentosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Beltraminelli et al., 2009<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">52/F, infraorbital area, small scaly plaque</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Pigmented lichenoid keratosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Nicholson and Gerami, 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry " rowspan="4" align="left" valign="top">39/F, forehead, ill-defined hyperpigmented macules</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK, CD68 and CD3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">R \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HMB45<span class="elsevierStyleSup">M</span> and S100<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Nicholson and Gerami, 2010<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">76/F, right periocular, well-demarcated hyperpigmented patch</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Fixed drug eruption</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK and CD3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MITF<span class="elsevierStyleSup">M</span>, HMB45, S100, and CD68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Silva et al., 2011<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">48/M, submandibular area of left neck, well-circumscribed, violaceous to hyperpigmented, nonblanching, polygonal patch</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1, MITF, SOX10, and S100 focal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Lichen planus pigmentosus/ Erythema dyschromicum perstans</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Gavino et al., 2011<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">4 UK cases with positive staining nests in 70 cases of lichen planus-like keratosis</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 and MIFT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Benign melanocytic nevi with lichenoid inflammation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CK and CD3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Abuzeid et al., 2011<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">1 UK case of positive staining nests in 53 cases of cutaneous lupus erythematosus (five UK negative staining nests)</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 and MIFT* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Cutaneous lupus erythematosus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">S100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Hall et al., 2015<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">48/M, central chest, irregular brown to violaceous patch</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1, MIFT, SOX10, S100*, and CD1a<span class="elsevierStyleSup">LEN</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Lichen planus actinicus</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">sAC<span class="elsevierStyleSup">M</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chung et al., 2015<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40/M, back, ankles, and feet, violaceous, polygonal, flat-topped, mildly pruritic papules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1 and SOX10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lichen planus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Caso actual</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">32/M, anterior shoulder, mammilated multifocal brown plaque</td><td class="td" title="table-entry " align="left" valign="top">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melan-A/MART-1, focal S100, and focal CK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Lichenoid process with marked pigment incontinence and melanocytic pseudonests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">− \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SOX10 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2026151.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pseudomelanocytic Nests or Melanocytic pseudonests in the Literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ducking stray “magic bullets”: A Melan-A alert" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 6 | 19 |
| 2024 Octubre | 111 | 39 | 150 |
| 2024 Septiembre | 102 | 20 | 122 |
| 2024 Agosto | 148 | 63 | 211 |
| 2024 Julio | 113 | 32 | 145 |
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| 2024 Mayo | 127 | 55 | 182 |
| 2024 Abril | 98 | 25 | 123 |
| 2024 Marzo | 122 | 32 | 154 |
| 2024 Febrero | 110 | 49 | 159 |
| 2024 Enero | 71 | 41 | 112 |
| 2023 Diciembre | 78 | 34 | 112 |
| 2023 Noviembre | 103 | 50 | 153 |
| 2023 Octubre | 93 | 45 | 138 |
| 2023 Septiembre | 91 | 32 | 123 |
| 2023 Agosto | 68 | 28 | 96 |
| 2023 Julio | 87 | 36 | 123 |
| 2023 Junio | 95 | 32 | 127 |
| 2023 Mayo | 88 | 33 | 121 |
| 2023 Abril | 68 | 34 | 102 |
| 2023 Marzo | 78 | 28 | 106 |
| 2023 Febrero | 71 | 31 | 102 |
| 2023 Enero | 65 | 35 | 100 |
| 2022 Diciembre | 67 | 47 | 114 |
| 2022 Noviembre | 60 | 27 | 87 |
| 2022 Octubre | 44 | 27 | 71 |
| 2022 Septiembre | 40 | 59 | 99 |
| 2022 Agosto | 39 | 43 | 82 |
| 2022 Julio | 25 | 44 | 69 |
| 2022 Junio | 32 | 34 | 66 |
| 2022 Mayo | 54 | 50 | 104 |
| 2022 Abril | 90 | 25 | 115 |
| 2022 Marzo | 46 | 56 | 102 |
| 2022 Febrero | 45 | 19 | 64 |
| 2022 Enero | 49 | 44 | 93 |
| 2021 Diciembre | 52 | 42 | 94 |
| 2021 Noviembre | 64 | 41 | 105 |
| 2021 Octubre | 53 | 57 | 110 |
| 2021 Septiembre | 59 | 37 | 96 |
| 2021 Agosto | 67 | 34 | 101 |
| 2021 Julio | 53 | 26 | 79 |
| 2021 Junio | 45 | 22 | 67 |
| 2021 Mayo | 63 | 42 | 105 |
| 2021 Abril | 95 | 55 | 150 |
| 2021 Marzo | 81 | 25 | 106 |
| 2021 Febrero | 82 | 19 | 101 |
| 2021 Enero | 55 | 16 | 71 |
| 2020 Diciembre | 52 | 24 | 76 |
| 2020 Noviembre | 34 | 15 | 49 |
| 2020 Octubre | 21 | 12 | 33 |
| 2020 Septiembre | 35 | 16 | 51 |
| 2020 Agosto | 23 | 12 | 35 |
| 2020 Julio | 22 | 12 | 34 |
| 2020 Junio | 39 | 24 | 63 |
| 2020 Mayo | 12 | 11 | 23 |
| 2020 Abril | 13 | 7 | 20 |
| 2020 Marzo | 25 | 11 | 36 |
| 2020 Febrero | 8 | 0 | 8 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Septiembre | 3 | 2 | 5 |
| 2019 Mayo | 4 | 0 | 4 |
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