Case and Research Letters
Simultaneous Disappearance of Various Nevi in a Patient with Autoimmune Disorders
Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados
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Álvarez-Chinchilla, I. Poveda Montoyo, B. Encabo-Durán, J. Bañuls Roca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P.J." "apellidos" => "Álvarez-Chinchilla" "email" => array:1 [ 0 => "pedroalvarezchinchilla@gmail.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" => "I." "apellidos" => "Poveda Montoyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Encabo-Durán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Bañuls Roca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d’Alacant, Alicante, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados" ] ] "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" => 1050 "Ancho" => 1400 "Tamanyo" => 179741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images showing changes in the patient's nevi.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During digital follow-up of a 42-year-old woman with atypical nevi using a MoleMax II video dermoscopy system (Derma Medical, London, UK), the patient's melanocytic lesions progressively disappeared and were practically absent by the end of a 3-year period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She presented with several autoimmune processes, including HLA-B27-positive sacroiliitis, ANA-positive peripheral arthritis, and autoimmune hypothyroidism that was treated with supplemental L-tyrosine. She had no personal or family history of melanoma. There was no evidence of a halo phenomenon or any other reaction around the nevi at any time. Several potential explanations can account for the disappearance of melanocytic nevi. Progressive disappearance in adulthood is a described feature of acquired melanocytic nevi (AMN).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">However, the rapid disappearance of AMN in young adults, as in the present case, is unusual. This involution can be caused by certain specific reactions. The halo or Sutton nevus can progressively fade and ultimately disappear, leaving a depigmented halo surrounding the site of the original nevus. Histologically, the condition is characterized by the presence of lymphocytic infiltrate with predominance of CD8<span class="elsevierStyleSup">+</span> T lymphocytes. This infiltrate results in progressive destruction of the melanocytes via a mechanism similar to that observed in vitiligo. This is the most common mechanism by which nevi disappear.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> Isolated reports have also described the disappearance of congenital melanocytic nevi, with or without a halo. In some cases histology has revealed the persistence of melanocytes despite apparent clinical disappearance.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A completely different form of nevus disappearance involves an eccematoid reaction around the nevus (Meyerson nevus) followed by nevus involution, and is characterized by eczema-like histological findings.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Because AMN and melanoma induce the expression of similar antigens, AMN can disappear in melanoma patients, a consequence of an immune system reaction that occurs spontaneously or is induced by immunotherapy with anti-CTL01A4 and anti-PD-1 agents.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Although less common, the disappearance of nevi in patients with neither eczema nor halo nevi has been described, although few of those cases involved involution of practically all nevi, as occurred in our patient.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The literature describes 3 dermoscopic patterns associated with the disappearance of melanocytic nevi: halo phenomena; blue regression (peppering), caused by the action of melanophages, and white regression, characterized by a white fibrotic area with a pseudo-cicatricial appearance; and lesion disappearance with neither halo nor regression. In the case of the third pattern, which was observed in our patient, the lesions undergo a progressive loss of pigment and the dermoscopic pattern fades until lesion disappearance.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Given our patient's history of autoimmune diseases, the mechanism underlying nevus disappearance in this case was most likely immune in nature, although this was not histologically verified.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to be familiar with the different ways in which melanocytic lesions can evolve, since clinical lesion disappearance does not always imply histological disappearance, and to remember that digital dermoscopy is a useful method by which to monitor these patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" 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: Álvarez-Chinchilla PJ, Poveda Montoyo I, Encabo-Durán B, Bañuls Roca J. Desaparición simultánea de nevus en un paciente con procesos autoinmunes asociados. Actas Dermosifiliogr. 2018;109:927–928.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 1400 "Tamanyo" => 179741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and dermoscopic images showing changes in the patient's nevi.</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" => "Dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Bologna" 1 => "J.L. Jorizzo" 2 => "J.V. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 21 | 9 | 30 |
| 2024 Octubre | 137 | 48 | 185 |
| 2024 Septiembre | 120 | 31 | 151 |
| 2024 Agosto | 144 | 72 | 216 |
| 2024 Julio | 130 | 41 | 171 |
| 2024 Junio | 143 | 57 | 200 |
| 2024 Mayo | 92 | 52 | 144 |
| 2024 Abril | 110 | 43 | 153 |
| 2024 Marzo | 114 | 41 | 155 |
| 2024 Febrero | 124 | 39 | 163 |
| 2024 Enero | 115 | 37 | 152 |
| 2023 Diciembre | 99 | 30 | 129 |
| 2023 Noviembre | 143 | 25 | 168 |
| 2023 Octubre | 145 | 33 | 178 |
| 2023 Septiembre | 141 | 36 | 177 |
| 2023 Agosto | 122 | 16 | 138 |
| 2023 Julio | 154 | 35 | 189 |
| 2023 Junio | 146 | 28 | 174 |
| 2023 Mayo | 186 | 22 | 208 |
| 2023 Abril | 133 | 23 | 156 |
| 2023 Marzo | 120 | 27 | 147 |
| 2023 Febrero | 118 | 33 | 151 |
| 2023 Enero | 148 | 36 | 184 |
| 2022 Diciembre | 109 | 44 | 153 |
| 2022 Noviembre | 43 | 24 | 67 |
| 2022 Octubre | 54 | 24 | 78 |
| 2022 Septiembre | 52 | 30 | 82 |
| 2022 Agosto | 61 | 41 | 102 |
| 2022 Julio | 57 | 59 | 116 |
| 2022 Junio | 38 | 33 | 71 |
| 2022 Mayo | 132 | 48 | 180 |
| 2022 Abril | 127 | 39 | 166 |
| 2022 Marzo | 117 | 52 | 169 |
| 2022 Febrero | 107 | 35 | 142 |
| 2022 Enero | 141 | 49 | 190 |
| 2021 Diciembre | 72 | 39 | 111 |
| 2021 Noviembre | 98 | 42 | 140 |
| 2021 Octubre | 103 | 56 | 159 |
| 2021 Septiembre | 79 | 44 | 123 |
| 2021 Agosto | 122 | 36 | 158 |
| 2021 Julio | 86 | 34 | 120 |
| 2021 Junio | 82 | 28 | 110 |
| 2021 Mayo | 69 | 57 | 126 |
| 2021 Abril | 136 | 98 | 234 |
| 2021 Marzo | 89 | 41 | 130 |
| 2021 Febrero | 65 | 28 | 93 |
| 2021 Enero | 57 | 25 | 82 |
| 2020 Diciembre | 40 | 36 | 76 |
| 2020 Noviembre | 30 | 41 | 71 |
| 2020 Octubre | 14 | 27 | 41 |
| 2020 Septiembre | 26 | 24 | 50 |
| 2020 Agosto | 20 | 20 | 40 |
| 2020 Julio | 12 | 15 | 27 |
| 2020 Junio | 25 | 28 | 53 |
| 2020 Mayo | 8 | 9 | 17 |
| 2020 Abril | 12 | 12 | 24 |
| 2020 Marzo | 12 | 11 | 23 |
| 2020 Febrero | 1 | 0 | 1 |
| 2019 Mayo | 0 | 1 | 1 |
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