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Introduccion: el nevo melanocitico (NM) congenito gigante es una lesion pigmentada de gran tamano, usualmente presente desde el nacimiento, aunque algunas lesiones pueden aparecer a los pocos meses de vida. Es una proliferacion atipica benigna de melanocitos en la piel que puede tener morfologias curiosas. Se asocia en algunas ocasiones, a manifestaciones extracutaneas y al desarrollo de melanoma. Se caracteriza por una lesion hiperpigmentada en diferentes tonos del marron y puede afectar desde el encefalo hasta los miembros inferiores. La localizacion mas frecuente es el tronco posterior, la cara, el cuero cabelludo y las extremidades. Caso clinico: se presenta caso clinico de una paciente adolescente con NM gigante en calzon con multiples lesiones satelites, con el objetivo de realizar una revision del tema y senalar la importancia del control periodico y seguimiento. Conclusion: el NM gigante congenito es una alteracion cutanea benigna, que implica serio compromiso estetico en la medida que aumente de tamano. Se deben enfatizar la dificultad del tratamiento y las implicaciones medico sociales. Rev.cienc.biomed. 2015;6(1):155-159 PALABRAS CLAVE Nevo; Nevo pigmentado; Melanoma; Melanocitos. SUMMARY Introduction: the Giant Congenital Melanocytic Nevus (GCMN) is a pigmented lesion of great size, usually presented since the birth, although some lesions could appear in the first months of life. It is an atypical benign proliferation of melanocytes in the skin that could have curious morphologies. It is associated in some cases to extracutaneous manifestations and melanoma development. It is characterized by a hyperpigmented lesion in different tones of brown and could affect since the brain until the lower limbs. The most frequent location is the posterior trunk, the face, scalp and extremities. Case report: the case of a young female patient with GCMN «in garment» with several satellite lesions is presented in order to carry out a thematic review and to indicate the importance of the control period and following. Conclusion: the GCMN is a benign cutaneous alteration that implies serious esthetic disorders when it increases its size. The treatment difficulties and the medico-social implications must be kept in mind. Rev.cienc.biomed. 2015;6(1):155-159 KEYWORDS Nevus, Pigmented nevus; Melanoma; Melanocytes.

Managing the balance between accurately identifying early stage melanomas while avoiding obtaining biopsy specimens of benign lesions (ie, overbiopsy) is the major challenge of melanoma detection. Decision making can be especially difficult in patients with extensive atypical nevi. Recognizing that the primary screening modality for melanoma is subjective examination, studies have shown a tendency toward overbiopsy. Even low-risk routine surgical procedures are associated with morbidity, mounting health care costs, and patient anxiety. Recent advancements in noninvasive diagnostic modalities have helped improve diagnostic accuracy, especially when managing melanocytic lesions of uncertain diagnosis. Breakthroughs in artificial intelligence have also shown exciting potential in changing the landscape of melanoma detection. In the first article in this continuing medical education series, we review novel diagnostic technologies, such as automated 2- and 3-dimensional total body imaging with sequential digital dermoscopic imaging, reflectance confocal microscopy, and electrical impedance spectroscopy, and we explore the logistics and implications of potentially integrating artificial intelligence into existing melanoma management paradigms.

BACKGROUND Pigmentary problems are one of the most frequent causes for dermatologic consultation. Skin colour is highly individual and the variations are controlled by numerous genes. Correct diagnosis of skin disorders including pigmented lesions depends on histopathologic examination of skin biopsies and clinicopathologic correlation. METHODS This is a hospital based observational study done for a period of 2 years from July 2017 to June 2019 with a sample size of 88 cases in the Department of Pathology, Andhra Medical College, Visakhapatnam. Specimens were formalin fixed and the tissue was adequately processed for histopathological examination. The sections were stained routinely with haematoxylin and eosin and examined under light microscopy. RESULTS Out of the 88 cases, 30 cases were inflammatory lesions which include 14 cases of classic lichen planus, 6 cases of lichen planus hypertrophicus, 9 cases of lichen planus pigmentosus and 1 case of lichenoid keratosis. 35 cases were benign lesions comprising 21 cases of benign melanocytic nevi and 14 cases of seborrheic keratosis. 23 malignant lesions include 16 cases of basal cell carcinoma and 7 cases of melanoma. Most common affected age group was 51-60 yrs. Most common site involved in malignant lesions was face (34.33%). There is slight female preponderance. Most common pigmented lesion under malignant category was basal cell carcinoma about 16 cases. 75 cases (85%) were correlated clinically. CONCLUSIONS Classic Lichen planus is the most common lesion seen under inflammatory category. The diagnosis of seborrheic keratosis is mainly based on the histopathological examination in order to differentiate from other pigmented skin lesions, hence a careful histopathological diagnosis is important.

Pigmentation is a common clinical finding of an oral cavity, but a proper diagnosis of the lesions is very challenging. Pigmentation can be focal, multifocal, associated with systemic/genetic disorder, or due to exogenous agents. Pigmented lesions are either melanocytic or nonmelanocytic. Pigmented lesions of the oral cavity have a broad spectrum of diversity. They present as racial pigmentation, innocuous lesions (amalgam tattoo, oral melanotic macule), benign nevi, and life-threatening malignant melanoma, and they can also produce a diagnostic dilemma. Thus, a proper diagnosis of a pigmented lesion in an early stage is very important for the accurate treatment plan. In this review, pigmented lesions of the oral cavity are briefly discussed.

Cancerous melanoma can be easily distinguished from non-cancerous melanoma by considering few exclusive attributes. These features are selected to be utilized in the final phase of classification process. The pigmented lesion is classified by extracting the attributes in accordance with the obtained ABCD. These attributes can be analyzed for quantifying a mole as a common injury or melanoma. The cancer can be detected using different phases in which pre-processing is performed, features are extracted and the classification is carried out. This paper reviews several methods to detect melanoma cancer with regard to certain performance metrics.

Observing a metastatic malignant melanoma and its primary lesion at the same time is rare. The histopathological detection of any unusual pigmented lesion is critical.

Giant congenital melanocytic nevus (GCMN) is a deeply pigmented lesion, often associated with hypertrichosis and multiple scattered satellite lesions. During infancy apart from textural changes, rapidly growing “proliferative nodules” mimicking melanoma can occur in the nevus. Areas of the nevus may be infiltrated by an overgrowth of fat or nerve tissue, so-called lipomatous or neurotized areas, respectively, common in larger nevi. We report a case of GCMN associated with multiple neurotized areas mimicking large neurofibromas, a rare phenomenon.

Summary Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low‐risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion‐directed examination is low.

We conduct a bicentric cohort study to assess the existence of a possible association between drug-induced photosensitivity and Breslow thickness among melanoma patients. Our study suggests that women who have multiple chronic photosensitizing drugs intake are more likely to develop thicker cutaneous melanoma. Larger cohort studies are needed to confirm this finding

A 69-year-old woman with a nonrelevant past medical history was referred to an outpatient colorectal clinic because of the incidental finding of an anal pigmented lesion during a routine gynecological examination. Anal inspection and proctoscopy indicated possible anal melanoma ( and ).

A 46 year old white woman was referred for ophthalmologic evaluation of a pigmented lesion on the ocular surface of her left eye. The lesion had been noted during a routine eye examination by her general practitioner. She had first noticed the lesion six years earlier, believing it to be gradually increasing in size. Slit lamp biomicroscopy of the eye is shown in fig 1. No cysts were noted within the lesion and no other lesions were evident on complete ophthalmic examination, which included eversion of the eyelids and …

A 58-year-old patient presented for a newly developing small non-pigmented lesion, located on the left cheek. The patient had a previous history of melanoma, Breslow thickness 1.2 mm, located on the back, and excision of nodular basal cell carcinoma on the scalp. Dermoscopic examination revealed a discrete red pseudo-network, the so-called strawberry pattern, intersected by whitish hair follicles and covered by fine scales giving clues for actinic keratoses.

A 67-year-old man reported for pigmented lesion, located on the gluteal region. The lesion was 2.8 × 2 cm in diameter, with sharp demarcation, and highly pigmented edges, while the central part was less pigmented. Dermoscopic evaluation of the lesion revealed atypical pigment network at the periphery of the lesion, regression area in the central part, and blue-whitish vail indicating a more aggressive form of melanoma. The patient was sent to a plastic surgeon for surgical excision and histopathologic confirmation. A superficial spreading melanoma with nodular component and Breslow thickness of 3.2 mm was diagnosed.

A 46-year-old lady was admitted due to a 0.8 cm large pigmented lesion, irregularly shaped, located in the right preauricular region. The patient’s mother had previously excised a melanoma, Breslow thickness 1.3 mm, located on the back. The personal history of previously excisions of malignant skin tumors was negative, but the patient had a history of extensive sun exposure. Clinically, the lesion was a sharply demarcated flat macule, with shades of light brown color, occupying most of the lesion, while in the upper inner side of the lesion, the darker shade of brown was noticed supporting clinical suspicion. Dermoscopic examination revealed the shades of grey coloration in the central part of the lesion along with the presence of asymmetric pigmented follicles and obliterated hair follicles, corresponding to the diagnosis of lentigo maligna melanoma. The surgical excision was performed, and histopathology revealed lentigo maligna melanoma, Breslow thickness 0.6 mm.

A young 28-year-old patient was presented with a large pigmented flat lesion of roundish shape, with sharp demarcations, 2.2 × 1.8 cm in diameter, located on the left pectoral region. The patient had no skin cancers, including melanoma and non-melanoma skin cancer in his personal and family history. A dermoscopic examination of a highly suspicious lesion was performed and revealed a prominent atypical pigment network, pseudopods at the periphery of the lesion, while in the central part of the lesion a blue-whitish veil was detected. The young patient was urgently sent to a plastic surgeon for excision, and histopathologic examination revealed superficial spreading melanoma, Breslow thickness 2.8 mm.

A 90-years-old patient underwent a surgery for a nodule on the vertex with the outcome of non-ulcered nodular melanoma, which was dermis-infiltrating with 2.9 mm Breslow. Associated to the nodular component there was an extended pigmented lesion, as in the Picture 17.1.

A 38-year old patient presented for newly developed highly pigmented nevus located on the right knee. Clinical examination revealed a small, 0.8 cm in diameter, roundish, sharply demarcated, highly pigmented lesion, located on the patient’s right knee. Dermoscopic examination revealed an atypical prominent pigment network associated with whitish lines throughout almost the entire lesion indicating the diagnosis of early melanoma. The lesion was excised, and the pathohistological examination confirmed the diagnosis of melanoma in situ.

A 72-year old lady was referred due to excessive growth of nodular pigmented lesion located on the right lateral side of the nose. Clinically, a large bluish pigmented lesion, 2 × 1 cm in diameter, located on the right side of the nose was ugly duckling positive suggesting the possible diagnosis of nodular pigmented melanoma. Fortunately, dermoscopic examination revealed thick arborizing vessels associated with numerous erosions covered by hemorrhagic crusts, indicating the diagnosis of pigmented nodular basal cell carcinoma, afterward confirmed by pathohistology.

A 46-year-old patient presented for nodular highly pigmented lesion suspected for diagnosis of melanoma, located on the back. Although the clinical appearance was highly suspicious of melanoma, dermoscopic examination revealed different dermoscopic features, namely thick arborizing vessels, numerous blue-gray globules, and dots, indicating the diagnosis of pigmented nodular basal cell carcinoma, which was excised and confirmed by pathohistology.

A 60-year-old woman, with phototype III skin and with no previous family or personal history of melanoma, presented to our department for a total skin check-up. One of his relatives, who was a physician, detected a 1-mm dark pigmented macule on the right arm that had been previously unnoticed by the patient. The patient had a moderate number of melanocytic nevi, predominantly macular. 10×-magnification dermoscopic imaging showed homogeneous pigmentation. 40×-magnification dermoscopic showed a central pigmented dark blotch, and surrounding pigmented dots and apparent peripheral streaks.

A 71-year-old man presented to the dermatology outpatient clinic because of pigmented lesions on his inguinal area. In the inguinal area, 5 cm diameter, verrucous pigmented lesion was observed dermoscopic examination of this lesion revealed fissures and ridges cerebriform appearance, hairpin blood vessels, and moth-eaten border (Fig. 38.1). Verrucous carcinoma and melanoma were considered and biopsy was taken.

An 58-year-old female patient came for a preventive exam in a screening campaign for early diagnosis of melanoma. She pointed out the lesion on her arm, unable to determine the duration of the lesion. Her personal and family history for cutaneous malignances were negative. Previously, in her youth, she had unprotected UV exposure during summer months. She was otherwise healthy, without chronic conditions, and she was not taking any medication.