Syn .: Naevi. Def .: Usually congenital skin abnormalities involving ectodermal and / or mesodermal structures. The most common ground for moles are mosaic disorders.
Non-melanocytic nevi are usually congenital but not inherited. Some melanocytic nevi can undergo neoplastic transformation, leading to the development of malignant melanoma. Birthmarks appear at different ages and persist throughout life. Moles: – non-melanocytic (naevi): epidermal nevi, nevi and benign neoplasms of sebaceous glands, nevi and benign neoplasms of sweat glands, nevi and benign neoplasms of hair follicle, nevi and benign neoplasms of vascular origin, nevi and benign neoplasms of connective tissue and nerve origin ; – melanocytic (naevi pigmentosi): skin nevi (blue nevus, Mongolian stain, Ota nevus, Ito nevus); normal melanocytic moles (lentil stain, Clark’s nevus, birthmark
SKIN NAMES (naevi epidermales)
Papillary birthmark (Fig. 22.1)
Syn.: Naevus verrucosus.
Def .: Brown or skin color hyperkeratotic changes, usually unilateral, appearing in early childhood and lasting until the end of life.
Epid .: The most common form among epidermal nevi.
Etiol .: The birthmark is derived from an embryonic ectoderm. There are somatic mutations that cause mosaicism.
Clinical: Hard, hyperkeratotic changes. They are papillary in nature. Their arrangement is most often one-sided (naevus unilateralis), less often bilateral. Initially, the changes are the color of healthy skin. Then they gradually take on a brown shade. The papillary nevus remains permanent.
Hist .: Papillomatous epidermal hyperplasia.
DR .: Papillary lichen planus, psoriasis, viral warts.
Healing: Surgical, cryotherapy, laser therapy, chemical peels. The birthmark is removed for cosmetic reasons.
DIG. 22.1. Papillary birthmark.
Inflammatory linear papillary epidermal nevus (Fig. 22.2)
Syn.: Infl ammatory linear verrucous epidermal nevus (ILVEN).
Def .: Papillary epidermal nevus, inflammatory and linear in nature.
Epid .: The K: M ratio is 4: 1.
Etiol .: The birthmark is derived from an embryonic ectoderm. There are somatic mutations that cause mosaicism.
Loc: Often in the groin area.
Clinical: Erythematous lesions with an exfoliating surface, arranged linearly along the long axis of the body. The changes are accompanied by inflammation and intense itching.
Hist: Papillomatous epidermal growth. There may be signs of inflammation in the dermis.
DR .: Psoriasis, Darier’s disease, linear lichen planus, chronic simple lichen.
Healing: Surgical, cryotherapy, laser therapy, chemical peels. Relief of pruritus: topical or intralesional corticosteroids, pulsed dye laser irradiation.
DIG. 22.2. Linear inflammatory papillary birthmark.
Seborrheic wart (Fig. 22.3)
Syn.: Seborrheic wart, senile seborrheic wart, seborrheic wart, seborrheic keratosis.
Def .: Hyperkeratotic, papillary lesions, sometimes pedunculated, which are actually benign epidermal neoplasms.
Epid .: The most common neoplastic lesion. It usually appears after the age of 30. It is slightly more common in men.
Etiol .: Origin unknown. The sowing form of seborrheic warts may appear as a result of the release of growth factors by neoplastic tumors.
Loc .: Primarily the skin of the trunk, sometimes the skin of the face (hairline), neck, proximal sections of the upper and lower limbs, the backs of the hands.
Clinical: Initially, the lesions are a few millimeters long, flat or slightly raised, light brown or skin-colored eruptions. Subsequently, hyperkeratotic, yellowish or brown, papillary formations appear. They are well demarcated from the surroundings, often lofty, as if placed on the skin.
Hist .: Proliferation of keratinocyte-like cells of the basal layer of the epidermis, pseudocysts (crypts filled with horny masses).
DR .: Actinic keratosis, basal cell carcinoma, malignant melanoma.
Healing: Cryotherapy, curettage, surgical removal, laser therapy.
Year: Sowing multiple lesions on the trunk may indicate the presence of cancer of the internal organs, e.g. cancer of the gastrointestinal tract (Leser-Trélat symptom).
DIG. 22.3. Seborrheic wart.
NAMES AND Mild Neoplastic CHANGES DERIVATED FROM SEBOBIC GANGLES
The sebaceous mark (Fig. 22.4)
Syn .: Naevus sebaceus, Jadassohn’s sebaceous nevus (Jadassohn nevus sebaceus).
Def .: Congenital hamartoma-type lesion affecting the skin and its appendages, which is dominated by excessive proliferation of the sebaceous glands. Most often it has the form of a single, yellowish tumor with a papillary and lobular surface located within the hairy scalp.
Epid .: Occurs with a frequency of 0,3%.
Etiol .: Familial occurrence of the sebaceous nevus has been described. The lesion is present at birth and increases in adolescence under the influence of androgen stimulation.
Loc .: Hairy scalp (especially the temporo-frontal area), face (cheeks), neck.
Clinical: In childhood, the lesions take the form of flat lesions. Then they grow with the baby. They take on a characteristic appearance in adolescence. They then take the form of a yellowish tumor which is well demarcated from the surroundings and has a papillary, hairless surface.
Hist .: Early changes resemble epidermal nevi but contain numerous hair buds. In adults: increase in the number of sebaceous glands, increase in the number of apocrine and eccrine structures, acanthosis, hyperkeratosis, hyperplasia of the skin papillae.
DR .: Warting melanocytic nevus.
Heal .: Surgical. Moles are removed, especially from irritated areas or in the case of a suspected transformation of the mole into a malignant tumor.
Year: 10-30% of sebaceous nevi develops tumors (eg basal cell carcinomas) mainly in areas exposed to permanent irritation.
DIG. 22.4. The sebaceous mark.
Sebaceous adenoma (Fig. 22.5)
Syn.: Adenoma sebaceum.
Def .: Usually multiple, sometimes isolated, yellowish nodules on the head and neck in adults.
Localization: The nodules are located symmetrically around the seborrheic face.
Clinical: Most often multiple, non-confluent, yellow-pink nodules. Numerous changes in the type of sebaceous adenoma are characteristic of Bourneville-Pringle syndrome.
Hist .: Disorganized overgrowth of the sebaceous glands, some cells not fully mature.
DR: Basal cell carcinoma.
Healing: Surgical removal of the lesion, cryotherapy, laser therapy.
DIG. 22.5. Sebaceous adenoma.
NAMES AND Mild Neoplastic CHANGES RESULTING FROM SWEAT GANGLES
Sweat adenoma (Fig. 22.6)
Syn.: Syringoma.
Def .: Numerous, small, smooth-surfaced papular eruptions originating from the cells of the intra-epidermal ducts of the eccrine sweat glands.
Epid .: They are probably the most common adnexal tumors. They occur mainly in young women.
Lock: Eyelids (mainly under the eyes), neck, chest, abdomen.
Clinical: Minor (one to several millimeters), smooth, lumpy eruptions of healthy skin, pale or slightly brownish.
Hist .: Normal epidermis, numerous, small, cystic or ductal structures in the skin with bands of basal cells.
DR .: Yellow tufts, flat warts, milia.
Healing: Surgery, laser therapy, dermabrasion. There is no effective treatment for disseminated lesions.
Papillary sweat adenoma
Syn.: Syringocystadenoma papilliferum.
Def .: A single lump, most often located on the scalp or face, appears in early childhood as a result of differentiation into the ducts of the apocrine glands.
Loc .: Hairy scalp, temple, cheek.
Clinical: A single lump with a papillary, hairless surface. Sometimes there is a fistula in the center of the nodule, from which comes out a brown liquid that dries into a scab.
Hist .: Cystic spaces in the skin with many indentations and a finger-like cross-section.
DR .: Basal cell carcinoma, common wart, seborrheic wart.
Heal .: Surgical.
DIG. 22.6. Sweat adenoma.
Oblak
Syn .: Cylindroma, turban tumor, Spiegler’s tumor.
Def .: A benign, single or multiple adnexal tumor originating from the sweat glands located on the scalp.
Loc .: Hairy scalp.
Clinical: The tumor shows considerable cohesiveness, it has a healthy skin color or pink, it is hairless. Tumor larger than other tumors of the hair follicle. Telangiectasias often occur on its surface. If a patient has numerous larger tumors, then these lesions are referred to as turban tumor.
Hist .: Overlapping skin basal cell sockets containing PAS – positive hyaline inclusions, surrounded by a dense hyaline (or amorphous) membrane.
DR .: Basal cell carcinoma, various types of cysts, neurofibromatosis.
Heal .: Surgical.
STAMPS AND Mild Neoplastic CHANGES ARISING FROM THE LAMINARY MEDIUM
Blackheadse
Syn.: I’m eating naevus.
Def .: Abnormal development of hair follicles, resulting in the formation of keratin-filled depressions in the skin.
Epid .: Rarely seen.
Loc .: Chest, face, neck, proximal parts of the upper limbs.
Clinical: Punctal depressions of the skin filled with keratin. Changes in the face are often linear. There are no complaints, unless the lesions become inflamed. The inflammatory nevus is similar to acne vulgaris.
Hist .: Numerous, yawning, dilated hair follicles, filled with horn plugs.
DR: Acne vulgaris.
Heal .: Surgical.
Bellows nevus
Syn.: Trichofolliculoma.
Def: A hamartomatous tumor originating from a hair follicle.
Lok .: Face and neck.
Wedge: A fine, domed bump, usually pierced by twisted white hairs protruding from a central cavity. The color of the tumor is reddish or close to the color of the skin.
Hist .: An dilated hair follicle or a cyst containing hair. Incomplete bellow structures branch out from the centrally located opening.
Treat .: Surgical (there is a possibility of malignant transformation of the tumor).
STANDARD AND Mild Neoplastic CHANGES OF VASCULAR ORIGIN
Def .: Changes that result from the deformation (expansion or growth) of capillaries, arteries, veins or lymph vessels, occurring at birth or occurring throughout life. Most of the vascular lesions are associated with vascular hyperplasia (neoplasm), so they should be classified as benign neoplasms.
Hemangiomas of the infancy period (Fig. 22.7)
Syn.: Neonatal haemangioma, haemangioma capillare, haemangioma cavernosum.
Def .: Usually single red spots or bumps, 1-25 cm in diameter, most often located in the head or neck, tending to regress spontaneously.
Epid .: They occur in 10% of infants at the end of the first year of life.
Loc .: Head and neck (50-60%), trunk (25%), limbs, oral mucosa.
Clinical: Single, less often multiple, red spots or tumors with a tendency to spontaneously resolve. Regression begins with the central part of the hemangioma, which gradually turns bright. Initially, in the first year of life, infantile hemangiomas may show an increasing tendency, then disappear to 5-10. year Eruptions disappear without a trace in as many as 80% of cases. In the remaining cases, the recovery of the angiomas is almost complete.
Hist .: Proliferation of endothelial cells in the vessels of the skin and / or subcutaneous tissue.
But: Changes usually resolve spontaneously, with changes of the type of haemangioma cavernosum usually disappearing as a result of pressure or mechanical trauma. In addition, systemic corticosteroids, laser therapy and cryotherapy should be considered in the treatment.
DIG. 22.7. Cavernous hemangiomas.
Flat vascular nevus (Fig. 22.8)
Syn .: Naevus flammeus, red wine stain (port wine naevus).
Def .: A horizontal lesion of the skin, often unilateral, located most often on the neck and face. Flat hemangiomas only dilate the vessels, so they are not classified as neoplasms. Flat vascular nevus may be accompanied by soft tissue hypertrophy.
Epid .: Occurs with a frequency of 0,1-1%.
Etiol .: Somatic mosaicism, autosomal dominant inheritance.
Lock: Mostly the face or other areas of the body. Larger spots often appear along the Blaschko line.
Clinical: At birth, the lesions appear as pale pink spots or discs of various sizes. These changes increase proportionally as the child grows. In adults, they are bright red, irregular, and may also appear papular and nodular. Unilateral flat vascular nevus are life-long, while centrally located lesions may resolve spontaneously. Flat hemangiomas may be accompanied by various systemic disorders, most often glaucoma, changes in the CNS, sometimes in the skeleton.
DL .: Research on glaucoma and changes in the CNS.
Hist .: Widened vessels of the dermis.
DR: Not necessary.
But: Laser therapy, cryotherapy, midline and neck lesions may resolve spontaneously. Cosmetic camouflage.
DIG. 22.8. Flat vascular nevus.
Vascular granuloma (Fig. 22.9)
Syn.: Granuloma teleangiectodes.
Def .: Rapidly appearing skin eruption associated with neoplasm of blood vessels caused by trauma or bacterial infections.
Epid .: It occurs mainly in children and young adults. It may appear at any age in the course of retinoid therapy.
Etiol .: The appearance of a vascular granuloma is associated with a trauma, sometimes it appears on the gums in pregnant women.
Loc.: Face, torso, fingers and toes, the area of the lateral edge of the nails (retinoid therapy), acne lesions (isotretinoin therapy), gums (pregnant women).
Clinical: A single, cyan-red nodule several millimeters in diameter (up to approx. 10-15 mm) with a moist, easily bleeding surface and a pedunculated base. It shows rapid growth and a tendency to ulcerate.
Hist .: Neoplasm of capillaries with the presence of infiltrates, mainly polynuclear leukocytes.
DR .: Malignant melanoma, neoplastic metastases to the skin.
Healing: Surgical, electrocoagulation, laser therapy, curettage, chemical cauterization. In the case of disseminated vascular granulomas in patients with acne vulgaris, 1 mg / kg is used. prednisolone in short inserts.
Year: Most vascular granulomas resolve on their own.
DIG. 22.9. Vascular granuloma.
Stellate hemangioma (Fig. 22.10)
Syn .: Angioma stellatum, vascular spider (naevus araneus, spider nevus).
Def .: Acquired vascular lesion with the character of a red papule with numerous, radially spreading fine, dilated vessels. It is not a true vascular birthmark. Belongs to telangiectasia.
Epid .: There are no changes in the type of stellate hemangioma at birth. They appear later, depending on the etiological factors. They most often occur in girls and young women.Ethiol .: The appearance of stellate hemangiomas is associated with the effects of estrogens (often during pregnancy or during estrogen therapy), liver diseases, connective tissue diseases (mainly CREST syndrome), sometimes they may appear spontaneously.
Loc .: Face, limbs, torso.
Clinical: Usually numerous, small (the size of a pinhead), red nodules with radiating capillaries.
Hist .: Enlarged central vessel and branches radially extending from it.
Healing: Electrocoagulation, laser coagulation, possibly surgical removal.
DIG. 22.10. Stellate hemangioma.
Sufficient hemangioma, ruby point
Syn .: Angioma senile, cherry haemangioma, ruby point, de Morgan stain.
Def .: Ruby-red vascular lesions that appear in large numbers in adults.
Epid .: Very common, found in most adults, most often over 30 years of age. With age, the number of lesions increases.
Etiol .: Sometimes there is a family predisposition to the occurrence of stellate hemangiomas. Sudden seeding may be related to pregnancy or to a prolactin-producing tumor.
Lok .: First of all, the skin of the torso.
Clinical: Numerous, round, domed vascular lesions, bright red in color and several millimeters in diameter.
DL .: In the case of sudden spreading of numerous lesions, tests for prolactin-producing neoplasm should be performed.
Hist .: Dilated capillaries with flattened endothelial cells.
Healing: Electrocoagulation, laser coagulation, possibly surgical removal.
Lymphatic moles
Syn.: Lymphangioma.
Def .: Changes usually occurring from birth due to enlargement or dilation of lymphatic vessels. There are common (superficial) lymphangiomas – lymphangioma simplex and cavernous (deep) lymphangiomas – lymphangioma cavernosum.
Epid .: Lymphangiomas usually occur in childhood. Normal lymphangiomas are most often observed from birth, much more often in girls.
Etiol .: Disruption of the connection between the lymphatic vessels in the skin and their deeper counterparts. In deep (cavernous) lymphangiomas, changes arise from deeper lymphatic reservoirs.
Localization: Superficial lymphangiomas usually located in the area of the oral mucosa (mainly the tongue) and in the proximal parts of the limbs, groin, armpits and trunk. Deep lymphangiomas are most often located on the neck, as well as in the mouth and around the eye sockets.
Clinical: Common lymphangioma resembles a frog’s croak. It has the form of grouped, light bubbles from which a clear liquid emerges after the puncture. The cavernous lymphangioma, in turn, is in the form of deeper, elastic nodular formations, sometimes covered with transparent vesicles. Lymphangiomas located on the extremities can be accompanied by severe vascular malformations.
Hist .: In common lymphangioma a large, dilated vessel is observed, containing thick protein material and a small number of red blood cells. In deep lymphangiomas, the cavities are much larger and often associated with smooth muscle fibers.
DR .: Normal lymphangiomas are differentiated from keratoderma and papillary hemangiomas, and cavernous hemangiomas from soft tissue neoplasms in children.
Healing: Surgical, in addition, compression and intravascular coagulation are used.
NAMES AND MENTAL TUMORS OF CONNECTIVE TISSUE AND NERVOUS ORIGIN
Soft fibroma (Fig. 22.11 and 22.12)
Syn.: Soft fibroma.
Def .: Congenital cancer of connective tissue origin may appear at any age.
Epid .: Single lesions of the nature of soft fibromas are found in the majority of adults, most often in women and obese people.
Etiol .: The appearance of soft fibromas may be the result of obesity and endocrine disorders.
Loc. Neck, nape, armpits, groins, under the nipple area.
Clinical: Numerous soft bumps or nodules ranging in diameter from a few millimeters to several centimeters, skin-colored or brownish, pedunculated and baggy hanging.
Hist .: Acanthosis with papillomatosis in the epidermis.
DR .: Soft cell birthmarks, papillomas, lipomas.
Heal .: Surgical.
FIGURE 22.11. Soft fibroma.
FIGURE 22.12. Soft fibromas.
Hard fibroma
Syn.: Fibroma condition.
Def .: Fibrous reaction that can occur regardless of age.
Epid .: Fibromas of the skin are extremely common. At least one such lesion is found in the majority of adults, especially women.
Etiol .: Unknown. Skin fibromas are the result of a fibrous reaction to an injury, most commonly an insect bite or inflammation of the hair follicle.
Loc .: Lower limbs first of all.
Clinical: Single, small, fairly hard lump, skin-colored or light brown. When compressing adjacent skin, the hard fibroma contracts or convex (Fitzpatrick’s symptom).
Hist .: Acantotic epidermis with clusters of basal cells or with sebaceous lobes. In the dermis, you can find a fibrous infiltrate, a cellular infiltrate, and vessels with a lace pattern.
DR .: Fibrous hemangioma, keloid, pigmented nevus.
But: Surgical removal of the fibroma may result in an unsightly scar.
Kelnowiec (Fig. 22.13)
syn.: keloid.
Def .: A tumor composed of fibrous connective tissue arises at the site of the injury – with its border crossing or with no apparent cause. Keloids are divided into secondary keloids, which arise at the site of the injury, and spontaneous keloids, appearing for no apparent reason.
Epid .: Keloids are more common in black people, especially in people with family predispositions. They are mainly exposed to children and young adults, often in the third decade of life.
Etiol .: Unknown. The development of keloids is influenced by: race, age, body area, type of wound (more often in burn wounds), secondary bacterial infections.
Loc .: Sternum area (mainly spontaneous keloids), shoulder girdle, earlobes, face and elbows.
Clinical: Hard, smooth bumps with crab claw-like protrusions. They appear weeks or months after the skin injury. Initially, they are red in color, but fade with time.
Hist .: Proliferation of fibroblasts, dense collagen fibers.
DR .: Hypertrophic scars, skin fibromas.
But: Usually it does not bring satisfactory results. Intra-focal corticosteroids and / or cryotherapy, focal gamma interferon or corticosteroid occlusion are used. Recurrences may occur after surgical treatment.
RYC.22.13. Keloid
Neurofibroma
Syn.: Neurophy broma.
Def .: A benign tumor originating in the sheath of nerve fibers, composed of Schwann cells, fibroblasts and cells resembling nerve cells.
Clinical: Usually a single lump of soft consistency and varying in size. When pressed with the fingertip, the neurofibroma invades the skin. In its plural form, it may be associated with Recklinghausen disease.
Hist .: A delimited lesion containing Schwann cells, fibroblasts, endothelial cells, mast cells, fibroblasts that surround nerve fibers, and axons randomly arranged in the matrix.
DR .: Skin birthmark, hard fibroma.
Heal .: Surgical.
Lipoma
Syn.: Lipoma.
Def .: Benign tumor derived from adipose tissue.
Epid .: One of the most common cancers. At least one lipoma lesion is seen in adults.
Etiol .: Unknown. Lipomas can run in families. In multiple lipomas, inheritance is autosomal dominant.
Lock: Any, most often neck and torso, less often limbs.
Clinical: Asymptomatic, single or multiple, well-defined tumor with a soft consistency. The diameter of the tumor may vary from one to more than fifteen centimeters. The skin above the tumor is unchanged and easily shifted.
Hist .: A thin or fragmented connective tissue capsule surrounding normal fat cells.
DR .: Cysts, neurofibromas, mucous tumors, metastatic tumors.
Heal .: Surgical.
MELANOCYTES STATEMENTS
The birthmark is blue (Fig. 22.14)
Syn.: Naevus coeruleus, blue nevus.
Def .: Mild pigmented lesion with the nature of a blue or blue-gray nodule.
Epid .: The lump is present at birth or appears in early childhood.
Etiol .: Genetic conditions, rare family occurrence.
Loc: Any part of the body, often the skin of the limbs.
Clinical: Usually a single, blue, compact and well-demarcated nodule up to 1 cm in diameter.
Hist .: In the dermis, as well as in the subcutaneous tissue, there are elongated, spindle-shaped melanocytes containing melanin granules.
DR .: Hard fibroma, neurofi broma, neurilemmoma, metastasis of malignant melanoma to the subcutaneous tissue.
Treatment: Observation or surgical removal of the lesion is indicated.
FIGURE 22.14. The birthmark is blue
Mongolian stain
Syn.: Macula mongolica, mongolian spot.
Def .: Blue or gray-blue diffuse skin discoloration located in the sacro-caudal area.
Epid .: It occurs mainly in children of colored races (in Asians and Latinos – over 90%) and in approx. 10% of white children. It usually disappears within 3-4 years after birth, sometimes it persists into middle age.
Loc .: The sacrum-caudal area.
Clinical: Blue or gray-blue discoloration in the sacro-caudal area.
Hist .: Dendritic cells containing melanin, sometimes melanophores in the dermis.
DR .: Cavernous hemangioma.
But .: It is not necessary because the change does not malignantly transform.
The birthmark of Ota
Syn.: Dark brown-coeruleus ophthalmo-maxillary Ota, oculodermal melanocytosis.
Def .: The most common one-sided bluish or brown spots on the face can include the sclera, conjunctiva, cornea and retina of the eye, nasal and oral mucosa.
Epid .: The birthmark of Ota occurs primarily in people of the Asian race. The K: M ratio is 3: 1. The changes appear shortly after birth or during puberty and hormonal changes.
Etiol .: The appearance of an Ota nevus is influenced by hormonal changes (puberty, pregnancy, menstruation).
Locality: The areas of the skin supplied by the first and second branches of the fifth cranial nerve: the temporal, orbital, zygomatic and frontal areas of the facial skin.
Clinical: Bluish or brown spots located in the temporal, orbital, zygomatic and frontal areas of the face. The spots are characterized by irregular demarcation and sometimes the presence of satellites. They can include the sclera, conjunctiva, cornea and retina of the eye, nasal and oral mucosa. The changes are most often one-sided.
Hist .: Elongated, dendritic melanocytes located between the collagen fibers of the upper reticulate layer of the dermis.
DR .: Cavernous hemangioma.
Heal: Observation, laser therapy, cosmetic camouflage.
Ito’s Mark
Syn.: Naevus fusco-coeruleus deltoidemacromialis, deltoideoacromial melanocytosis.
Def .: Bluish or brown spots located in the supraclavicular area and in the area of the shoulder blades and nape.
Etiol .: Similar to the Ota birthmark.
Loc .: Supraclavicular area, neck and shoulder blades.
Clinical: Blue or brown patches occupying the supraclavicular area, the area of the shoulder blades and the nape of the neck.
Hist .: Similar to the birthmark of Ota.
DR .: Vascular changes in the subcutaneous tissue.
But .: Not necessary.
Lentil stain
Syn.: Lentigo simplex.
Def .: A small, flat, well-demarcated brown spot that may be the first stage in the development of a melanocytic nevus.
Epid .: A small number of lentil spots occur in almost all people.
Etiol .: Seed changes may occur in children as a result of immune disorders, iatrogenic immunosuppression, and sometimes due to sunburn.
Clinical: Flat brown spots the size of a lentil grain.
Hist .: There is an increased number of normal melanocytes in the basal layer of the epidermis.
DR .: Melanocytic nevus (connecting nevus).
But: Diagnostic excision (histopathology) in case of suspected malignant transformation.
Clark’s mark
Def .: Slightly raised, mild pigmented nevus with a smooth or slightly papillary surface.
Etiol .: The formation of the Clark’s birthmark is genetically determined. In addition, the etiology takes into account hormonal factors and intense exposure to ultraviolet radiation.
Clinical: Slightly raised, smooth or slightly papillary pigmented lesion.
Hist .: Melanocytes located on the dermal-epidermal border and in the upper layers of the dermis.
DR .: Seborrheic wart, malignant melanoma.
But: Diagnostic excision (histopathology) in case of suspected malignant transformation.
Miescher’s birthmark
Def .: Mild, nodular, slightly pigmented lesion with a broad base, usually located on the skin of the face.
Etiol .: The formation of Miescher’s birthmark is genetically determined.
Loc .: The skin of the face.
Clinical: Lumpy, slightly pigmented lesion with a broad base and a smooth surface.
Hist .: Melanocytes located on the dermal-epidermal border and in the upper layers of the dermis.
DR .: Spitz birthmark, amelanotic melanoma, fibroma.
But: Diagnostic excision (histopathology) in case of suspected malignant transformation.
The mark of Unna
Def .: Mild, highly pigmented papillary nevus, most often located on the skin of the torso.
Etiol .: The formation of the Unna birthmark is genetically determined.
Lok .: First of all, the skin of the torso.
Clinical: Strongly pigmented, papillary birthmark, which may resemble a seborrheic wart, most often located on the skin of the trunk.
Hist .: Melanocytes are located on the dermal-epidermal border and in the upper layers of the skin.
DR .: Seborrheic wart, malignant melanoma.
Treat: In case of irritation or mechanical trauma of the nevus, remove it for prophylactic indications.
The mark of Spitz (Fig. 22.15)
Syn.: Melanoma juvenile, spindle and epithelioid cell nevus.
Def .: Mild, single, flat, brown-red lump, most common on the face in children and adolescents.
Epid .: The birthmark occurs primarily in children, and also in 25% of cases in people over 30 years of age.
Etiol .: Presumably, the Spitz nevus is an acquired nevus, although it may be associated with many other congenital disorders.
Loc .: The skin of the face.
Clinical: A single, well-defined nodule with a smooth surface and a red or bluish color. Multiple telangiectasias often appear on the surface of the nodule. The lesion is not prone to decay and inflammation.
Hist .: There are single, large, spindle-shaped melanocytes or melanocytes arranged in nests at the border of the skin and epidermis. Cells have large nuclei with few and normal patterns of division. There is no cellular atypia.
DR .: Malignant melanoma, other pigmented nevus, hemangioma, hard fibroma.
Treatment: Diagnostic excision (histopathology) with a minimal margin of healthy tissues.
FIGURE 22.15. The mark of Spitz
Birthmarks (Fig. 22.16)
Syn .: Hairy birthmark, giant birthmark, bathing birthmark.
Def .: Melanocytic nevus, often large in size and covered with terminal hair, already present at birth.
Epid .: Birthmarks are rare, in about 1% of newborns. Giant birthmarks appear with a frequency of 1: 5000- 1: 20 births.
Etiol .: Unknown. Birthmarks probably arise as a result of disturbed migration of melanocytes from the nerve crest cells during embryonic development.
FIGURE 22.16. Massive birthmark
Clinical: A birthmark is characterized by a varied clinical picture, ranging in size from a few millimeters to the size of the entire skin surface. It is usually recognized at birth, but may also appear later – in infancy. Most of the birthmarks are covered with terminal hairs, although hairless changes are also found. Most moles are dark in color, with a warty surface and an oval shape. Depending on their size, birthmarks are divided into: small (up to 1,5 cm in diameter), medium (1,5 cm to 20 cm in diameter) and large (over 20 cm in diameter). Large nevi in approx. 6-15% of cases can undergo neoplastic transformation into malignant melanoma. Moreover, the presence of large birthmarks may be related to the presence of congenital diseases and syndromes (neurofibromatosis type I, neurocutaneous melanosis).
Hist .: The skin and skin appendages contain melanocytic cells and a large number of terminal hairs.
DR. Coffee-milk-colored spots, epidermal nevi, flat nevus, acquired melanocytic nevus.
Treat: Surgical (risk of developing malignant melanoma). The birthmark is removed in stages; expanders, free skin grafts or flap plasty are used.
Flat birthmark
Syn.: Naevus spilus.
Def .: Mild pigmentary lesion with little risk of conversion to melanoma. It has the form of a large, light brown discoloration, with numerous small, dark papules and nodules dispersed within it.
Epid .: At birth, usually only a light brown spot is observed, dark spots appear later.
Etiol .: The formation of a flat nevus is genetically determined.
Loc .: Usually the skin of the torso.
Clinical: Flat birthmark has the appearance of a coffee-milk-colored spot with numerous small speckled birthmarks.
Hist .: The histological picture is heterogeneous: features of connecting, complex and Spitz nevi are observed.
DR .: Malignant melanoma.
But: Doesn’t require treatment. If the appearance of the mole changes, a biopsy should be taken to rule out malignant growth.
Birthmark with discoloration (Fig. 22.17)
Syn .: Sutton’s birthmark, halo-halo naevi birthmark, vitiligo.
Def .: Pigmented nevus surrounded by a characteristic white border, most often regressing. Among the moles with discoloration, two varieties are distinguished: inflammatory and non-inflammatory. Only inflammatory changes undergo spontaneous regression.
Epid .: The birthmark most often occurs in young people, often in children with multiple birthmarks. Sometimes the appearance of a halo nevus is preceded by a sunburn. Changes of this type are frequent in patients with vitiligo and in patients with metastases in the course of malignant melanoma.
Etiol .: The etiology takes into account the involvement of immunological mechanisms. The destruction of the melanocytes of the nevus and its surroundings occurs as a result of the accumulation of lymphocytes and the following immune reactions.
Loc .: Most often the skin of the back.
FIGURE 22.17. Birthmark with discoloration
Clinical: Usually a single birthmark surrounded by an area of discoloration. The birthmark may fade over time, but the area of discoloration may re-pigment over time.
Hist .: In the inflammatory variant, the dermis has an infiltration of lymphoid cells and macrophages. Melanocyte nests are scattered and damaged.
DR .: Malignant melanoma with regression features.
Heal: A halo birthmark does not require treatment. Prophylactic removal is necessary when in doubt about the nature of the melanocytic lesion.
Dysplastic moles
Syn.: Dysplastic naevi.
Def .: Acquired melanocytic nevi, usually flat, characterized by atypia in the clinical picture and a characteristic histopathological picture. The presence of several atypical nevi (10-100) among numerous common melanocytic nevi is referred to as the dysplastic (atypical) nevus syndrome.
Epid .: A single dysplastic nevus occurs in about 60-90% of the population. The number of moles usually increases during puberty, during pregnancy, or with excessive exposure to sunlight or in the course of immunosuppression. The syndrome of dysplastic nevi is, in turn, a rare unit.
Etiol .: Multifactorial inheritance caused by many genes seems to be probable.
Lok .: First of all, the torso.
Clinical: Usually flat, dark lesions from a few to several millimeters in diameter. They are characterized by an asymmetrical shape, irregular edges, heterogeneous pigmentation (from light to black-brown) and variable dynamics of development. In addition, they may be slightly convex or have a warty surface. In some cases, there are areas of regression or peripheral redness. On the basis of a dysplastic nevus, melanoma may develop.
Hist .: Nests of melanocytes spread beyond the boundaries of the main part of the nevus. In addition, there is an increase in the number of melanocytes in the connecting zone, with a tendency to spread towards the stratum corneum. There is a frequent development of fibrosis in the papillary layer with a lymphocytic reaction. Sometimes there is increased vessel formation.
DR .: Malignant melanoma.
But: If a malignant transformation is suspected, a diagnostic excision of the nevus. Regular observation of dysplastic moles with a dermoscope or videodermatoscope is necessary – at six-month intervals. In addition, photoprotection and self-control should be used.
LITERATURE:
1. Habif T.P.: Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed, Mosby, Philadelphia 2003.
2. Jabłońska S .: Skin diseases, vol. 1-2, PZWL, Warsaw 1973.
3. Jabłońska S., Chorzelski T .: Histopathology of the skin, PZWL, Warsaw 1965.
4. Mallory SB, Bree A., Chern P .: Pediatric dermatology – diagnosis and treatment, ed. half. Kaszuba A., Czelej Publishing House, Lublin 2007.
5. McKee PH: Atlas of skin pathology, ed. Omulecki A., Wydawnictwo Elsevier Urban & Partner, Wrocław 2003.
6. Du Vivier A .: Atlas of clinical dermatology, ed. half. Majewski S., Elsevier Urban & Partner Publishing House, Wrocław 2003.
7. Straszyński A .: Outline of dermatology and venereology, PZWL, Warsaw 1971.
8. Braun-Falco O., Plewig G., Wolff HH, Burgdorf WHC: Dermatology, eds. half. Gliński W., Wolska H., Wydawnictwo Czelej, Lublin 2004.
9. Th omas L., Braun RP: Atlas of dermoscopy, ed. half. Kaszuba A., Urban & Partner, Wrocław 2008.
Source: A. Kaszuba, Z. Adamski “Practitioner’s guide. Dermatology”; XNUMXst edition, Czelej Publishing House