Background. The term "clonal nevus" is used to describe a variant of melanocyt ic nevus that histologically exhibits a localized proliferation of pigmented epi thelioid dermal melanocytes within an otherwise...Background. The term "clonal nevus" is used to describe a variant of melanocyt ic nevus that histologically exhibits a localized proliferation of pigmented epi thelioid dermal melanocytes within an otherwise ordinary nevus (Ball NJ, Golitz LE. Melanocytic nevi with focal atypical epithelioid cell components:a review o f seventy-three cases. J Am Acad Dermatol 1994; 30:724-729). Reports to date have focused on the histologic appearance of these lesions. Aim. To characterize the clinical appearance of clonal nevi. Methods. Clinical and histologic examin ations were performed of a single clonal nevus from each of five patients (two m en and three women; age range, 37-80 years). Results. All nevi were round to ov al in shape with smooth, well-defined borders. They were uniformly tan to light brown in color, except for a single blue-gray to blue-black focus of hyperpig mentation. The diameters of the nevi ranged from 2.5 to 10 mm. In individual nev i, the hyperpigmented focus was either centrally or eccentrically located and me asured 1-2 mm in diameter. Histologically, these lesions showed banal melanocyt es associated with a localized proliferation of melanocytes with abundant pigmen ted cytoplasm in the dermis, admixed with melanophages. Conclusions. The appeara nce of clonal nevi-tan with a focus of blue-gray to blue-black pigmentation- allows one to recognize the lesion clinically.展开更多
Background: Because the early detection of cutaneous melanoma can dramatically improve survival, identification and surveillance of persons at risk have received much attention. Objective: Our purpose was to examine t...Background: Because the early detection of cutaneous melanoma can dramatically improve survival, identification and surveillance of persons at risk have received much attention. Objective: Our purpose was to examine the influences of personal or family history, patterns of detection, and prior skin biopsies (considered to be a measurement of surveillance by medical personnel) on the Breslow depth of cutaneous melanomas. Methods: A retrospective cohort analysis of 218 patients with a history of at least one invasive cutaneous melanoma who visited the Yale Pigmented Lesion Clinic between January 1995 and January 1996 was performed. Data on patterns of detection, melanocytic nevi, and skin biopsies before and after the initial diagnosis of melanoma were collected, and patients with a family history of melanoma were compared with sporadic patients. Results: Initial melanomas discovered by dermatologists were more likely to be 0.75 mm or less in depth than those found by other physicians (P=.03). Although patients detected 45% of the initial primary melanomas (98/218), dermatologists discovered 80% of the second primary tumors (33/41; P=.001). A personal history of melanoma was predictive of a thinner Breslow depth (P=.01), but a family history of melanoma was not. Having a biopsy of any type or combination of types of skin lesion(s) performed in the 5 years, 2 years, or 1 year before the first diagnosis of melanoma did not predict a melanoma of thinner Breslow depth among either familial or sporadic patients. The mean number of skin biopsies performed per patient was 8 times higher in the 5- year period after (5.6) versus the 5- year period before (0.7) the initial diagnosis of melanoma, with a peak in the first year after the diagnosis (2.3 vs 0.25 in the prior year). In 27 patients, one or more skin biopsies were performed in the year before the initial diagnosis of melanoma; 41% of these biopsies (23/56)were of lesions in normally exposed sites (eg, the face, neck, and forearms) compared with 22% of the melanomas (6/27). Limitations: Since an invasive melanoma (with the possible exception of a nodular melanoma) would likely have been present for at least a year, plausible explanations for why evidence of previous dermatologic care did not appear to result in earlier detection include performance of a limited rather than a total body skin examination as well as subtle clinical features of early melanomas. However, this study cannot give weight to these explanations because at the time new Pigmented Lesion Clinic patients were not routinely asked about previous total body skin examinations. Conclusions: The disappointing trends seen in this study, with neither the wellestablished risk factor of a family history of melanoma nor previously having a skin biopsy predicting thinner melanomas, highlight the need to establish criteria defining the subset of patients for whom appropriate management requires periodic total body skin examination.展开更多
文摘Background. The term "clonal nevus" is used to describe a variant of melanocyt ic nevus that histologically exhibits a localized proliferation of pigmented epi thelioid dermal melanocytes within an otherwise ordinary nevus (Ball NJ, Golitz LE. Melanocytic nevi with focal atypical epithelioid cell components:a review o f seventy-three cases. J Am Acad Dermatol 1994; 30:724-729). Reports to date have focused on the histologic appearance of these lesions. Aim. To characterize the clinical appearance of clonal nevi. Methods. Clinical and histologic examin ations were performed of a single clonal nevus from each of five patients (two m en and three women; age range, 37-80 years). Results. All nevi were round to ov al in shape with smooth, well-defined borders. They were uniformly tan to light brown in color, except for a single blue-gray to blue-black focus of hyperpig mentation. The diameters of the nevi ranged from 2.5 to 10 mm. In individual nev i, the hyperpigmented focus was either centrally or eccentrically located and me asured 1-2 mm in diameter. Histologically, these lesions showed banal melanocyt es associated with a localized proliferation of melanocytes with abundant pigmen ted cytoplasm in the dermis, admixed with melanophages. Conclusions. The appeara nce of clonal nevi-tan with a focus of blue-gray to blue-black pigmentation- allows one to recognize the lesion clinically.
文摘Background: Because the early detection of cutaneous melanoma can dramatically improve survival, identification and surveillance of persons at risk have received much attention. Objective: Our purpose was to examine the influences of personal or family history, patterns of detection, and prior skin biopsies (considered to be a measurement of surveillance by medical personnel) on the Breslow depth of cutaneous melanomas. Methods: A retrospective cohort analysis of 218 patients with a history of at least one invasive cutaneous melanoma who visited the Yale Pigmented Lesion Clinic between January 1995 and January 1996 was performed. Data on patterns of detection, melanocytic nevi, and skin biopsies before and after the initial diagnosis of melanoma were collected, and patients with a family history of melanoma were compared with sporadic patients. Results: Initial melanomas discovered by dermatologists were more likely to be 0.75 mm or less in depth than those found by other physicians (P=.03). Although patients detected 45% of the initial primary melanomas (98/218), dermatologists discovered 80% of the second primary tumors (33/41; P=.001). A personal history of melanoma was predictive of a thinner Breslow depth (P=.01), but a family history of melanoma was not. Having a biopsy of any type or combination of types of skin lesion(s) performed in the 5 years, 2 years, or 1 year before the first diagnosis of melanoma did not predict a melanoma of thinner Breslow depth among either familial or sporadic patients. The mean number of skin biopsies performed per patient was 8 times higher in the 5- year period after (5.6) versus the 5- year period before (0.7) the initial diagnosis of melanoma, with a peak in the first year after the diagnosis (2.3 vs 0.25 in the prior year). In 27 patients, one or more skin biopsies were performed in the year before the initial diagnosis of melanoma; 41% of these biopsies (23/56)were of lesions in normally exposed sites (eg, the face, neck, and forearms) compared with 22% of the melanomas (6/27). Limitations: Since an invasive melanoma (with the possible exception of a nodular melanoma) would likely have been present for at least a year, plausible explanations for why evidence of previous dermatologic care did not appear to result in earlier detection include performance of a limited rather than a total body skin examination as well as subtle clinical features of early melanomas. However, this study cannot give weight to these explanations because at the time new Pigmented Lesion Clinic patients were not routinely asked about previous total body skin examinations. Conclusions: The disappointing trends seen in this study, with neither the wellestablished risk factor of a family history of melanoma nor previously having a skin biopsy predicting thinner melanomas, highlight the need to establish criteria defining the subset of patients for whom appropriate management requires periodic total body skin examination.
