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PubMed2006

Primary acquired melanosis of the conjunctiva.

BACKGROUND: Primary acquired melanosis (PAM) presents as a unilateral patchy area of conjunctival pigmentation mostly found in middle-aged or elderly white patients. Because PAM has the potential of becoming malignant, it is important to recognize PAM and to rule out other causes of pigmented lesions. The presence or absence of atypia is helpful in determining the potential for malignancy, because PAM without atypia is usually benign, whereas PAM with atypia may convert into a conjunctival melanoma. If atypia is present, the presence or absence of epithelioid cells and the pattern of intraepithelial growth are the main factors in determining the likelihood of neoplastic transformation. However, atypia can only be determined with histopathologic examination. Therefore, a biopsy is usually recommended. CASE REPORT: A 72-year-old white man presented for his annual examination with no visual complaints. His ocular history was remarkable for early cataracts and for a choroidal nevus. Slit lamp examination found a large dark area of elevated conjunctival pigmentation at the medial canthus that extended onto the superior bulbar conjunctiva and superior palpebral conjunctiva in the left eye. No conjunctival pigmentation had been noted previously. Results of a biopsy indicated primary acquired melanosis with atypia. The lesion was surgically excised, and the conjunctiva was reconstructed with an amniotic membrane graft. The patient was subsequently treated with topical 5-fluorouracil chemotherapy. There have been no signs of recurrence to date after his treatment. CONCLUSION: Because of the potential for malignancy, biopsies of all cases of primary acquired melanosis are indicated. If atypia is present, treatment options include local excision, cryotherapy, and topical chemotherapy.

Aged↗
PubMed1980

Idiopathic acquired melanosis.

Acquired melanosis is the clinical term used to describe a slowly enlarging, diffusely pigmented lesion of the conjunctiva which may also involve the lids, caruncle or cornea. The controversial histologic classifications are reviewed and suggestions made regarding useful and accurate terminology. In acquired melanosis, development of malignant melanoma may occur. Previous work indicates that the prognosis of the resulting melanoma may be assessed by histopathologic staging as is done in cutaneous melanoma. The suggested management of acquired melanosis is close observation with excisional biopsies of areas clinically suggestive of invasive melanomas. Examination of the entire biopsy by serial or staged sections is essential for accurate histopathologic diagnosis. Invasive melanomas have been conventionally treated by local excision or exenteration. Radiation therapy may be a beneficial adjunct.

Adult↗
PubMed1986

Congenital neurocutaneous melanosis with metastatic orbital malignant melanoma.

Proptosis and ptosis, caused by a large orbital mass that was excised and determined to be malignant melanoma, developed in a 4-year-old girl with congenital neurocutaneous melanosis (multiple large or giant cutaneous nevi associated with abnormal leptomeningeal pigmentation). Shortly thereafter, the patient had evidence suggestive of systemic metastases and died. The orbital tumor was likely metastatic from a primary meningeal melanoma. Other possible sources of metastatic tumor are discussed. It is unlikely that this was a primary orbital melanoma because the patient had no clinical or pathologic manifestations of pre-existing oculocutaneous melanosis, orbital melanosis, or orbital blue nevus.

Biopsy↗
PubMed1983

Becker's melanosis: associated abnormalities.

Becker's melanosis is a distinct clinical entity. We report herein two cases with extensive lesions accompanied by subjacent and distant soft tissue and bony abnormalities. Review of the world's literature reveals several additional cases of structural abnormalities associated with Becker's melanosis. Rather than just a dermatologic curiosity, Becker's melanosis may be a marker for underlying structural anomalies.

Acanthosis Nigricans↗
PubMed1989

Generalized melanosis in occult primary melanoma.

Once encountered, generalized melanosis as a consequence of disseminated melanoma is not easily forgotten. Cases in the literature usually have resulted from primary cutaneous melanoma. A case of generalized melanosis caused by an occult primary melanoma is reported in a patient who originally complained of increased pigmentation. Findings of light microscopic studies of involved skin, pathogenesis of generalized melanosis, and possible sites of origin of the primary neoplasm are discussed.

Adult↗
PubMed1989

Penile melanosis.

Five patients with penile melanosis are described. The lesions consisted of macular hyperpigmentation of the penile shaft and/or glans. Histologically only hyperpigmentation of the basal cell layer was observed with no melanocytic hyperplasia. Patients had follow-up for 3 to 13 years; enlargement of some lesions was observed, but the condition remained benign. The main differential diagnostic problem was with acral lentiginous melanoma. Penile melanosis shares clinical and microscopic features with Laugier-Hunziker syndrome of the buccal mucosa and vulvovaginal melanosis. We suggest that the three disorders be grouped as essential melanotic hyperpigmentation of mucosa.

Adolescent↗
PubMed1996

Generalized melanosis caused by melanoma of the rectum.

Only 29 cases of generalized melanosis caused by melanoma have been described in the English-language literature since the beginning of this century. This is the first reported case in which the primary site of melanoma was the mucosal surface of the rectum and melanosis was a presenting sign of the disease. Generalized melanosis carries a dismal prognosis; none of the reported patients lived beyond 1 year after the onset of pigmentation.

Fatal Outcome↗
PubMed2002

Elemental sulphur and alkali elutable melanin detected in oral melanosis and malignant melanoma by energy-filtering transmission electron microscopy.

BACKGROUND: The morphology and contents of melanosomes are important features for differentiating melanocyte-derived melanotic lesions such as melanosis and malignant melanoma. METHODS: In this study, we attempted to elucidate the structure of melanin and sulphur content in oral melanosis and malignant melanomas by ultrastructural analysis. RESULTS: In oral melanosis, the essential pathological findings were overproduction of eumelanin and discharge of melanin into keratinocytes. In malignant melanoma in situ, pleomorphic and ellipsoid abnormal melanosomes with an increase in sulphur content and alkali elution rate were detected. In invasive malignant melanoma, the irregular ellipsoid and spheroid melanosomes existing either as discrete bodies or compound melanosomes with furtherly increased sulphur content and alkali elution were detected. CONCLUSIONS: Our findings suggest that abnormal melanosome morphology and high sulphur content are predictive markers for assessment of early or precancerous melanotic lesions and malignant melanoma.

Alkalies↗
PubMed1997

Melanosis of the appendix: prevalence, distribution and review of the pathogenesis of 47 cases.

The appendix is reported to be a common site for melanosis, especially at autopsy although to date there have been few studies expanding or qualifying this statement. Based on 47 cases identified from a series of 636 consecutive surgical specimens the prevalence, pattern of distribution, nature of the pigment and current knowledge of the aetiology and pathogenesis of melanosis of the appendix is reviewed and compared with melanosis coli.

Adult↗
PubMed1985

[Treatment of primary acquired melanosis of the conjunctiva].

The progression to malignancy of primary acquired melanosis of the conjunctiva with cytologic atypia is often insidious and may not be recognized clinically. Because of the bad prognosis of such melanomas, destruction of the intraepithelial lesion has been recommended. We have been freezing proliferative melanosis with the aid of a cryoprobe. A double freeze-thaw cycle at -70 degrees to -80 degrees was sufficient to destroy the epithelium and eradicate atypical melanocytes without serious complications. Focal nodules, arising in acquired melanosis representing invasive melanomas, however, should be excised initially. Cryotherapy may then be applied to the base and surroundings of the tumor.

Adult↗
PubMed1985

Melanosis of the vulva. A clinical simulator of malignant melanoma.

Eight patients with melanosis of the vulva are presented in order to illustrate the characteristic clinical and histopathologic features of the condition. Despite clinical features that may be indistinguishable from those of malignant melanoma, the patchy pigmentation of melanosis that is seen mostly on the vulva, but also on the penis, shows wholly different histologic changes than those of melanoma, namely, a slightly increased number of typical melanocytes arranged as solitary units at the dermal-epidermal junction of a hyperpigmented epidermis. It is important to identify melanosis of the vulva for what it is, because overdiagnosis of it as malignant melanoma may result in needless radical surgery.

Adult↗
PubMed2004

Diffuse melanosis after chemotherapy-induced tumor lysis syndrome in a patient with metastatic melanoma.

Diffuse melanosis is a rare event associated with advanced metastatic malignant melanoma. A 35-year-old woman with stage IV melanoma is presented, who developed slate bluish-gray to brown discoloration of her skin after chemotherapy-induced tumor lysis syndrome. A number of studies were performed to re-evaluate possible mechanisms of melanosis. Skin tissue was examined on routine hematoxylin-and-eosin-stained sections, Fontana stains, immunohistochemical studies with antibodies for Melan-A, gp100, tyrosinase, FXIIIa, and CD68, and by electron microscopy. The main cell types found to contain melanin pigment were histiocytes and dendritic cells. In the dermis, they were distributed mainly around venules. In the subcutaneous fat, they were scattered throughout the fat lobule. Melanin pigment was not only seen within cells but also extracellularly. No melanoma cells were seen in the skin. No increase in melanin pigment or number of melanocytes was seen in the epidermis. A bone marrow biopsy contained melanophages but no melanoma cells. Ultrastructural examination of the patient's serum revealed the presence of melanosomes. Sequence analysis of the tumor's cDNA failed to identify any mutations in the tyrosinase gene, and no tyrosinase protein was detected in non-melanocytic cells, indicating that it was unlikely that a mutation had resulted in a secretory form of the protein. These findings document that diffuse melanosis may result from tumor lysis, with release of melanosomes into the bloodstream.

Adult↗
PubMed1996

Successful treatment of mucosal melanosis of the lip with normal pulsed ruby laser.

Melanosis of the lip is not rare in Orientals. Although it causes cosmetic problems, treatment of this pigmentary disorder is often neglected because a satisfactory tool for complete removal of mucosal melanosis has not yet been developed. The pulsed ruby laser, which has a wavelength of 694 nm and a short pulse duration of 1-2 msec, selectively damages pigmented cells in the skin. In this study, six Japanese patients with labial melanosis, manifested as labial lentigo and Peutz-Jeghers syndrome, were successfully treated with the pulsed ruby laser. The therapy achieved rapid results without producing changes in mucosal texture or recurrence after operation.

Adolescent↗
PubMed1982

Riehl's melanosis.

In Riehl's melanosis, first observed in 1917, facial hyperpigmentation, most pronounced on the forehead and in the zygomatic and/or temporal regions is the dominant symptom. Riehl could find no explanation for the condition, but suggested that certain foods used during the war could be responsible. Riehl's melanosis has later been observed in dark-complexioned people in whom hyperpigmentation with pigment incontinence may be the main sign of contact dermatitis caused by certain allergens. Riehl's melanosis is today almost synonymous with pigmented contact dermatitis of the face. The commonest cause has been sensitizing chemicals in cosmetics.

Cosmetics↗
PubMed2005

Becker's melanosis: a report of 12 cases with atypical presentation.

Becker's melanosis is a distinct clinical entity. It usually presents in adolescence as a unilateral, hyperpigmented, hairy cutaneous hamartoma. We report herein 12 cases of Becker's melanosis that differ in their presentation from classical Becker's melanosis, and we believe that such presentations are not uncommon.

Adolescent↗
PubMed1989

Familial iris melanosis--a misnomer?

Iris melanosis is an unusual condition characterised by the presence of minute, discrete, pigmented elevations arising from the anterior surface of the iris. We encountered two unrelated Mexican families in which all children, but no parent, had varying degrees of the condition bilaterally. Some family members also gave findings suggestive of ocular hypertension. No family member had any other ocular or cutaneous pigmentary changes with the exception of a hairy naevus on the thigh of one member. To our knowledge these are the first families reported with more than one member having isolated iris melanosis. This is also the first report of a possible relationship with ocular hypertension. Finally we suggest that the term 'melanosis' may be a misnomer, since the condition is characterised not by abnormal iris hyperpigmentation but by discrete, round elevations on the anterior iris surface.

Adolescent↗
PubMed1990

Guttate psoriasis sparing Becker's melanosis--a case report.

A young man with Becker's melanosis developed typical guttate psoriasis following an attack of tonsillitis. The psoriatic lesions spared the area of melanosis, suggesting that there may be local factors within an area of Becker's melanosis which inhibit the development of psoriasis.

Adolescent↗
PubMed2004

Melanosis coli involving pericolonic lymph nodes associated with the herbal laxative Swiss Kriss: a rare and incidental finding in a patient with colonic adenocarcinoma.

Melanosis coli is a well-known condition in which macrophages filled with a lipofuscin-like pigment are found in the colonic lamina propria. The condition has been associated with the ingestion of anthracene laxatives and is believed to be caused by increased epithelial apoptosis. Although melanosis coli is a frequent finding in colonic biopsies and resection specimens, to our knowledge the presence of identical pigment in macrophages of pericolonic lymph nodes has been reported in only 4 other patients in the English literature. We report the case of a patient who underwent a left hemicolectomy for colonic adenocarcinoma and was found incidentally to have melanosis coli associated with long-term use of the herbal laxative Swiss Kriss, not only in his colonic mucosa, but also in the colonic submucosa and in his pericolonic lymph nodes.

Adenocarcinoma↗