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Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 144-145

A young boy with brownish papules and plaque


1 Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Dermatology, College of Medicine and JNM Hospital, Kalyani, West Bengal, India
3 Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India

Date of Web Publication27-Mar-2017

Correspondence Address:
Anupam Das
“Prerana” 19, Phoolbagan, Kolkata - 700 086, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.184438

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How to cite this article:
Das A, Mondal A, Kumar P. A young boy with brownish papules and plaque. Indian J Paediatr Dermatol 2017;18:144-5

How to cite this URL:
Das A, Mondal A, Kumar P. A young boy with brownish papules and plaque. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 6];18:144-5. Available from: http://www.ijpd.in/text.asp?2017/18/2/144/184438

Sir,

A 9-year-old boy presented to us with few asymptomatic elevated skin lesions on the right flank for 7–8 months and on the face for 2 months [Figure 1]. Rest of the history was unremarkable. Cutaneous examination revealed solitary well-circumscribed brownish plaque over right flank and two similar brownish papules on the face. Plaque on flank was notable for wisp of hair coming out from its center. Rest of the cutaneous and systemic examination was noncontributory. Histological examination showed nests of melanocytes in the dermis, without any other significant alterations [Figure 2]. Based on the clinical and histological findings, a diagnosis of “acquired melanocytic nevus of intradermal type” was done.
Figure 1: Brownish plaque with wisp of hair on right flank (a) and brownish papules on face (b)

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Figure 2: Photomicrograph showing nests of melanocytes in the dermis, without any other significant alterations. (a) H and E, ×40 and (b) H and E, ×100)

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Melanocytic nevus, commonly known as mole, may be congenital or acquired. Acquired one usually develops in increasing numbers throughout childhood and early adulthood (particularly at puberty) and then slowly involutes. Genetic and environmental factors (especially sunlight) influence the development of these melanocytic nevi.[1] Acquired nevi are further classified into junctional (flat, uniformly pigmented, dark brown to black color), compound (elevated, lighter shade of brown), and intradermal (more elevated, pale brown, or even skin-colored) types.[2] The interest in these benign lesions lies in their relationship with melanoma as there is a small but definitive risk of development of melanoma in these lesions and hence, such cases should remain under follow-up and/or perform the regular self-examination. Immunohistochemical stains can be of great value in the diagnosis of a melanocytic neoplasm. S-100, MelanA/Mart-1 (A103), tyrosinase (T311), and microphthalmia transcription factor typically stain both the junctional and the dermal components of common acquired nevi, with sensitivities approaching 100%.[3] The clinical differentials in our case were dermatofibroma (painful nodule, dimple sign positive, histology showing nodular dermal proliferation of spindle-shaped fibroblasts and myofibroblasts), trichofolliculoma (wisp of hairs coming out of lesion, histology showing central patulous follicular infundibulum, from which fully formed follicles radiate) and leiomyoma (painful tumor and histology showing collection of fusiform myocytes).[4] These lesions do not require any treatment and can be smartly left over but a changing lesion suspicious of melanoma warrants surgical excision and histological workup.

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  References Top

1.
Kennedy C, Bajdik CD, Willemze R, De Gruijl FR, Bouwes Bavinck JN; Leiden Skin Cancer Study. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 2003;120:1087-93.  Back to cited text no. 1
    
2.
Chamlin SL, Williams ML. Pigmented lesions in adolescents. Adolesc Med 2001;12:v, 195-212.  Back to cited text no. 2
    
3.
Prieto VG, Shea CR. Use of immunohistochemistry in melanocytic lesions. J Cutan Pathol 2008;35 Suppl 2:1-10.  Back to cited text no. 3
    
4.
James WD, Elton DM, Berger TG. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. UK: Saunders Elsevier; 2011. p. 675-93.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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