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LETTERS TO EDITOR  
Year : 2018  |  Volume : 61  |  Issue : 1  |  Page : 155-156
An unusual presentation of multiple congenital melanocytic nevi with a whole-body distribution


Department of Plastic and Reconstructive Surgery, The First Bethune Hospital of Jilin University, Changchun, China

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Date of Web Publication22-Mar-2018
 

How to cite this article:
Liu HP, Zhang D. An unusual presentation of multiple congenital melanocytic nevi with a whole-body distribution. Indian J Pathol Microbiol 2018;61:155-6

How to cite this URL:
Liu HP, Zhang D. An unusual presentation of multiple congenital melanocytic nevi with a whole-body distribution. Indian J Pathol Microbiol [serial online] 2018 [cited 2021 Oct 28];61:155-6. Available from: https://www.ijpmonline.org/text.asp?2018/61/1/155/228173




Editor,

One of the most common skin lesions in children and adolescents is the congenital melanocytic nevus (CMN).[1] Most CMN is solitary with <5% being multiple.[2] The presence of numerous small and medium CMN with multifocal involvement is rare. Here, we report an unusual case of multiple small and medium size of CMN with a whole-body distribution.

A 5-year-old male child had multiple moles with the birth that were distributed throughout the whole-body surface. They had become more prominent as the child grew up, but their number remained unchanged. The family history was noncontributory.

On physical examination, multiple pigmented nevi were seen on the whole-body surface [Figure 1]. The lesions were of various sizes. They were irregular-shaped moles with black color. There is no clear boundary between the lesion and the surrounding skin. Details about the CMN larger than 3 mm are shown in [Table 1]. The nevi smaller than 3 mm were not counted. His neurological examination and ultrasound abdomen were all normal.
Figure 1: (a and b) Photograph of a patient presented with multiple congenital melanocytic nevi with a whole-body distribution (frontal and posterior view)

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Table 1: The numbers and the areas of distribution of the CMN larger than 3 mm

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At the parents' request, five nevi on the face were removed by excision that was performed under general anesthesia. Histopathological examination of the specimens showed pigmented cells in the junctional zone [Figure 2]. The child was kept under observation as an outpatient for 1 year. The skin lesions showed no remarkable change in size.
Figure 2: (a) Intradermal nevi with the nevus cells extending to the deep dermis and the upper subcutis (H and E, ×4) (b) Melanocytic nests of nevus cells at the dermoepidermal junction. Diffuse infiltrate of nevomelanocytes in the deep dermis (H and E, ×20)

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A CMN is defined as a melanocytic nevus present at birth or one which appears within first few months of life. Most CMN is solitary. The multiple CMN is more usually associated with a large. To the best of our knowledge, the whole-body surface distribution of multiple small and medium size of CMN seems to be unique.

CMN are commonly categorized according to size. Because of the Kopf et al.[3] classification's major limitations, here, a new size classification for CMN is proposed.[4] The proposed classification is as follows:

  • Small <1.5 cm
  • Medium 1.5–10 cm
  • Large 11–20 cm
  • Giant >20 cm.


According to the new size classification, in our case, there are 87 nevi in small size and 106 nevi in medium size. There are also numerous nevi smaller than 3 mm which cannot be accounted. Hence, many nevi with different sizes all presented in a child have never been report in the literature.

There is much written on the malignant potential and management of CMN. The risk for development of melanoma within small- and medium-sized CMN is controversial. A recent study of 351 patients with a large CMN found that individuals with more than 20 satellite nevi were fivefold more likely to have NCM than those with 20 or fewer satellite nevi (12.5% vs. 2.5%).[5] Fortunately, the child's neurological examination and ultrasound abdomen were all normal.

Treatment of this case is challenging. Total excision of so many nevi is apparently difficult and impractical. In our case, the specimen obtained by a partial excision might not be representative for total histopathological examination, and the patient was informed regular visits at least every 3 months.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lyon VB. Congenital melanocytic nevi. Pediatr Clin North Am 2010;57:1155-76.  Back to cited text no. 1
    
2.
Lin YT, Teng RJ, Chiu HC, Yau KI, Chang MH, Shan YZ, et al. An unusual presentation of multiple congenital melanocytic nevi with a limb distribution. Dermatology 1997;194:362-3.  Back to cited text no. 2
    
3.
Kopf AW, Bart RS, Hennessey P. Congenital nevocytic nevi and malignant melanomas. J Am Acad Dermatol 1979;1:123–130.  Back to cited text no. 3
    
4.
Ruiz-Maldonado R. Measuring congenital melanocytic nevi. Pediatr Dermatol 2004;21:178-9.  Back to cited text no. 4
    
5.
Marghoob AA, Dusza S, Oliveria S, Halpern AC. Number of satellite Nevi as a correlate for neurocutaneous melanocytosis in patients with large congenital melanocytic nevi. Arch Dermatol 2004;140:171-5.  Back to cited text no. 5
    

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Correspondence Address:
Duo Zhang
Department of Plastic and Reconstructive Surgery, The First Bethune Hospital of Jilin University, No. 71, Xin Min Street, Changchun 130021
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_477_16

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    Figures

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  [Table 1]



 

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