0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Brief Report |

A Symmetric Eczematous Eruption Harboring Thousands of Melanocytic Lesions

Vladimir Ratushny, MD, PhD1; Stefan Kraft, MD2; Samuel L. Moschella, MD3; Lyn M. Duncan, MD2; Donald P. Lawrence, MD4; Hensin Tsao, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston
2Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
3Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
4Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital and Harvard Medical School, Boston
JAMA Dermatol. 2016;152(9):1021-1024. doi:10.1001/jamadermatol.2016.1150.
Text Size: A A A
Published online

Importance  The abrupt appearance of melanocytic lesions is a unique phenomenon that can occur in the setting of eruptive nevi or epidermotropic melanoma metastases.

Objective  To examine the immunohistochemical and genetic mutative features of a novel case of an eczematous reaction followed by the abrupt appearance of melanocytic lesions.

Design, Setting, and Participant  Case report of a 48-year-old woman with no significant medical history who first presented with an eczematous dermatitis on her torso, extremities, and buttocks and who subsequently developed thousands of pinpoint, histologically atypical melanocytic tumors and invasive melanoma within the areas of inflammation.

Main Outcomes and Measures  Immunohistochemical and mutational analyses of the patient’s melanocytic tumors were conducted.

Results  Mutational analysis of the pigmented lesions did not identify any activating mutations in BRAF, PTEN, NRAS, KRAS, and HRAS. Immunohistochemical analyses of 9 biopsied pigmented lesions all showed normal expression of the tumor suppressors p16 and PTEN and no expression of mutated BRAF V600E protein.

Conclusions and Relevance  To our knowledge, this is a previously unreported eruption comprising 2 distinct components: an eczematous reaction and a wave of melanocytic proliferations within the inflammatory regions. Possible explanations for this patient’s condition, include immune stimulation leading to nevogenesis, benign “nevic” metastases, eruptive nevi, and epidermotropic metastatic melanoma.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Clinical Findings of Case

A, Photograph of the patient’s back showing a well-delineated symmetric eczematous eruption harboring thousands of 2- to 3-mm melanocytic lesions. Note the close alliance between the inflammation and eruptive nevi. B, Close-up of right flank demonstrating the demarcation between affected and nonaffected skin. C, Ill-defined eczematous eruption on abdomen with pinpoint melanocytic lesions. D, Close-up of 1- to 3-mm pigmented papules.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Spectrum of Melanocytic Lesions

A-F, Original magnifications ×300. A, Moderately atypical compound melanocytic proliferation with chronic inflammation and melanophages (hematoxylin-eosin). B, Melanoma in situ with low-level pagetoid spread and chronic inflammation with melanophages. C, Severely atypical epidermal and dermal melanocytic proliferation. The cells show marked cytologic atypia and a lack of maturation in the dermal component, with occasional dermal mitoses (arrowhead). D, p16 Expression was retained in all lesions. E, PTEN expression was retained in all lesions. F, BRAF V600E staining was absent in all lesions.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

539 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();