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Correspondence |

Anatomic Transitions and the Histopathologic Features of Melanocytic Nevi

Toshiaki Saida, MD, PhD; Shigeo Kawachi, MD, PhD; Hiroshi Koga, MD
Arch Dermatol. 2008;144(9):1232-1233. doi:10.1001/archderm.144.9.1232.
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In their letter, Braun et al1 reported a case of an acral melanocytic lesion that exhibited a completely benign dermoscopic pattern but was histopathologically diagnosed as melanoma in situ. As previously noted,2 despite benign clinical features, melanocytic nevi located in transition sites between glabrous and nonglabrous skin and in interdigital areas often histopathologically exhibit a random, irregular distribution of melanocytes as solitary units and in nests within the epidermis (Figure). The lesion described by Braun et al1 may be such a case. At first, we diagnosed these cases as malignant melanoma. Later, we noticed that most of melanocytic lesions affecting these anatomic sites showed a random, irregular distribution of melanocytes as solitary units and in nests within the epidermis. Noteworthy is that most patients with this presentation were young, ranging in age from 10 to 30 years. Malignant melanomas on acral skin mostly affect older persons. Furthermore, most of the lesions were clinically benign: small and regular in color (unpublished data, 2007), though some were larger, as in the case reported by Braun et al.1 These findings prompted us to consider that these lesions were not melanomas but rather melanocytic nevi. And now we believe that most melanocytic nevi located on the transition areas show histopathologic features mimicking those of malignant melanoma.

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Figure.

Clinical and histopathologic features of a melanocytic nevus located on a transition area (the fourth interdigital area of the right foot) of a 23-year-old woman. A, This brownish black macule, 5 mm in diameter, shows virtually no irregularity in shape or color. B-D, In all of the histopathologic photographs (hematoxylin-eosin), we see that melanocytes proliferate mainly as solitary units within the epidermis, and many of them are situated above the dermoepidermal junction, mimicking histopathologic features of melanoma in situ. However, overall distribution of melanocytes within the lesion is mostly symmetrical and orderly. The nuclei of melanocytes are relatively large but not hyperchromatic; instead, they are vesicular. In addition, there is virtually no inflammatory cell infiltrate in the dermis. The original magnifications are ×12, ×38, and ×84 for panels B, C, and D, respectively.

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