Portal de Periódicos da CAPES

Bilateral nevus of Ito and nevus spilus in the same patient

2008; Elsevier BV; Volume: 59; Issue: 2 Linguagem: Inglês

10.1016/j.jaad.2008.03.011

1097-6787

Felicidade Trindade, Carlos Santonja, Luís Requena,

Skin and Cellular Biology Research

To the Editor: A 57-year-old Caucasian woman presented with a bilateral pigmented, gray-blue patch on her back. The hyperpigmentation appeared during puberty and was always asymptomatic. Physical examination revealed macular gray-blue hyperpigmentation on the right and left side of the back extending to the supraclavicular area and proximal upper aspect of arms clinically characteristic of nevus of Ito (Fig 1). The patient also had a congenital patch of hyperpigmentation containing darkly pigmented macules on the left lumbar area, consistent with a nevus spilus. Histologic examination from the bilateral gray-blue patch on her back showed normal epidermis and a few spindle-shaped melanocytes containing melanin, which were sparsely scattered between the collagen bundles in the mid dermis, whose axis were parallel to the skin surface (Fig 2). Fontana-Masson silver stain revealed abundant brown pigment within the cytoplasm of the spindle cells, which also showed immunoreactivity for S-100 protein, Melan-A, and HMB-45. Histopathologic examination from a café au lait–colored background pigmentation of the lumbar area containing darkly pigmented macules showed increased pigmentation in the basal layer of the epidermis, lentiginous epidermal hyperplasia, and an increased number of single melanocytes along the dermoepidermal junction. The final diagnosis was a bilateral nevus of Ito and a nevus spilus. The patient is being followed up annually without any evidence of systemic involvement. Nevus of Ito, nevus of Ota, and Mongolian spot are 3 variants of dermal melanocytoses and each of them can be distinguished by their clinical manifestations.1Stanford D.G. Georgouras K.E. Dermal melanocytosis: a clinical spectrum.Australas J Dermatol. 1996; 37: 19-25Crossref PubMed Scopus (50) Google Scholar In general they are rare in Caucasians. These dermal melanocytoses comprise a variety of congenital and acquired conditions characterized by a sparse population of intradermal dendritic, variably pigmented, spindle-shaped melanocytes.1Stanford D.G. Georgouras K.E. Dermal melanocytosis: a clinical spectrum.Australas J Dermatol. 1996; 37: 19-25Crossref PubMed Scopus (50) Google Scholar More than 50% of nevi of Ota and Ito are present at birth, and most of the remaining appear around puberty.2Mataix J. López N. Haro R. González E. Angulo J. Requena L. Late-onset Ito's nevus: an uncommon acquired dermal melanocytosis.J Cutan Pathol. 2007; 34: 640-643Crossref PubMed Scopus (33) Google Scholar Nevus of Ito is a dermal melanocytosis that usually presents as a unilateral blue, gray, or brown patch.3Mishima Y. Mevorah B. Nevus Ota and nevus Ito in American Negroes.J Invest Dermatol. 1961; 36: 133-154PubMed Scopus (72) Google Scholar It has the same features of Ota's nevus except that it occurs in the distribution of the posterior supraclavicular and lateral cutaneous brachial nerves, to involve the shoulder, side of the neck, and supraclavicular areas.2Mataix J. López N. Haro R. González E. Angulo J. Requena L. Late-onset Ito's nevus: an uncommon acquired dermal melanocytosis.J Cutan Pathol. 2007; 34: 640-643Crossref PubMed Scopus (33) Google Scholar Nevus of Ito is usually asymptomatic and causes little cosmetic concern to patients. Bilateral nevus of Ito has been reported by Kim et al4Kim B.H. Oh Y.J. Lee K.W. Houh W. Bilateral Ota nevus and bilateral Ito nevus: 2 cases of extensive dermal melanocytic nevi associated with vascular nevus.Korean J Dermatol. 1981; 19: 503-507Google Scholar in two female patients, aged 15 and 24 years, who presented with bilateral nevi of Ota, bilateral nevus of Ito, and nevus anemicus. Speckled lentiginous nevus or nevus spilus is a clinicopathologic variant of congenital melanocytic nevus presenting as a variable number of black, brown, or red-brown macules and papules within a patch of tan-to-brown hyperpigmentation. The lesions are present at birth or noted during the first years of life. In its earliest stage, it can be confused with a café au lait macule. The trunk is the most common site of occurrence. Histopathologically, nevus spilus is usually characterized by a lentiginous hyperplasia of single melanocytes along dermoepidermal junction in the café au lait areas, whereas the scattered pigmented papules show features of superficial congenital melanocytic nevus. In our case, the biopsy specimen was taken from café au lait–colored background pigmentation and for that reason histopathologic study showed only a proliferation of epithelioid melanocytes arranged as single units along the dermoepidermal junction of a lentiginous epidermis.5Weedon D. Speckled lentiginous nevus (nevus spilus).in: Skin pathology. 2nd ed. Churchill Livingstone, London2002: 805-806Google Scholar We emphasize this case because the bilateral nevus of Ito is an extremely rare pathology in Caucasian individuals and to our knowledge the association with a nevus spilus has never been reported.