Combined nevi are melanocytic lesions composed of two or more distinct types of melanocytic populations within the same lesion. Different types of combined nevi may form bizarrely shaped, multicolored skin lesions, making them one of the greatest melanoma mimickers. We report a 48-year-old female patient with suspicious skin lesion in the left lumbar region. Clinically, there was an oval, slightly asymmetrical lesion measuring 6 x 4 mm, showing multiple colors and shades of brown and black. A dermoscopic examination revealed a brown-bluish coloration in the right part of the lesion, while a fine pigment network with perifollicular halo was found in the left part of the lesion, suggesting the diagnosis of a combined nevus. Histological examination showed a poorly circumscribed proliferation of dendritic melanocytes in the superficial and deep dermis and proliferation of melanocytes in the dermoepidermal junction. A surgical excision of the tumor was performed, in order to confirm the dermoscopic findings. In conclusion, dermoscopy is useful in differentiating combined nevi from other melanocytic lesions.
Danijela Popović, Andrija Jović, Danica Tiodorović, Nataša Vidović and Ivana Graovac
Basal cell carcinoma (BCC) is the most common type of skin cancer and the most common type of tumor in the human population in general. Clinical variants of BCC include nodular, superficial, pigmented, morpheaform, cystic, metatypical types and fibroepithelioma of Pinkus. Giant BCC is a rare type of carcinoma, accounting for less than 1% of all cases of BCC. Most often they occur on the trunk. BCC belongs to the group of aggressive tumors, leading to the invasion of deeper tissues, and examples of metastasis of this type of tumor can be found in the reference literature. In this case report, we present a case of a 76-year-old female patient with a giant ulcerous form of basal cell carcinoma on the back.
Vuka Katić, Danijela Radojković, Zoran Radovanović, Ivan Nagorni, Andrija Jović and Maja Nedić
Papillary carcinoma of the breast is an extremely rare form of breast carcinoma in males. We report a case of an 83-year-old man who presented with a retroareolar palpable mass, associated with bloody nipple discharge. Cytological characteristics were rare clusters and papillary formations with enlarged hyperchromatic nuclei, surrounded by erythrocytes. Having in mind that a reliable cytological diagnosis of papillary carcinoma cannot be made and that all papillary lesions observed in cytological material should be excised for histological examination, breast conserving surgery (BCS) was performed.
Histologically, cystic ducts were lined with atypical papillary formations bridging the duct lumen, but with the absence of both myoepithelial cells and stromal invasion. Prolactin and testosterone serum levels were decreased. Immunohistochemical examination on actin, estrogen and progesteron receptors was negative.
The authors have pointed out that the patient had left orchiectomy, induced by tuberculous orchiepididymitis with scrotal fistula, performed thirty years before. Twelve months after breast conserving surgery, the patient is still alive.
Danica Tiodorović, Andrija Jović, Danijela Popović, Hristina Kocić, Aleksandra Ignjatović, Jovana Antonijević and Filip Veličković
The aim of this study was to analyze the dermoscopic features in patients with pathohistologically confirmed basal cell carcinoma (BCC). Our retrospective study included 54 patients with 76 BCCs in total, diagnosed in 2016 and 2017. All lesions were classified into four clinical types: nodular, pigmented, superficial and infiltrative. Digital dermoscopic images were evaluated by three observers. We selected five dermoscopic features for analysis, including: the absence of pigment network, the presence of arborizing vessels, blue-gray globules and ovoid nests, leaf-like areas and ulcerations. In the total of 54 patients, there were 22 females and 32 males. At the moment of establishing the diagnosis, the patients’ age was in the range from 31 to 84 years (median age 67 years). The most frequent clinical type was the nodular type with 28 confirmed diagnoses. Nodular BCC was more frequently localized on the head and neck areas compared to the trunk and limbs (p < 0.01). Dermoscopically, the absence of pigmented network was verified in all cases. Arborizing vessels were present in 71 (93.4%) lesions, blue-gray globules and ovoid nests in 33 (42.1%), ulcerations in 44 (57.9%), and leaf-like areas in 5 (6.6%) lesions. Blue-gray globules and ovoid nests were significantly frequent in pigmented BCC in comparison to other clinical types of BCC (p < 0.01). In conclusion, using dermoscopy, it is entirely possible to make a reliable diagnosis of BCC as well as to differentiate it from others skin tumors.
Azithromycin-Induced Longitudinal Melanonychia in a Child-a Case Report
Andrija Jović, Danica Tiodorović, Danijela Popović, Hristina Kocić, Zorana Zlatanović, Milan Kostić and Giovanni Damiani
Melanonychia refers to a brown or black coloration of the nail plate caused by numerous factors. Regarding the arrangement of pigmentation, we can differentiate between total melanonychia, when pigmentation involves the whole nail plate, or transverse or longitudinal melanonychia, when pigmentation involves the nail in a form of transverse or longitudinal band of pigmentation, respectively. Since longitudinal melanonychia can be a sign of numerous benign and malignant lesions, it often poses a diagnostic challenge for a dermatologist. Herein, we report a case of a 13-year-old girl who developed longitudinal melanonychia on multiple nails after receiving a therapy with azithromycin.