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  • Author: Dimitrije Brašanac x
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Tanja Tirnanić, Dimitrije Brašanac and Lidija Kandolf Sekulović

Abstract

The term “nevi of special sites” refers to melanocytic nevi of specific anatomic locations including the breast, axillae, umbilicus, genitalia, flexural areas, acral surfaces, ear, scalp and the conjunctiva. Nevi from these anatomic sites display sometimes dermoscopic and histological features of melanoma, resulting in unnecessarily high rates of excisions and re-excisions. Some authors have categorized nevi excised in the axillary, breast, umbilical and perineal areas as the nevi of the milk line. Two patients, a 32-year-old female and 23-year-old male with breast and periumbilical pigmented lesions, presented to our Department during 2017. Dermoscopy revealed features that were highly specific for melanoma. Excisional biopsies were done and histopathology revealed benign nevi with present site-related atypia. Irregular blotches, non-uniform radial streaks, blue-gray veil, and regression are the most specific features of melanoma of the breast and flexural areas. Excision is always recommended in pigmented lesions on the breast and flexural areas, which exhibit these features. However, larger studies are needed to define specific criteria required to distinguish special-site nevi from melanoma.

Open access

Danijela D. Dobrosavljević, Dimitrije Brašanac, Silvana Lukić and Ljiljana Medenica

Abstract

Digital dermoscopy (epiluminiscence microscopy) is a technology for in vivo imaging of the skin used for the differentiation of pigmented skin lesions. Melanocytic tumors and pigmentations of the nails and acral skin regions represent differential diagnostic problems that can hardly be evaluated with the naked eye, especially at an early stage. Two patients with a total of three very suspicious lesions underwent dermoscopy. Clinical diagnoses were as follows: subungual hemorrhage, plantar wart (previously treated as a plantar wart several times) and acral melanoma. Dermoscopy increased the suspicion to: subungual melanoma, acral amelanotic melanoma and acral nevus, respectively. Histologic examination has verified the following diagnoses: subungual melanoma, acral lentiginous melanoma and acral junctional nevus. Dermoscopic examination of pigmented structures on the above-mentioned sites is a very useful adjunct in establishing accurate diagnosis that can help in differentiating benign from malignant lesions.

Open access

Ivana Ilijin, Željko Mijušković, Dimitrije Brašanac and Lidija Kandolf Sekulović

Abstract

Mycosis fungoides (MF) belongs to a group of primary cutaneous T-cell lymphomas, with characteristic small- to medium-sized neoplastic T-lymphocytes with hyperchromatic and cerebriform nuclei. Folliculotropic mycosis fungoides (FMF) represents a variant of mycosis fungoides, which is histologically characterized by folliculotropic T-cell infiltrates, with or without mucinous degeneration of the hair follicles. Clinical features of FMF are characterized by appearance of grouped follicular papules, acneiform lesions, indurated plaques, sometimes tumors, which usually involve the head and neck region. The diagnosis is based on clinical presentation, histopathological and immunohistochemical (IHC) findings of skin biopsy specimens. The treatment of FMF, and generally MF, should be stage-adapted. Case report: We present a case of a 33-year-old male with an eight-month history of erythematous papules on his forehead accompanied by intense pruritus. Histopathological findings showed folliculotropic and perivascular lymphocytic infiltrates. An increased CD4/CD8 ratio of interfollicular lymphocytes with accumulation of Langerhans cell confirmed the diagnosis of FMF. Our patient was diagnosed with an early stage - IA, and P-UVA phototherapy was recommended due to ineffectiveness of prescribed topical corticosteroids that had shortterm effects. Conclusion: Folliculotropic mycosis fungoides represents a diagnostic challenge due to the great diversity of clinical manifestations. We presented a rare case of folliculotropic mycosis fungoides in a young adult, who presented with erythematous papules, accompanied by intense pruritus on the forehead, which lasted for several months. Histopathological and IHC analysis confirmed the diagnosis of folliculotropic mycosis fungoides stage IA. Due to an inadequate response to a topical corticosteroid, P-UVA phototherapy was administered, as well as close follow-up, essential for timely treatment of this frequently therapy-resistant disease.