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Dermatology

Which of the following malignancies are associated with congenital melanocytic nevi (CMN) ?

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Congenital melanocytic nevus. Large 22 cm plaque with dark papules on lateral aspect of hip.

A. Squamous cell carcinoma

B. Basal cell carcinoma

C. Melanoma

D. Cutaneous T cell lymphoma

Answer: C

Congenital melanocytic nevi (CMN) are a benign proliferation of melanocytes. Although rare, there is an increased risk of melanoma in children with CMN. The risk of melanoma (approximately 2.5%) is increased in CMN measuring greater than 20 cm. Squamous cell carcinoma, basal cell carcinoma, and cutaneous T cell lymphoma is not associated with CMN.

Reference: Lieberman MR, Virmani P, Chotikanatis K, Glick SA. Birthmarks of Medical Significance. NeoReviews. 2015;16(1):e26.

A newborn baby is evaluated in primary care clinic and is found to have a reddish lesion on her right eyelid. What is the most likely diagnosis and next step in evaluation?

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Port Wine Stain (or nevus flammeus).

A. Nevus simplex; obtain biopsy

B. Nevus flammeus; obtain ophthalmology consult and MRI of brain

C. Café au lait macule; refer to dermatology

D. Congenital melanocytic nevus; refer to surgery for excision

Answer: B

A reddish lesion on the eyelid is most likely a vascular lesion called a port wine stain (PWS) or nevus flammeus which is found in the distribution of the trigeminal nerve. PWSs are often solitary lesions but may be associated with Sturge-Weber syndrome (triad of glaucoma, seizures, and PWS). Refer to ophthalmology to evaluate for intraocular abnormalities, and obtain a contrast MRI to evaluate for leptomeningeal and brain abnormalities. Nevus simplex (also called salmon patch, stork bite if on the nape, or angel kisses if on the eyelids) are found in up to 50% of babies and are benign lesions that fade over time; biopsy is not indicated . Café au lait macules are nonvascular flat pigmented lesions and may be isolated lesions or associated with other conditions such as neurofibromatosis type 1. Congenital melanocytic nevi (CMN) are a benign proliferation of melanocytes; referral and management is based on the size of the lesion.

 

image

Congenital melanocytic nevus. Large 22 cm plaque with dark papules on lateral aspect of hip.

image

Port Wine Stain (or nevus flammeus).

 

image

Large café-au-lait spot on ...

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