Search Results (12)

Background/Objectives: Collision tumors between seborrheic keratosis and melanoma represent a well-known diagnostic pitfall, particularly when the benign keratinocytic component constitutes the predominant portion of the lesion. In such cases, melanoma-specific dermoscopic clues may be obscured by typical seborrheic keratosis patterns, leading to potential underestimation. The aim of this scoping review was to map and summarize the dermoscopic interface features reported in melanoma–seborrheic keratosis collision tumors. Secondary aims were to discuss diagnostic pitfalls, explore potential tumor microenvironment considerations, and assess the adjunctive role of Wood’s lamp-assisted dermoscopy. Methods: This review was conducted as a scoping review and reported according to the PRISMA-ScR guidelines using PubMed, Scopus, and Web of Science. Studies reporting histologically confirmed melanoma–seborrheic keratosis collision tumors with available dermoscopic documentation were included. Eligible articles consisted of case reports and case series. Dermoscopic features at the interface between seborrheic keratosis and melanoma were qualitatively synthesized. Results: Five studies describing five melanoma-seborrheic keratosis collision tumors met the inclusion criteria. In all cases, the seborrheic keratosis component was dermoscopically recognizable. Asymmetric interface-related hyperpigmentation was consistently observed in collisions involving pigmented melanomas, whereas it was absent in the single reported case of hypopigmented melanoma. Conclusions: Asymmetric interface-related hyperpigmentation within seborrheic keratosis is a recurrent dermoscopic finding in melanoma–seborrheic keratosis collision tumors and could be considered a monitoring clue rather than a melanoma-specific diagnostic criterion. Given the dynamic nature of melanoma growth, longitudinal assessment of the dermoscopic interface may be particularly informative. Adjunctive techniques, including Wood’s lamp-assisted dermoscopy, may support interface-focused evaluation in selected equivocal cases. Full article

Skin pigmentation results from the melanin production by melanocytes, an essential process for protection against ultraviolet radiation and for maintaining cutaneous homeostasis. Disruptions in this balance lead to pigmentary disorders, such as hyperpigmentation, which is characterized by localized or diffuse darkening of the skin. Its most prevalent forms include melasma, post-inflammatory hyperpigmentation, and solar lentigines, often driven by hormonal, inflammatory, and environmental factors, particularly sun exposure. Despite being clinically benign, these conditions have a significant impact on self-esteem and quality of life. Conventional treatments rely on depigmenting agents such as hydroquinone, retinoids, and corticosteroids, as well as chemical peels, and laser or light-based therapies, frequently used in combination. However, limited efficacy, prolonged treatment durations, and potential adverse effects underscore the need for safer and more effective alternatives. In recent years, research has focused on developing novel approaches, with nanotechnology-based delivery systems and minimally invasive techniques, such as microneedling, standing out as particularly promising fields. In parallel, the growing number of interventional clinical trials reflects an increasing interest in optimizing topical depigmenting strategies. This review summarizes the main types of hyperpigmentation, the depigmenting substances currently used, and emerging therapeutic approaches with potential clinical impact. Full article

Linear atrophoderma of Moulin (LAM) is a rare, benign dermatosis characterized by unilateral, hyperpigmented, slightly atrophic plaques distributed along Blaschko’s lines. We report the case of an 18-year-old woman with a four-year history of asymptomatic lesions on the right abdomen, thigh, and foot. Histopathology revealed basal layer hyperpigmentation, mild collagen thickening, and a sparse perivascular lymphocytic infiltrate, without sclerosis. The clinical and histological findings confirmed the diagnosis of LAM. Given the stable course and absence of symptoms, a conservative approach with follow-up was adopted. This case underscores the importance of recognizing LAM’s distinctive presentation to avoid unnecessary treatments. Full article

Hydroxyurea (HU), a cornerstone treatment for myeloproliferative disorders, is associated with a wide range of cutaneous side effects, from xerosis and hyperpigmentation to more severe conditions like dermatomyositis-like eruptions (DM-LE) and nonmelanoma skin cancers (NMSC), particularly squamous cell carcinoma (SCC). In this review, we present a unique case of HU-induced DM-LE with histological evidence of keratinocyte dysplasia and p53 overexpression, followed by a systematic analysis of similar cases. Our findings reveal that the clinical presentation of DM-LE, while typically considered benign, shares clinical and histological features with hydroxyurea-associated squamous dysplasia (HUSD), a precancerous condition that may progress to SCC in chronically exposed patients. Key insights include the characteristic histopathological findings of DM-LE, the role of chronic HU therapy and UV-induced damage in promoting p53 overexpression, and the overlap between DM-LE and HUSD. Regular dermatologic monitoring, patient education on photoprotection, and the careful assessment of skin lesions in long-term HU users are essential for the early detection and prevention of malignancies. This review underscores the importance of distinguishing between DM-LE, HUSD, and SCC to optimize management and minimize risks associated with HU therapy. Full article

Spindle cell lipoma (SCL) is a benign adipocytic tumor usually found in the subcutis of the posterior neck, upper back, and shoulder, predominantly in middle-aged males. This case report describes an atypical presentation of SCL in a 26-year-old male with a history of malignant melanoma. The patient presented with an erythematous plaque with central hyperpigmentation on the right upper arm, an uncommon location and presentation for SCL. Histopathological examination revealed an atypical myxoid spindle cell neoplasm with CD34 positivity and an overlying mildly atypical compound melanocytic nevus. The unusual clinical and histological features, combined with the patient’s melanoma history, complicated the differential diagnosis, which included dermatofibrosarcoma protuberans (DFSP) and solitary fibrous tumors (SFTs). A wide local excision with 2 cm margins was performed, and subsequent pathology confirmed clear margins, supporting the diagnosis of SCL. This case highlights the importance of including SCL in the differential diagnosis of CD34-positive spindle cell tumors, even when clinical and histological presentations are atypical, and underscores the need for thorough histopathological evaluation and a broad differential diagnosis in patients with a history of melanoma. Full article

(1) Introduction: In cosmetic dermatology, benign hyperpigmentation is a prevalent issue. Solar lentigo and other melanoses are bringing patients to the attention of physicians more and more often. The Q-switched 1064/532-nanometer (nm) laser is the gold standard device to treat these conditions. A new generation of these machines, able to shorten pulse duration to hundreds of picoseconds, has emerged showing better preliminary results. In order to treat hypermelanoses in Asians, we used a Q-switched laser with a picosecond pulse. (2) Methods: A retrospective recruitment of 31 Asian individuals requesting treatment for melanosis was conducted at Catanzaro’s Magna Graecia University, University of Rome Tor Vergata and Villa Bella Antiaging. Although they might have varied, the treatment settings were typically as follows: for dermic lesions, a pulse wavelength of 1064 nm with a duration of 450 picoseconds (ps) was used, and for epidermal lesions, a pulse wavelength of 532 nm with a duration of 370 ps was used. Up to four laser treatments were carried out, each at least 30 days apart. During a three-month follow-up after the final session, patient satisfaction was evaluated using a visual analogue scale (VAS). Images taken prior to laser treatments and thereafter were compared, and the aesthetic effect was scored on a five-point scale by two blinded specialists. (3) Results: Of the 31 patients recruited, 25 (80.6%) were female and 6 were male (19.4%). The average stated age was 48.96 ± 13.68. During the dermatological examination, all patients were found to have nearly completely removed melanosis, with a mean VAS score of 7.03 ± 1.35 and a five-point evaluation scale of 2.71 ± 0.78. Conclusions: The Q-switched 1064/532 nm laser can be seen as a safe and effective option to treat benign hypermelanosis in Asian patients. Compared to other technologies, the use of a picosecond pulse appears to promise superior outcomes. To validate the results of this investigation, however, a clinical trial comparing the many commercially accessible therapy options is required. Full article

Cutaneous leiomyoma is a benign tumor, mainly composed of smooth muscle cells and arising from the arrector pili muscle of hair follicles. The diagnosis of leiomyomas is of paramount importance, as they can often be associated with underlying malignancies (e.g., renal cell carcinoma, leiomyosarcoma) and specific genetic mutations. We report the case of a 27-year-old Caucasian male patient that presented to our attention with a rare segmental and Zoosteriform type II leiomyoma. We performed an analysis of the cutaneous lesions using dermoscopy, reflectance confocal microscopy (RCM) and histology. We found that, using dermoscopy, the leiomyomas showed a dermatofibroma-like appearance with a central hypopigmented area, peripheral delicate hyperpigmentation and also erythematous areas and ectatic vessels. RCM, although not specific, showed groups of hypo-reflective areas distributed in the most superficial papillary dermis, which in histology and immunohistochemistry corresponded to the most superficial protrusions in the papillary dermis of the tumoral bundles. Finally, we discuss the management of patients with multiple leiomyomas and stress the fact that, in the cases of multiple leiomyomas, an annual sonography of the kidneys associated with dermatological and (in women) gynecological consultations are needed to ensure the early identification of an underlying tumor. A genetic consultation to detect an eventual FH mutation is recommended, but since in some cases the FH result may be negative, the above recommended controls remain always of paramount importance. Full article

The pigmentation of the fungiform papillae of the tongue is a rare idiopathic condition in which only the fungiform papillae appear hyperpigmented. In the absence of any reviews on the subject, we conducted a systematic review of the aetiopathogenesis and pathophysiology of pigmented fungiform papillae (PFP) of the tongue, including its demographic and histopathological features, trying to outline a possible aetiology. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) was performed using PubMed, Scopus, EMBASE databases and manual searches, for publications between January 1974 and July 2022. Inclusion criteria were case reports defining patients’ characteristics, their general medical and dental conditions, histopathological and/or immunohistochemical findings, all with a final definitive diagnosis of PFP. Overall, 51 studies comprising 69 cases of PFP which included histopathological descriptions were reviewed. Prominent features consisted of hyperpigmentation of melanocytes, melanophages, chromatophores, and a lymphocytic infiltrate in the subepidermal area of the fungiform papillae. On special staining, PFP contained melanin, not iron or hemosiderin. On immunohistochemistry, immune-reactive CD3+ T lymphocytes, S-100 and Sox10, but non-immune-reactive melan-A intraepithelial melanocytes were noted in some studies. The presence of hyperpigmented melanocytes and melanophages, with non-immune-reactive melan-A, suggests that PFP are a benign and physiological form of pigmentation. The inflammatory infiltrates described in some papillary lesions could possibly be due to traumatic events during mastication. Nevertheless, the true reasons for the hyperpigmentation of the fungiform papillae are as of yet elusive, and remain to be determined. Full article

Becker’s nevus (BN) is a cutaneous hamartoma of benign nature that develops through adolescence and affects mostly young men. The nevus is usually located unilaterally and is characterized by hypertrichosis and hyperpigmentation. Despite recent advances in treatment modalities, no effective treatment has been established for BN hyperpigmentation. We sought to assess the efficacy and safety of fractional Erbium: YAG 2940 nm and Q-switched Nd: YAG 1064 nm lasers in the treatment of BN hyperpigmentation. Twenty-three patients with BN were included in a prospective, randomized-controlled, observer-blinded, split-lesion comparative technique trial. In each patient, two similar square test regions were randomized to either be treated with a fractional Erbium: YAG 2940 nm laser or with a Q-switched Nd: YAG 1064 nm laser. Each patient was treated with three sessions at six-week intervals. At the follow-up, clearance of hyperpigmentation was assessed by physician global assessment, visual analogue scale, grade of improvement, patient global assessment, and patient satisfaction. Regions treated with the fractional Erbium: YAG 2940 nm laser demonstrated significantly better improvement compared to ones treated with the Q-switched Nd: YAG 1064 nm (p-value = 0.001) laser. Adverse effects such as repigmentation and hypertrophic scarring were not reported during the follow-up period. The outcomes were cosmetically acceptable with overall high satisfaction among the included patients. Our data suggest a superior role for the fractional Erbium: YAG (2940 nm) laser in the treatment of BN hyperpigmentation compared to the Q-switched Nd: YAG (1064 nm) laser, along with being a safer method and having no reported side effects. Full article

Seborrheic keratosis, which is a benign tumor composed of epidermal keratinocytes, develops common in the elderly. Uric acid generated by upregulated guanine deaminase (GDA) has been identified to cause UV-induced keratinocyte senescence in seborrheic keratosis. Seborrheic keratosis is also frequently pigmented. Growing evidences indicate that hyperuricemia is a risk factor of acanthosis nigricans, an acquired skin hyperpigmentation. The objective of this study was to investigate role of GDA and its metabolic end product, uric acid, in hyperpigmentation of patients with seborrheic keratosis using their lesional and non-lesional skin specimen sets and cultured primary human epidermal keratinocytes with or without GDA overexpression or uric acid treatment. GDA-overexpressing keratinocytes or their conditioned media containing uric acid increased expression levels of MITF and tyrosinase in melanocytes. Uric acid released from keratinocytes was facilitated by ABCG2 transporter with the help of PDZK1 interaction. Released uric acid was taken by URAT1 transporter in melanocytes, stimulating melanogenesis through p38 MAPK activation. Overall, GDA upregulation in seborrheic keratosis plays a role in melanogenesis via its metabolic end product uric acid, suggesting that seborrheic keratosis as an example of hyperpigmentation associated with photoaging. Full article

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices. Full article

(1) Benign melanoses are a frequent issue in aesthetic dermatology. Solar lentigo, ephelides, café au lait spots, and other melanoses represent a cosmetic issue for a growing number of subjects. The Q-switched 1064/532-nanometer (nm) laser may be considered the gold standard for management of these aesthetic issues. A new generation of Q-switched lasers, capable of concentrating the energy pulse in the spectrum of hundreds of picoseconds, is emerging, promising better results than previous ones. In this paper, we report the use of a Q-switched laser with a picosecond pulse to manage hypermelanoses. (2) Methods: 36 patients seeking melanosis removal were retrospectively enrolled at Magna Graecia University of Catanzaro. Treatment parameters, although variable, were the following: 1064 nm with a pulse duration of 450 picoseconds (ps) for dermic lesions and 532 nm with 370 ps for epidermal lesions. Up to four treatments, with a minimum interval between laser treatments of 30 days, were performed. After the last session, patients’ satisfaction was assessed at a three-month follow up with a Visual Analogue Scale (VAS). Two blinded dermatologists measured the aesthetic outcome using a five-point scale comparing pictures before laser sessions and during follow-up. (3) Results: 36 patients were enrolled; 23 were females (63.9%) and 13 males (36.1%). The mean reported age was 49.2 ± 18.9 years. All participants were assessed with a complete/almost complete melanosis removal at the dermatological evaluation, with a mean VAS score of 9.39 ± 0.90. (4) Conclusions: The Q-switched 1064/532 nm laser may be considered the main weapon in treating benign hypermelanosis. The picosecond pulse seems to guarantee better results than other devices. However, a clinical trial comparing Q-switched nanosecond pulse with picosecond pulse is necessary to confirm this study’s findings. Full article