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Acquired linear blue nevi
268
Brief communications
c o u l d a c c o u n t for the discrepancy b e t w e e n these results.1 Solely cutaneous disease usually has a shorter course and is easier to eradicate. As such, it m a y represent a " c l a s s i c " f o r m o f L P with oral involvem e n t perhaps representing a lichenoid tissue reaction to H P V . Finally, lesions o f oral L P m i g h t be m o r e susceptible to infection or colonization with H P V than those o n the skin.
REFERENCES 1. Boyd AS, Neldner KH. Lichen planns. J Am Acad Dermatol 1991;25:593-619. 2. Jontell M, Watts S, Wallstr/Sm M, et al. Human papilloma virus in erosive oral lichen planus. J Oral Pathol Med 1990;19:273-7. 3. Manos MM, Ting Y, Wright DK, et al. Use of polymerase chain reaction amplification for the detection of genital human papillomavimses. Cancer Cells 1989;7:209-14. 4. Leonardi CL, Zhu WY, Kinsey WH, et al. Seborrheic keratoses from the genital region may contain human papillomavims DNA. Arch Dermatol 1991;127:1203-6. 5. Bauer HM, Ting Y, Greet CE, et al. Genital human papillomavims infection in female university students as determined by a PCR-based method. JAMA 1991 ;265:47 2-7.
Journal of the American Academy of Dermatology February 1997
6. Saiki RK, Gelfand DH, Stoffel S, et al. Primer-directed enzymatic ampfification of DNA with a thermostable DNA polymerase. Science 1988;239:487-91. 7. Brody I. Electron-microscopic demonstration of bacteria in the skin of patients with lichen tuber planus. Nature 1965; 207:96-8. 8. Vincent SD, Fotos PG, Baker KA, et al. Oral lichen planus: the clinical, historical, and therapeutic features of 100 cases. Oral Surg Oral Med Oral Pathol 1990;70:165-71. 9. Lundstrtm IMC, Anneroth GB, Holmberg K. Candidain patients with oral lichen planus. Int J Oral Surg 1984;13:22638. 10. Maitland N J, Cox MF, Lynas C, et al. Detection of human papillomavims DNA in biopsies of human oral tissue. Br J Cancer 1987;56:245-50. 11. Jenison SA; Xiu-ping Y, Valentine JM, et al. Evidence of prevalent genital-type human papillomavirus infections in adults and children. J Infect Dis 1990;162:60-9. 12. Pierceal WE, Goldberg LH, Ananthaswamy t-IN. Presence of human papilloma virus type 16 DNA sequences in human nonmelanoma skin cancers. J Invest Dermatol 1991; 97:880-4. 13. Soler C, Chardonnet Y, Euvrard S, et al. Evaluation of human papillomavirus type 5 on frozen sections of multiple lesions from transplant recipients with in situ hybridization and non-isotopic probes. Dermatology 1992;184:24853.
Acquired linear blue nevi B r u c e J. Bart, M D Minneapolis, Minnesota
T h e blue n e v u s is a benign, usually solitary, melanocytic dermal neoplasm. Occasionally, multiple blue nevi are seen scattered or in groups, but only rarely do they o c c u r in a linear distribution. I describe a patient in w h o m blue nevi, appearing in a linear distribution, d e v e l o p e d after t r a u m a to the skin.
CASE REPORT A 62-year-old woman had multiple pigmented skin lesions. During World War II, when she was '10 years old, she was "sprayed with bullets" while holding her right arm over her head to protect herself. She maintained that this resulted in "powder burns" to the fight arm that perFrom the Department of Dermatology, Hennepin County Medical Center. Reprint requests: Brace J. Bart, MD, Hennepin County Medical Center, Department of Dermatology,701 Park Ave., Minneapolis, MN 55415. J Am Acad Dermatol 1997;36:268-9. Copyright © 1997 by the American Academy of Dermatology. 0190-9622/97/$5.00 + 0 16/54/76978
sisted unchanged. Her mother had had a melanoma. Examination revealed 2 to 5 mm, multiple, deep blue papules in an irregularly linear distribution on the extensor surface of the fight arm and forearm (Fig. 1). There was a single similar 5 m m papule on the upper mid back. In the mid-sternal region a 6 x 12 m m nodule was noted. The patient stated that this had appeared during the past 2 years. The surface of the nodule showed irregular speckled pigmentation with red, brown, and white components. The margin showed slight elevation and the central portion of the nodule was translucent. Biopsy specimens were obtained from the blue papule on the back and from two blue papules on the fight arm. The nodule on the anterior aspect of her chest was excised with a 2 m m margin. All three papules were blue nevi (Fig. 2, A), and the nodule on the chest was a melanoma (Clark's level II; Breslow thickness, 33 mm) (Fig. 2, B). Immunochemistry of the blue nevi and the melanoma demonstrated homogeneous staining with antibodies to S- 100 and HMB-45 proteins. The melanoma was excised with a 2 cm margin, to the level of the pectoralis fascia. No residual rumor was seen on histologic examination.
Journal of the American Academy of Dermatology Volume 36, Number 2, Part 1
Brief communications 269
Fig. 1. Blue nevi on extensor arm and forearm.
Two years later she had had no recurrence. The multiple blue nevi have persisted unchanged. DISCUSSION
Although most frequently seen as a solitary papule or nodule, multiple blue nevi have been reported, but seldom in a linear pattern. Upshaw, Ghormley, and Montgomery 1 described a boy who had a blue lesion on the skin of the left side of the thorax at 4 weeks of age. When he was examined at 9 years of age, multiple blue nodules were present in an irregular, linear, zosteriform distribution. Shenfield and Maize 2 described a 56-year-old man with multiple blue nevi in a linear pattern in the epigastric region; these developed when he was in his mid-twenties and persisted unchanged. An 18-year-old man with multiple linear blue nevi on the left leg since birth was described by Pittman and Fisher. 3 My patient recalled trauma preceding the development of multiple blue nevi. Three similar cases have been reported. After blunt trauma to the anterior aspect of the left leg of a 34-year-old woman, described by Pariser and Bluemink, 4 irregularly shaped brown macules developed in an interrupted, irregularly linear pattern. The distribution corresponded to the cutaneous innervation of the sural nerve. A biopsy specimen showed dendritic melanocytes in the papillary dermis in association with nonmyelinated nerve fibers. The authors suggested that trauma could have induced a "reactive neurotropic response," resulting in dermal melanocytosis. Hendricks 5 described a 14-year-old boy with more than 100 blue-brown macules and papules on the anterior aspect of his chest; these developed after a severe blistering sunburn. A biopsy specimen showed fusiform and dendritic pigmented cells
Fig. 2. A, Photomicrograph of biopsy specimen of papule from ann shows elongated melanocytes in mid dermis. B, Photomicrograph of biopsy specimen from nodule on chest shows atypical melanocytes at dermoepidermal junction. (A and B, Hematoxylin-eosin stain; original magnifications: A, x26; B, x40.)
within the lower two thirds of the dermis. Hendricks postulated that photoinjury may have induced proliferafion of dermal melanocytes. A 60-year-old man described by Jimenez et al. 6 had sustained an injury to his right wrist when he was 20 years old. This resulted in a bruise, followed by a blue-black patch, measuring 4 x 2.5 cm. A biopsy specimen demonstrated elongated melanocytes in the mid dermis, consistent with acquired dermal melanocytosis. REFERENCES
1. Upshaw BY, Gholmley RK, Montgomery H. Extensive blue nevus of Jadassohn-Teiche. Surgery 1947;22:761-5. 2. Shenfield HT, Maize JC. Multiple and agminated blue nevi. J Dermatol Surg Oncol 1980;6:725-8. 3. Pittman JL, Fisher BK. Plaque-type blue nevus. Arch Dermatol 1976;112:1127-8. 4. Pariser RJ, Bluemink CG. Acquired linear dermal melanocytosis. Arch Dermatol 1982;118:125-8. 5. Hendricks WM. Eruptive blue nevi. J Am Acad Dermatol 1981 ;4:50-3. 6. Jimenez E, Valle P, Villegas C, et al. Unusual acquired dermal melanocytosis. J Am Acad Dermatol 1994;30:277-8.
Brief communications
c o u l d a c c o u n t for the discrepancy b e t w e e n these results.1 Solely cutaneous disease usually has a shorter course and is easier to eradicate. As such, it m a y represent a " c l a s s i c " f o r m o f L P with oral involvem e n t perhaps representing a lichenoid tissue reaction to H P V . Finally, lesions o f oral L P m i g h t be m o r e susceptible to infection or colonization with H P V than those o n the skin.
REFERENCES 1. Boyd AS, Neldner KH. Lichen planns. J Am Acad Dermatol 1991;25:593-619. 2. Jontell M, Watts S, Wallstr/Sm M, et al. Human papilloma virus in erosive oral lichen planus. J Oral Pathol Med 1990;19:273-7. 3. Manos MM, Ting Y, Wright DK, et al. Use of polymerase chain reaction amplification for the detection of genital human papillomavimses. Cancer Cells 1989;7:209-14. 4. Leonardi CL, Zhu WY, Kinsey WH, et al. Seborrheic keratoses from the genital region may contain human papillomavims DNA. Arch Dermatol 1991;127:1203-6. 5. Bauer HM, Ting Y, Greet CE, et al. Genital human papillomavims infection in female university students as determined by a PCR-based method. JAMA 1991 ;265:47 2-7.
Journal of the American Academy of Dermatology February 1997
6. Saiki RK, Gelfand DH, Stoffel S, et al. Primer-directed enzymatic ampfification of DNA with a thermostable DNA polymerase. Science 1988;239:487-91. 7. Brody I. Electron-microscopic demonstration of bacteria in the skin of patients with lichen tuber planus. Nature 1965; 207:96-8. 8. Vincent SD, Fotos PG, Baker KA, et al. Oral lichen planus: the clinical, historical, and therapeutic features of 100 cases. Oral Surg Oral Med Oral Pathol 1990;70:165-71. 9. Lundstrtm IMC, Anneroth GB, Holmberg K. Candidain patients with oral lichen planus. Int J Oral Surg 1984;13:22638. 10. Maitland N J, Cox MF, Lynas C, et al. Detection of human papillomavims DNA in biopsies of human oral tissue. Br J Cancer 1987;56:245-50. 11. Jenison SA; Xiu-ping Y, Valentine JM, et al. Evidence of prevalent genital-type human papillomavirus infections in adults and children. J Infect Dis 1990;162:60-9. 12. Pierceal WE, Goldberg LH, Ananthaswamy t-IN. Presence of human papilloma virus type 16 DNA sequences in human nonmelanoma skin cancers. J Invest Dermatol 1991; 97:880-4. 13. Soler C, Chardonnet Y, Euvrard S, et al. Evaluation of human papillomavirus type 5 on frozen sections of multiple lesions from transplant recipients with in situ hybridization and non-isotopic probes. Dermatology 1992;184:24853.
Acquired linear blue nevi B r u c e J. Bart, M D Minneapolis, Minnesota
T h e blue n e v u s is a benign, usually solitary, melanocytic dermal neoplasm. Occasionally, multiple blue nevi are seen scattered or in groups, but only rarely do they o c c u r in a linear distribution. I describe a patient in w h o m blue nevi, appearing in a linear distribution, d e v e l o p e d after t r a u m a to the skin.
CASE REPORT A 62-year-old woman had multiple pigmented skin lesions. During World War II, when she was '10 years old, she was "sprayed with bullets" while holding her right arm over her head to protect herself. She maintained that this resulted in "powder burns" to the fight arm that perFrom the Department of Dermatology, Hennepin County Medical Center. Reprint requests: Brace J. Bart, MD, Hennepin County Medical Center, Department of Dermatology,701 Park Ave., Minneapolis, MN 55415. J Am Acad Dermatol 1997;36:268-9. Copyright © 1997 by the American Academy of Dermatology. 0190-9622/97/$5.00 + 0 16/54/76978
sisted unchanged. Her mother had had a melanoma. Examination revealed 2 to 5 mm, multiple, deep blue papules in an irregularly linear distribution on the extensor surface of the fight arm and forearm (Fig. 1). There was a single similar 5 m m papule on the upper mid back. In the mid-sternal region a 6 x 12 m m nodule was noted. The patient stated that this had appeared during the past 2 years. The surface of the nodule showed irregular speckled pigmentation with red, brown, and white components. The margin showed slight elevation and the central portion of the nodule was translucent. Biopsy specimens were obtained from the blue papule on the back and from two blue papules on the fight arm. The nodule on the anterior aspect of her chest was excised with a 2 m m margin. All three papules were blue nevi (Fig. 2, A), and the nodule on the chest was a melanoma (Clark's level II; Breslow thickness, 33 mm) (Fig. 2, B). Immunochemistry of the blue nevi and the melanoma demonstrated homogeneous staining with antibodies to S- 100 and HMB-45 proteins. The melanoma was excised with a 2 cm margin, to the level of the pectoralis fascia. No residual rumor was seen on histologic examination.
Journal of the American Academy of Dermatology Volume 36, Number 2, Part 1
Brief communications 269
Fig. 1. Blue nevi on extensor arm and forearm.
Two years later she had had no recurrence. The multiple blue nevi have persisted unchanged. DISCUSSION
Although most frequently seen as a solitary papule or nodule, multiple blue nevi have been reported, but seldom in a linear pattern. Upshaw, Ghormley, and Montgomery 1 described a boy who had a blue lesion on the skin of the left side of the thorax at 4 weeks of age. When he was examined at 9 years of age, multiple blue nodules were present in an irregular, linear, zosteriform distribution. Shenfield and Maize 2 described a 56-year-old man with multiple blue nevi in a linear pattern in the epigastric region; these developed when he was in his mid-twenties and persisted unchanged. An 18-year-old man with multiple linear blue nevi on the left leg since birth was described by Pittman and Fisher. 3 My patient recalled trauma preceding the development of multiple blue nevi. Three similar cases have been reported. After blunt trauma to the anterior aspect of the left leg of a 34-year-old woman, described by Pariser and Bluemink, 4 irregularly shaped brown macules developed in an interrupted, irregularly linear pattern. The distribution corresponded to the cutaneous innervation of the sural nerve. A biopsy specimen showed dendritic melanocytes in the papillary dermis in association with nonmyelinated nerve fibers. The authors suggested that trauma could have induced a "reactive neurotropic response," resulting in dermal melanocytosis. Hendricks 5 described a 14-year-old boy with more than 100 blue-brown macules and papules on the anterior aspect of his chest; these developed after a severe blistering sunburn. A biopsy specimen showed fusiform and dendritic pigmented cells
Fig. 2. A, Photomicrograph of biopsy specimen of papule from ann shows elongated melanocytes in mid dermis. B, Photomicrograph of biopsy specimen from nodule on chest shows atypical melanocytes at dermoepidermal junction. (A and B, Hematoxylin-eosin stain; original magnifications: A, x26; B, x40.)
within the lower two thirds of the dermis. Hendricks postulated that photoinjury may have induced proliferafion of dermal melanocytes. A 60-year-old man described by Jimenez et al. 6 had sustained an injury to his right wrist when he was 20 years old. This resulted in a bruise, followed by a blue-black patch, measuring 4 x 2.5 cm. A biopsy specimen demonstrated elongated melanocytes in the mid dermis, consistent with acquired dermal melanocytosis. REFERENCES
1. Upshaw BY, Gholmley RK, Montgomery H. Extensive blue nevus of Jadassohn-Teiche. Surgery 1947;22:761-5. 2. Shenfield HT, Maize JC. Multiple and agminated blue nevi. J Dermatol Surg Oncol 1980;6:725-8. 3. Pittman JL, Fisher BK. Plaque-type blue nevus. Arch Dermatol 1976;112:1127-8. 4. Pariser RJ, Bluemink CG. Acquired linear dermal melanocytosis. Arch Dermatol 1982;118:125-8. 5. Hendricks WM. Eruptive blue nevi. J Am Acad Dermatol 1981 ;4:50-3. 6. Jimenez E, Valle P, Villegas C, et al. Unusual acquired dermal melanocytosis. J Am Acad Dermatol 1994;30:277-8.