Chapter 77 - Hypermelanoses

Question 1

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis (2)

Epidemiology
- Mostly congenital
- Sporadic (rare familial cases)
- Asian and female predominance

Answer 1

• Nevus of Ota
• Nevus of Ito

Question 2

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Epidemiology
- Congenital
- Often familial
- Asian, African, and Hispanic populations with slight male predominance

Answer 2

Mongolian Spot

Question 3

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Epidemiology
- Acquired
- Familial or sporadic
- Asian and female predominance

Answer 3

Nevus of Hori

Question 4

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Epidemiology
- Congenital

Answer 4

Dermal Melanocyte Hamartoma

Question 5

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis (2)

Clinical presentation
Blue to slate-gray mottled macular hyperpigmentation

Answer 5

• Nevus of Ota
• Nevus of Ito

Question 6

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Clinical presentation
Uniform blue to slate-gray macular hyperpigmentation

Answer 6

Mongolian Spot

Question 7

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Clinical presentation
Brown-blue progressing to slate-gray mottled macular hyperpigmentation

Answer 7

Nevus of Hori

Question 8

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Clinical presentation
Mottled hyperpigmentation with small blue-gray macules in a diffuse pigmented patch

Answer 8

Dermal Melanocyte Hamartoma

Question 9

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Distribution
Trigeminal nerve

Answer 9

Nevus of Ota

Question 10

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Distribution
Acromioclavicular nerve

Answer 10

Nevus of Ito

Question 11

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Distribution
Lower back and sacrum

Answer 11

Mongolian Spot

Question 12

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Distribution
Especially malar region of the cheek (also forehead, upper eyelids, temple)

Answer 12

Nevus of Hori

Question 13

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Distribution
Dermatomal distribution

Answer 13

Dermal Melanocyte Hamartoma

Question 14

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis (2)

Histology
Spindle-shaped melanocytes diffusely throughout the dermal layers; sometimes more band-like melanocytic proliferation and stromal fibrotic reaction

Answer 14

• Nevus of Ota
• Nevus of Ito

Question 15

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Histology
Spindle-shaped melanocytes diffusely throughout the dermal layers

Answer 15

Mongolian Spot

Question 16

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Histology
Dermal melanocytes in the upper and mid dermis

Answer 16

Nevus of Hori

Question 17

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Histology
Dermal melanocytes in the upper two-thirds of the dermis (including subpapillary layer)

Answer 17

Dermal Melanocyte Hamartoma

Question 18

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Therapy (3)

• Nevus of Ota
• Nevus of Ito

Answer 18

• Quality-switched laser
• Cryotherapy
• Surgery

Question 19

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Therapy

Mongolian Spot

Answer 19

Usually spontaneous regression during childhood

Question 20

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Therapy

Nevus of Hori

Answer 20

Quality-switched laser in combination with bleaching cream and chemical peels

Question 21

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Therapy

Dermal Melanocyte Hamartoma

Answer 21

None

Question 22

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Associated features
Rare malignant transformation

Answer 22

Nevus of Ota

Question 23

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Associated features (2)
No associated features of medical concern

Answer 23

• Nevus of Ito
• Nevus of Hori

Question 24

TABLE 77-1
Differential Diagnosis and Management of Dermal Melanocytosis

Diagnosis

Associated features
Possible association with inborn errors of metabolism

Answer 24

Mongolian Spot

Question 25

TABLE 77-1 Differential Diagnosis and Management of Dermal Melanocytosis Diagnosis Associated features None

Answer 25

Dermal Melanocyte Hamartoma

Question 26

TABLE 77-3 Lightening Agents AGENT (2) MECHANISM OF ACTION Tyrosinase inhibitor

Answer 26

Hydroquinone Azelaic acid

Question 27

TABLE 77-3 Lightening Agents AGENT MECHANISM OF ACTION - Stimulate keratinocyte turnover - Reduce melanosome transfer - Tyrosinase inhibitor

Answer 27

Retinoids

Question 28

TABLE 77-3 Lightening Agents AGENT MECHANISM OF ACTION - Tyrosinase inhibitor - Inhibits melanosome maturation

Answer 28

Arbutin

Question 29

TABLE 77-3 Lightening Agents AGENT MECHANISM OF ACTION Interacts with copper and inhibits tyrosinase

Answer 29

Kojic acid

Question 30

TABLE 77-3 Lightening Agents AGENT MECHANISM OF ACTION - Plasmin inhibition - Antioxidant

Answer 30

Tranexamic acid