Letters to the Editor

subtropics, where the weather was usually hot and humid, and he did sweat a lot. The lack of association between the occurrence of the rash and summer time may be due to the consistent weather conditions in our country. Other differential diagnoses for EPC include erythema annulare centrifugum (EAC), erythema gyratum repens (EGR), necrolytic migratory erythema and Meyerson phenomenon.3 In our patient, neither the trailing scales behind an advancing border like superficial EAC, nor the concentric wood grain pattern of EGR, were observed. There was no localized halo of eczema within the pigmented lesion as in Meyerson phenomenon. Several paraneoplastic syndromes and dermatological disorders such as dermatomyositis, vitiligo and bullous diseases have been associated with melanoma.4 Only one recent report linked gyrate erythema with melanoma.5 In our patient, EPC developed along with the development of melanoma, and the complete removal of melanoma resulted in clearing of the erythema. This observation suggested that EPC could be a warning sign or paraneoplastic process in patients with melanoma. However, the specific correlation with internal malignancy for each paraneoplastic dermatoses varied and the association may be fortuitous. It is probably the case that EPC is not a specific paraneoplasia and associates more often with non-neoplastic conditions.1,2

CONFLICT OF INTEREST:

None.

Hsiao-Han WANG,1 Szu-Ying CHIN,2 Yi-Hsien SHIH2,3 1 Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, 2Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, and 3Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

doi: 10.1111/1346-8138.12812

REFERENCES 1 Ohmori R, Kikuchi K, Yamasaki K, Aiba S. A new type of annular erythema with perieccrine inflammation: erythema papulatum centrifugum. Dermatology 2013; 226: 298–301. 2 Ueda C, Makino T, Mizawa M, Shimizu T. Erythema papulatum centrifugum: a sweat-related dermatitis. J Am Acad Dermatol 2013; 69: e103–e105. 3 Narayanasetty NK, Pai VV, Athanikar SB. Annular lesions in dermatology. Indian J Dermatol 2013; 58: 157. 4 Wagner RF Jr, Nathanson L. Paraneoplastic syndromes, tumor markers, and other unusual features of malignant melanoma. J Am Acad Dermatol 1986; 14: 249–256. 5 Ahmad Z, Jaffe W, Craven N. Gyrate erythema and melanoma-a new clinical association. Ann Plast Surg 2013; 71: 631–633.

Speckled lentiginous nevus syndrome associated with an abnormality of tongue Dear Editor, We report a patient with speckled lentiginous nevus syndrome (SLNS) who had a special neurological abnormality, which has not been reported previously. A 17-year-old male presented with a small pigment lesion around the right corner of his mouth at the age of 2 years, while there were also dense darker papules on that lesion that gradually expanded to the right side of the head and neck, and stopped at the central line. He also showed muscle weakness in the right upper extremity, hyperhidrosis in an ipsilateral manner and his tongue was deviated to the right. No other family members had cutaneous or neurological abnormalities. -au-lait macUpon dermatological examination, a large cafe ule superimposed by multiple dark brown or black papules (size, 0.2–0.5 cm) involved the right side of his head (including right ear and lip mucosa) and neck, and his tongue was deviated to the right. The ipsilateral extremities exhibited cutaneous atrophy and hyperhidrosis, especially the right upper extremity. A complete neurological checkup, electromyograph and head computed tomography did not reveal any relevant additional pathological findings. Histopathological

examination showed lentigines and junctional or compound nevi (Fig 1). Speckled lentiginous nevus syndrome (SLNS) is a syndrome characterized by a segmental speckled lentiginous nevus (SLN) associated with ipsilateral hyperhidrosis, muscular weakness and skin dysesthesia.1 These symptoms are usually present at -au-lait birth, but may appear during the first year of life. Cafe macules can be topped by either brown or black papules or macules, and even blue nevi.2 It is theorized that SLNS may be a paradominant trait and is due to a localized defect in neural crest melanoblasts at an early developmental age.3 Speckled lentiginous nevus syndrome may be part of several complex syndromes, and each of them is associated with different cutaneous syndromes. Macular SLN is considered to be the hallmark of phacomatosis spilorosea (phacomatosis pigmentovascularis type IIIa/b), whereas papular SLN is typically present in phacomatosis pigmentokeratotica and SLNS.4 If SLNS combines with sebaceous nevus, it should be considered part of phacomatosis pigmentokeratotica, which is a rare syndrome associating with an organoid nevus, occasionally with sebaceous differentiation, a speckled lentiginous nevus,

Correspondence: Lin Cai, M.D., Department of Dermatology, Peking University People’s Hospital, 11 Xizhimen South Street, West District, Beijing 100044, China. Email: [email protected]

© 2015 Japanese Dermatological Association

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Letters to the Editor

(a)

(b)

(c)

(d)

and other extracutaneous anomalies. Phacomatosis spilorosea represents a rare cutaneous congenital malformation syndrome, characterized mainly by the presence of capillary malformation and pigmentary nevi. Our patient showed ipsilateral atrophy of extremities and the typical lateralized speckled lentiginous nevus, which supports the diagnosis of SLNS. To our knowledge, the main features of previous reports of SLNS have been the distribution of SLN and the neurological abnormality mainly concentrating on the trunk, arm and leg.5 Our patient is unique because the neurological abnormality appeared on this patient’s tongue.

CONFLICT OF INTEREST:

None declared.

Xiwan LIU, Zheng ZHAO, Qianxi XU, Lin CAI, Jianzhong ZHANG (e)

(f)

Department of Dermatology, Peking University People’s Hospital, Beijing, China doi: 10.1111/1346-8138.12806

REFERENCES

-au-lait macule superimposed by Figure 1. (a–e) A large cafe multiple dark brown or black papules (size, 0.2–0.5 cm) involved the right side of the patient’s head (including right ear and lip mucosa) and neck, and his tongue was deviated to the right. (f) Histopathological examination (hematoxylin–eosin, original magnification 9200)showed the club-shaped epidermal hyperplasia and the round to oval melanocytic nests at the dermoepidermal junction.

1 Happle R. Speckled lentiginous nevus syndrome: delinea- tion of a new distinctneurocutaneousphenotype. Eur J Dermatol 2002; 12: 133–135. 2 Vente C, Neumann C, Bertsch H et al. Speckled lentiginous nevus syndrome: report of a further case. Dermatology 2004; 209: 228–229. 3 Mendiratta V, Jabeen M, Barara M et al. Speckled lentiginous nevus syndrome with median nerve paresis: a rare syndrome with a new association. Indian Dermatol Online J 2013; 4: 234–235. 4 Vidaurri de la Cruz H, Happle R. Two distinct types of speckled lentiginous nevi characterized by macular versus papular speckles. Dermatology 2006; 212: 53–58. 5 Ramolia P, Treadwell P, Haggstrom A. Speckledlentiginous nevus syndrome associated with musculoskeletal abnormalities. Pediatr Dermatol 2009; 26: 298–301.

Injury-induced acquired dermal melanocytosis arising on an operation scar Dear Editor, Acquired dermal melanocytosis (ADM) is a pigmentary disorder clinically characterized by generally symmetrical blue–brown macules, frequently occurring on the face of Asian women, and histologically characterized by the presence of dendritic, spindle-shaped melanocytes in the dermis. A 70-year-old Japanese man, who had undergone a wide excision of Bowen’s disease on his right dorsal hand 3 years prior, presented with a blue–gray macule on the operation scar

(Fig. 1a,b). The size of the operation scar was approximately 2.5 cm. Examination revealed a 2 mm 9 2 mm, well-circumscribed, blue–gray patch on the dorsum of the right hand. Skin dermatoscopy showed homogeneous light blue pigmentation (Fig. 1c). We diagnosed it as a blue nevus or traumatic tattoo. Biopsy specimens from the macule showed scattered, spindleshaped dendritic cells containing melanin granules in the upper dermis (Fig. 1d,e). These spindle cells were positive for Melan-A (Fig. 1f). These clinical and histological findings were consistent

Correspondence: Eriko Itoh, M.D., Division of Skin Surface Sensing, Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Email: [email protected]

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Speckled lentiginous nevus syndrome associated with an abnormality of tongue.

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