MANIAC:clinico-pathological correlation pf an acral nevus with difficult interpretation

Resumen

Abstract

Background: acral nevi can present a pagetoid scatter of melanocytes, that is why they are called MANIAC (Melanocytic Acral Nevus with Intraepidermal Ascents of Cells), they can be confused with melanomas, leading to agressive but unnecessary treatments.
Objective: To establish a clinico-pathological correlation in order to obtain its clinical identification, thus avoiding terapeutic errors related to histopathological misdiagnosis.
Design: longitudinal retrospective study.
Methods: clinical and histopathologic retrospective analysis of 15 patients with MANIAC seen between 1994 and 2008 at Divisions of Oncology and Dermatopathology, Hospital Ramos Mejía,
Buenos Aires, Argentina.
Results: The majority of patients lacked any personal history (93%), ages ranged from 20-39 years (52%); they consulted for nevi control (80%); some cases were misdiagnosed as melanoma by other physicians (12%). Women had a slightly higher incidence (60%). The lesions were mostly found on the soles (total on feet 80%, of which 54% were on the soles). The most common clinical presentation was like a congenital nevus of early presentation (66%). The clinical features were banal; the majority presenting: a diameter <6 mm (87%), asymmetric shape (67%, of whom 60% were fusiform), dark homogeneous color (87%), sharp (80%) and regular (66%) borders,
fl at lesions (66%). Histopathologically they were divided among compound nevi (54%) and junctional nevi (46%).
Conclusions: MANIAC presents histopathologic characteristics classically attributed to melanoma. Pagetoid scatter of melanocytes could be over estimated, if taken alone, that is why dermatologists must avoid unnecessary aggressive treatments

(Dermatol Argent 2010;16(1):46-51).

Keywords: acral nevus, pagetoid spread, melanocytic ascent