Acta Dermato-Venereologica 99-1CompleteContent | Page 35

QUIZ SECTION 119 Bizarre Pigmented Lesion on the Scalp: A Quiz Giuseppe MICALI, Anna Elisa VERZÌ, Elisabetta D’AGATA and Francesco LACARRUBBA Dermatology Clinic, University of Catania, Via S. Sofia 78, IT-95123 Catania, Italy. E-mail: [email protected] A 7-year-old girl presented with a pigmented lesion on her scalp. The lesion had been present for 2 years and, according to her parents, had changed recently. Clinical examination revealed the presence on the right temporal region of a roundish, smooth, brown macule approximately 0.9×0.7 cm with unusual tiny speckles (Fig. 1A). Dermatoscopy showed a diffuse brown pigmentation and a regular network at the periphery; moreover, several yellowish globules of various shapes and dimensions were observed in the centre of the lesion (Fig. 1B). Reflectance confocal microscopy (VivaS- cope ® 3000, Lucid, MAVIG, Munich, Germany) revealed a meshwork pattern at the dermal–epidermal junction and several roundish clusters of moderately refractive large cells with a hypo-refractive centre in the superficial dermis (Fig. 2A). The lesion was excised and histopathological examination (haematoxylin and eosin staining) revealed the features of a compound melanocytic naevus characte- rized by junctional nests of large cells with a pale and clear cytoplasm (Fig. 2B). Fig. 1. (A) Roundish, smooth, brown macule with unusual tiny speckles on the scalp of a 7-year-old girl. (B) Dermatoscopy (×10) showing a diffuse brown pigmentation, a regular network at the periphery, and several yellowish globules of various shapes and dimensions in the centre. What is your diagnosis? See next page for answer. Fig. 2. (A) Reflectance confocal microscopy revealing a meshwork pattern at the dermal–epidermal junction and several roundish clusters of moderately refractive large cells with a hyporefractive centre in the superficial dermis. (B) Histopathological examination revealing junctional nests of large cells with a pale and clear cytoplasm (haematoxylin and eosin; H&E). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3039 Acta Derm Venereol 2019; 99: 119–120