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| CASE REPORT |
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| Year : 2019 | Volume
: 11
| Issue : 4 | Page : 167-169 |
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A rare pigmented lesion of the eyelid
Dilip Kumar Mishra1, Saumya Jakati1, Tarjani Vivek Dave2, M Agrawal3
1 Department of Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, Telangana, India
2 Ophthalmic Plastic Surgery Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
3 Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| Date of Web Publication | 19-Aug-2019 |
Correspondence Address:
Dr Dilip Kumar Mishra
Department of Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Road No. 02, Banjara Hills, KAR Campus, Hyderabad - 500 034, Telangana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijt.ijt_51_19
 Abstract | | |
This study aims to report a rare case of melanoacanthoma of the eyelid. Melanoacanthoma is very rare variant of seborrheic keratosis presenting as a rare benign pigmented lesion composed of both melanocytes and keratinocytes usually presenting over the head, neck, and trunk of elderly people. A 61-year-old female presented with 8 mm × 4 mm × 3 mm brownish black mass in her right lower lid for the past 4 years associated with itching. Clinical differential diagnosis of seborrheic keratosis and nevus was offered. The patient underwent shave biopsy, and biopsy tissue was sent for histopathological examination. A diagnosis of melanoacanthoma was made on histopathology. Melanoacanthoma of the eyelid is a rare entity, and one should consider in differential diagnosis of pigmented lesion of the eyelid mass.
Keywords: Melanoacanthoma, nevus, pigmented lesion, seborrheic keratosis
How to cite this article:
Mishra DK, Jakati S, Dave TV, Agrawal M. A rare pigmented lesion of the eyelid. Int J Trichol 2019;11:167-9 |
| Introduction | |  |
The term melanoacanthoma was coined by Mishima and Pinkus in 1960. Melanoacanthoma is a rare benign pigmented lesion which is composed of both keratinocytes and melanocytes.[1] The lesion is slow growing and usually presents as solitary lesion over the head and neck, or trunk, of older people.[2],[3] Melanoacanthoma clinically resembles with seborrheic keratosis or melanoma and may grow to the size of 3 cm or more in diameter.[4] Here, we report a rare case of right lower lid pigmented mass having classical histopathological picture of melanoacanthoma in an otherwise-hypertensive 61-year-old female.
| Case Report | | |
A 61-year-old female presented with a swelling in her right lower lid for the past 4 years associated with itching; she had a past history of falling of tree extract in the same eye; after that, the mass was slowly increasing in size. On examination, 8 mm × 4 mm × 3 mm brownish black-colored firm, mobile, and painless swelling involving the medial half of lower lid with sparing of punctum was noticed [Figure 1]a. The patient's visual acuity was 20/40 in the right and left eye without aid. The anterior and posterior segment examination of the right and left eye were quite unremarkable. The patient was hypertensive; other than that, there were no systemic abnormalities and lymphadenopathy found. | Figure 1: (a) Clinical photograph of the right eye showing 8 mm × 4 mm × 3 mm brownish black nodular mass in the lower lid. (b) Microphotograph showing acanthotic epidermis with pigmentation and horn cyst (H and E, ×40). (c) Microphotograph showing cells with ovoid nuclei and abundance of melanin in cytoplasm and bleached section in inset shows clear histomorphology of cells (H and E, ×400). (d) Postoperative follow-up clinical photograph
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Based on these findings, clinical differential diagnosis offered was seborrheic keratosis and nevus, and subsequently, the patient underwent shave biopsy and histopathological examination.
Postoperative period was uneventful, and at the last follow-up period, 6 months later, there was no evidence of any recurrence [Figure 1]d.
Histopathology
Gross pathological examination revealed a skin-covered firm darkly tan nodular mass measuring 8 mm × 4 mm × 2 mm with the cut surface being smooth brownish black. Microscopic examination showed well-defined tumor with focal hyperkeratosis, acanthosis, and slightly verrucous epidermis composed of keratinocytes and melanocytes. Melanin pigment is seen in cytoplasm of almost all the layers of epidermal cells. Horn cyst is also noted [Figure 1]b. High-power microscopy revealed cells having ovoid to basaloid nuclei with abundant melanin pigments in cytoplasm and bleached section in inset showed more clear histomorphology of these cells[Figure 1]c. All these microscopic findings confirm the melanoacanthoma.
| Discussion | | |
Melanoacanthoma is more commonly seen in light-skinned patients and manifests as pigmented papules, plaques, cutaneous horns, or nodules.[5] The lesions are usually solitary, and common sites are the head, neck, or trunk, of older patients.[2],[3] This one is benign pigmented lesion which is composed of both keratinocytes and melanocytes.[2] The absence of cellular atypia and the presence of cytoplasmic pigmentation in entire thickness of epidermis differentiate it from verrucous carcinoma. Two histological types of melanoacanthoma have been described: (a) clonal type where melanocytes and keratinocytes are clustered in small nests and (b) diffuse type where melanocytes are scattered unevenly throughout the lesions, as in our case where pigment was noticed in all the layers of epidermal cells.[5] Electron microscopic studies have revealed that there is a defect in the transfer of the melanin from these highly dendritic melanocytes to the keratinocytes. Immunofluorescent and immunoprecipitation studies have shown that melanoacanthomas are not related to malignant melanomas, and hence, simple excision or cryotherapy is curative [6] in our case.
| Conclusion | | |
Melanoacanthoma of the eyelid is a rare tumor, and it is impossible to diagnose this tumor on clinical examination. One should consider melanoacanthoma for a brownish black nodular lesion of the eyelid, and histopathological examination is mandatory for the confirmation of diagnosis and ruling out of melanoma or nevus. However, recurrences are rare; all such patient should be kept in close observation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgment
Author acknowledge Mr. B. Sreedhar Rao, G. Balajee and Mr. G. C. Naidu for the good section cutting and staining.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Mishima Y, Pinkus H. Benign mixed tumor of melanocytes and malpighian cells. Melanoacanthoma: Its relationship to Bloch's benign non-nevoid melanoepithelioma. Arch Dermatol 1960;81:539-50.  |
| 2. | Sexton FM, Maize JC. Melanotic macules and melanoacanthomas of the lip. A comparative study with census of the basal melanocyte population. Am J Dermatopathol 1987;9:438-44. |
| 3. | Delacrétaz J. Melanoacanthoma (author's transl). Dermatologica 1975;151:236-40. |
| 4. | Prince C, Mehregan AH, Hashimoto K, Plotnick H. Large melanoacanthomas: A report of five cases. J Cutan Pathol 1984;11:309-17. |
| 5. | Kihiczak GG, Centurión SA, Schwartz RA, Lambert WC. Giant cutaneous melanoacanthoma. Int J Dermatol 2004;43:936-7. |
| 6. | Schlappner OL, Rowden G, Philips TM, Rahim Z. Melanoacanthoma. Ultrastructural and immunological studies. J Cutan Pathol 1978;5:127-41. |
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