Cantisani, Carmen

Didona, Dario

Donati, Pietro

Garelli, Valentina

Muscardin, Luca M.

Paolino, Giovanni

Rossi, Alfredo

English

paolino, giovanni

GARELLI, VALENTINA

CANTISANI, CARMEN

ROSSI, Alfredo

Archivio della ricerca- Università di Roma La Sapienza

USING e-ANNOTATION TOOLS FOR ELECTRONIC PROOF CORRECTION Once you have Acrobat Reader open on your computer, click on the Comment tab at the right of the toolbar:  This will open up a panel down the right side of the document. The majority of tools you will use for annotating your proof will be in the Annotations section, pictured opposite. We’ve picked out some of these tools below: 1. Replace (Ins) Tool – for replacing text. Strikes a line through text and opens up a text box where replacement text can be entered. How to use it ? Highlight a word or sentence. ? Click on the Replace (Ins) icon in the Annotations section. ? Type the replacement text into the blue box that appears. 2. Strikethrough (Del) Tool – for deleting text. Strikes a red line through text that is to be deleted. How to use it ? Highlight a word or sentence. ? Click on the Strikethrough (Del) icon in the Annotations section. 3. Add note to text Tool – for highlighting a section to be changed to bold or italic. 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LETTER TO THE EDITORDear Editor,Melanosis of the lower lip subverted by filler injection: asimulator of early mucosal melanomaA 41-year-old Caucasian woman patient presented to ourdepartment with a 4-month history of a pigmented lesion ofthe lower lip, growing rapidly and with chromatic changes(Fig.1a). Furthermore, the patient complained of a mildburning and stinging sensation. Clinically, the lesion wasbrownish, with irregular borders and a diameter of 6.5 mm.The dermoscopy revealed a multi-component pattern(broader rail-tracks, parallel pattern and structurelessareas) with a grey color and sparse greyish dots.(Fig.1b)The familial and personal medical history were negative formalignancies. The patient stated that in the same area therehad been a small pigmented lesion for several years (un-changed through the years), that had shown growth and col-our changes only in the last months, after having aninjection of hyaluronic acid (HA) for aesthetic purposes.The histology revealed a pigmentation of the keratinocytesof the basal layer (without an increased number of melano-cytes or cytoarchitectural atypia), in association with severalmelanophages in the papillary dermis. In the deep dermisthere were multiple hyaline deposits, leading to a final diag-nosis of melanosis associated with deposits of HA (Fig.1c).Melanosis is a common cause of the benign pigmenta-tion of the mucosa and can be easily misdiagnosed as amelanoma.1 In addition, various factors can affect themorphology and structure of melanoses, including chronictrauma, inflammation and exogenous materials. For thisreason, a correct differential diagnosis is needed to avoidan unnecessary biopsy.1Soft tissue augmentation with HA fillers is one of themost popular contemporary aesthetic procedures. Mela-noses is not a usual adverse effect of HA as N-acetyl glu-cosamine, a precursor of HA, is well known for itsdepigmenting proprieties.4 In our patient, the hyalinedeposits most likely caused the chromatic changes, induc-ing the inflammation that might explain the recentenlargement of the lesion and the underlying infiltration ofmelanophages in the papillary dermis. These findings mayalso explain the grey color of the whole lesion, the sparsegreyish dots and the burning or stinging sensation. In addi-tion, HA may explain the whitish structureless areas, whilethe broader rail-tracks were related to the pigmented epi-dermis with acanthosis and elongated rete ridges (Fig.1b).According to Blum and colleagues3 our patient meetsmore closely the criteria of suspicious lesions (rapidgrowth, ≥ 2 colours, multiple patterns, structureless areasand dots) than of oral melanoses or other oral deposits(amalgam). Indeed, melanoses usually have fewer thantwo colours with few dermoscopic patterns (brown colour,circle or parallel pattern), while amalgam tattoos oftenshow a homogeneous whitish/bluish pattern.1,5In conclusion, the grey in the dermoscopy of the muco-sal lesions is related to melanophages in the superficialdermis and to an underlying inflammation, in our patientinduced by HA. When the grey colour is not associatedwith a polychromatic pattern or to other atypical dermo-Abbreviation:HA hyaluronic acid(a) (b) (c)Figure 1 (a) Clinical presentation of the melanosis. (b) Centre, dermoscopy of the lesion; upper left, whitish structureless areas corre-sponding to underlying deposits of hyaluronic acid (HE 9 30); upper right: grey of the lesion and greyish dots corresponding to sparse mel-anophages on the dermis (HE 9 20); lower left: broader rail track corresponding to acanthosis and elongated rete ridges of the epidermis(HE 9 30); lower right: dark brown corresponding to pigmented keratinocytes of the basal layer (HE 9 30). (c) Melanosis with underlyingdeposits of hyaluronic acid (HE 9 10).COLOR1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Australasian Journal of Dermatology (2016) , – doi: 10.1111/ajd.12475AJD12475Dispatch:29.2.16CE:DivyaJournalCodeManuscriptNo.No.ofpages:2PE:DhatchayaniS© 2016 The Australasian College of Dermatologistsscopic findings, it may be related to a melanosis. However,a multicomponent and a polychromatic pattern should bealways evaluated carefully. In this regard, the presence ofexogenous materials (widely used in aesthetic medicine)could further modify the dermoscopic structures of pre-existing mucosal pigmented lesions, leading to importantdiagnostic pitfalls.Giovanni Paolino,1 Valentina Garelli,11 Dario Didona,2Carmen Cantisani,1 Alfredo Rossi,1 Pietro Donati3 andLuca M Muscardin31Dermatological Clinic, Sapienza University of Roma,2Prima Divisione Dermatologica, Istituto Dermopaticodell’Immacolata-IRCCS, and 3Dermatopathological Labora-tory, San Gallicano Institute of Rome, Rome, ItalyREFERENCES1. Cinotti E, Couzan C, Perrot JL et al. In vivo confocal micro-scopic substrate of grey colour in melanosis. J. Eur. Acad. Der-matol. Venereol. 2015; 29: 2458–62.2. Lamichhane NS, An J, Liu Q et al. Primary malignant mucosalmelanoma of the upper lip: a case report and review of the lit-erature. BMC Res. Notes 2015; 8: 499. 23. Blum A, Simionescu O, Argenziano G et al. Dermoscopy of pig-mented lesions of the mucosa and the mucocutaneous junction:results of a multicenter study by the International DermoscopySociety (IDS). Arch. Dermatol. 2011; 147: 1181–7.4. Bertucci V, Lynde CB. Current Concepts in the Use of Small-Particle Hyaluronic Acid. Plast. Reconstr. Surg. 2015; 136(5Suppl): 132S–8S.5. Olszewska M, Banka A, Gorska R et al. Dermoscopy of pig-mented oral lesions. J. Dermatol. Case. Rep. 2008; 2: 43–8.21234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859© 2016 The Australasian College of DermatologistsAuthor Query FormJournal: AJDArticle: 12475Dear Author,During the copy-editing of your paper, the following queries arose. Please respond to these by markingup your proofs with the necessary changes/additions. Please write your answers on the query sheet ifthere is insufficient space on the page proofs. Please write clearly and follow the conventions shown onthe attached corrections sheet. If returning the proof by fax do not write too close to the paper's edge.Please remember that illegible mark-ups may delay publication.Many thanks for your assistance.Query reference Query Remarks1 AUTHOR: Please confirm that given names (red) and surnames/familynames (green) have been identified correctly.2 AUTHOR: Reference [2] has not been cited in the text. Please indicatewhere it should be cited; or delete from the Reference List and renumberthe References in the text and Reference List.© 2016 The Australasian College of Dermatologists

Melanosis of the lower lip subverted by filler injection: a simulator of early mucosal melanoma

Melanosis of the lower lip subverted by filler injection: a simulator of early mucosal melanoma

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