Background: Minigrafts using a 1-mm biopsy punch (1-mm minigrafts) are being increasingly used to treat vitiligo. However, there have been few reports of the use of 1-mm minigrafts in pediatric patients. Objective: To examine the effectiveness of combination therapy with 1-mm minigrafts and phototherapy in children with segmental vitiligo. Methods: Minigrafts were placed in 13 patients aged ≤16 years with segmental vitiligo. Following surgery, 11 patients underwent irradiation with excimer laser light and 2 with narrow-band ultraviolet B light. Results: A mean repigmentation of 81.6% was obtained. A particularly high mean repigmentation of 87.9% was seen in patients aged ≤12 years, indicating greater efficacy in these patients than in patients aged ≥13 years (mean, 67.5%). Although a transient cobblestone appearance occurred as an adverse effect, it improved over time. Conclusions: Combined treatment of segmental vitiligo with 1-mm minigrafts and phototherapy can be performed safely and is highly effective in young patients.

Pigmented epithelioid melanocytoma (PEM) was first described by Zembowickz et al. ( 1 ) as a distinctive group of melanocytic tumours, with a more favourable prognosis than conventional melanoma. The typical histopathological findings of PEM are proliferation of epithelioid, pleomorphic, atypical cells with heavy pigmentation in the dermis, and the aggregation of histiocytes in the center ofthe tumour (1-3). Because PEM is a relatively new and rare category of skin cancer, reports are limited. We describe here the dermoscopy findings of a case of PEM and investigate the immunohistochemical profiles ofthe tumour-infiltrating histiocytes. CASE REPORTA 77-year-oId Japanese woman consulted our outpatient clinic with a 2-year-history of a blue-black nodule on her right hand. On her first visit, physical examination disclosed a blue-black nodule on the dorsal part of her right hand, 13 mm in diameter (Fig. lA). Dermoscopy revealed blue-whitish monotonous features with a focal red-black area and a clear border (Fig. IB). We excised the tumour with a 20-mm surgical margin. Histological examination revealed proliferation of epithelioid, pleomorphic, atypical cells with heavy pigmentation in the dermis ( Fig. 2A). At the periphery ofthe tumour, epithelioid, pleomorphic, atypical cells were positive for Melan A and HMB-45 staining. At the center ofthe tumour, an aggregation of histiocytes, which were positive for CD68 and negative for Melan Fig. 1. (A) A blue-black, nodule 13 mm in size on the dorsal part ofthe right hand. (B) Blue-whitish, monotonous features with a focal red-black area and clear border.

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Diagnosis of superficial spreading melanoma in the early stage is often difficult, even with dermoscopy. We report the case of a 37-year-old Japanese woman with superficial spreading melanoma in her left buttock. The lesion developed 20 years before becoming visible and gradually enlarged over the past few years without any symptoms. Physical examination showed a well-demarcated dark-brown macule 10 mm in diameter. Dermoscopy demonstrated a central dark area with a blue-grey structureless area, a milky-red area with irregular blue-grey dots or globules suggestive of regression structures, and multifocal black pigmentation with whitish scaly areas. An abrupt intralesional change in color from a central dark area to a peripheral light-brown area was also seen. The peripheral area showed an atypical pigment network with an obscure mesh and holes. Histopathologic examination of the lesion showed acanthosis with melanocytic proliferation and nuclear atypia, a band-like lymphocytic infiltrate, melanophages and a few nests of melanocytes just beneath the epidermis. The epidermal melanocytes were positive for S-100, Melan-A and HMB-45, but the dermal nests of melanocytes were negative for HMB-45 and positive for S-100 and Melan-A. A diagnosis of superficial spreading melanoma with a tumor thickness of 0.4 mm (pT1aN0M0, stage 1A) was established based on the clinical, dermoscopic and histopathologic findings. This case suggests that dermoscopy is useful in the diagnosis of this condition. An abrupt intralesional change of color might be a new indicator of early superficial spreading melanoma.