Small and medium congenital melanocytic nevi are relatively common but present a small but significant risk of malignant transformation. Because prophylactic excision of all nevi is impractical, dermoscopic evaluation has a role in the clinical decision-making process. Dermoscopy of benign congenital nevi reveals a globular or homogenous pattern, black or brown dots and globules, small milia-like cysts within the globules, and terminal hairs. Dermoscopic criteria of melanoma are outlined here, with discussion of common scoring methods, the seven-point checklist, the ABCD rule, pattern analysis, and the Menzies criteria. Serial examination of congenital nevi with dermoscopy and excision of those lesions with malignant criteria are useful in the management of congenital melanocytic nevi.
A 60-year-old white woman with polycythemia rubra vera post splenectomy in November 2001 was found to have peripheral white blood cell counts increasing over 3 months. Cytogenetics revealed trisomy of chromosomes 8 and 9, and bone marrow biopsy showed hypercellular, fibrotic bone marrow consistent with myelofibrosis of polycythemia rubra vera. Two months later, the patient developed acute swelling and pain in her lower extremities. The clinical symptoms along with confirmatory histology supported the diagnosis of eosinophilic fasciitis. This is the first reported case in the English literature of an association between polycythemia vera and eosinophilic fasciitis.
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