A Finely Wrinkled, Band-like Naevus Associated with Hyper- and Hypopigmented Spots: A New Entity?

Abstract

We report here a case of a Japanese man with an unusual congenital band-like naevus, consisting of a finely wrinkled skin area with a mosaic of hyper-and hypopigmented spots involving only the right side of his chest. To our knowledge, there are no previous reports of this presentation of congenital naevus. CASE REPORTA 36-year-old Japanese man presented with a band-like pigmentedareaononly the right side of his chest, which had been present since birth. As there had been no particular change in either its colour or size, he had not consulted a dermatologist previously. There was no family history of a similar skin change.On his first visit, he had a well-suntanned skin due to his hobby of marine sports., together with a roughly S-shaped. band-like, and mildly pigmented., lesion localized only on the right side ofthe mid-chest ( Fig. la). Although the skin texture appeared rough due to the presence of fine wrinkles, the lesions were in fact smooth on palpation. On closer inspection, the mildly pigmented plaque appeared more wrinkled than the surrounding normal skin, presenting a reticular pattern dotted with hyper-and hypopigmented spotty areas (Fig. lb). The spotty changes were composed of variously sized, darkly hyperpigmemed, hypopigmented or almost nornial looking, finely wrinkled areas, which did not appear to conform to any ofthe so-far reported cases of congenital skin lesions. He had no other abnormalities in the skin, hair or teeth, and no clinically observable sexual ambiguity or family history of similar skin changes.Histologically, in the darkly hyperpigmented spot, we found atrophie epidermis and basal hypermelanosis that was prominently noted at the tips of elongated rete ridges whose covering stratum corneum was somewhat thickened and compact containing scattered melanin granules. Moreover, there were scattered melanophages among a mild mononuclear cell infiltrate at the perivascular portion ofthe upper dermis. Neither a nest of melanocytes nor sclerosis ofthe dermis was detectable (Fig. 2a). Other mildly hyperpigmented portions showed thin epidermis, mild basal hypermelanosis and a few melanophages in the upper dermis. On the other hand, the hypopigmented spot revealed a thin epidermis covered by rather thick and compact stratum corneum with no changes suggestive of scar or amyloid deposition in the dermis (Fig. 2b). There were neither hair follicles nor eccrine sweat glands in the specimens. He did not require any further treatment for his skin lesion. DISCUSSIONTo our knowledge, the skin changes found in this patient are unique among the types of congenital naevus described to date. Its clinical feature had been stable since birth, showing a well-defined, band-like, finely wrinkled, mildly pigmentary skin area confined to the right side ofthe chest. On a closer examination, this consisted of hyper-, hypo-, and even depigmented spotty areas. If there had been any telangiectatic component, we could have described it as poikilodermatous. Although there was no clinical sign of inflammation, histolog...