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Study
January 2002

Melanocytic Proliferations Associated With Lichen Sclerosus

Author Affiliations

From the Divisions of Dermatology and Dermatopathology (Dr Carlson), Department of Pathology, Albany Medical College, Albany, NY (Drs Carlson, Mu, and Mihm); Department of Pathology, University of Tennessee, Memphis (Dr Slominski); Department of Dermato-Venerology, Bispebjerg Hospital, Copenhagen, Denmark (Dr Weismann); Regional Medical Laboratories, Tulsa, Okla (Dr Crowson); Associates in Gynecologic Care, Albany (Dr Malfetano); M. D. Anderson Cancer Center, Houston, Tex (Dr Prieto); and Department of Pathology, Massachusetts General Hospital, Boston (Dr Mihm).

Arch Dermatol. 2002;138(1):77-87. doi:10.1001/archderm.138.1.77
Abstract

Objectives  To describe the clinicopathologic features of melanocytic proliferations associated with lichen sclerosus (LS) and to compare these findings with those in controls.

Design  Cohort study.

Setting  Academic and private practice dermatology and dermatopathology services.

Patients  Cases of melanocytic proliferations associated with LS and consecutive controls with persistent (recurrent) melanocytic nevi, persistent malignant melanomas, and compound melanocytic nevi.

Main Outcome Measures  Diagnostic criteria and disease recurrence.

Results  Eleven patients, all female, with a mean age of 40 years (range, 8-83 years), presented with pigmented lesions clinically suspected to be malignant melanoma or atypical melanocytic nevi affecting the vulva (7 patients), perineum (3 patients), or chest (1 patient). Lichen sclerosus was first identified in the biopsy specimen and subsequently confirmed clinically. In 10 cases, a melanocytic nevus was superimposed on LS (overlying or entrapped by sclerosis), whereas LS was found at the periphery of vulvar malignant melanoma. After complete excision, no recurrences have been reported for the melanocytic nevi in LS (mean follow-up, 29 months; range, 4-60 months). Compared with control lesions, the LS melanocytic nevi most closely resembled persistent melanocytic nevi and could be distinguished from persistent malignant melanoma histologically. Melanocytes, nevoid or malignant, proliferating contiguously with fibrotic or sclerotic collagen, contained abundant melanin, diffusely expressed HMB-45, and had a higher Ki-67 labeling index than ordinary melanocytic nevi. However, persistent malignant melanoma exhibited mitotic figures, significantly higher Ki-67 labeling index, and deep dermal HMB-45 expression compared with LS melanocytic nevi and persistent melanocytic nevi.

Conclusions  Melanocytic nevi occurring in LS have features in common with persistent melanocytic nevi and can mimic malignant melanoma. An "activated" melanocytic phenotype is seen in LS melanocytic nevi, implicating a stromal-induced change.

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