Pseudomelanoma AKA Recurrent Nevus

Pseudomelanoma (also known as a “Recurrent nevus”) is a cutaneous condition in which melantic skin lesions clinically resemble a superficial spreading melanoma at the site of a recent shave removal of a melanocytic nevus.

Problem with the Recurrent Nevus

The melanocytes left behind in the wound regrows in an abnormal pattern. Rather than the even and regular lace like network, the pigments tends to grow in streaks of varying width within the scar. This is often accompanied by scarring, inflammation, and blood vessel changes - giving both the clinical and histologic impression of a melanoma or a severe dysplastic nevus. When the patient is reexamined years later without the assistance of the original biopsy report, the physician will often require the removal of the scar with the recurrent nevus to assure that a melanoma is not missed.

Saucerization biopsy

Also known as “scoop”, “scallop”, or “shave” excisional biopsy, or “shave” excision. A trend has occurred in dermatology over the last 10 years with the advocacy of a deep shave excision of a pigmented lesion. An author published the result of this method and advocated it as better than standard excision and less time consuming. The added economic benefit is that many surgeons bill the procedure as an excision, rather than a shave biopsy.

This save the added time for hemostasis, instruments, and suture cost. The great disadvantage, seen years later is the numerous scallop scars, and a very difficult to deal with lesions called a “recurrent melanocytic nevus”. What has happened is that many “shave” excisions does not adequately penetrate the dermis or subcutanous fat enough to include the entire melanocytic lesion. Residual melanocytes regrow into the scar. The combination of scarring, inflammation, blood vessels, and atypical pigmented streaks seen in these recurrent nevus gives the perfect dermatoscopic picture of a melanoma.

When a second physicians re-examine the patient, he or she has no choice but to recommend the reexcision of the scar. If one does not have access to the original pathology report, it is impossible to tell a recurring nevus from a severely dysplastic nevus or a melanoma. As the procedure is widely practiced, it is not unusual to see a patient with dozens of scallop scars, with as many as 20% of the scar showing residual pigmentation. The second issue with the shave excision is fat herniation, iatrogenic anetoderma, and hypertrophic scarring. As the deep shave excision either completely remove the full thickness of the dermis or greatly diminishing the dermal thickness, subcutanous fat can herniate outward or pucker the skin out in an unattractive way. In areas prone to friction, this can result in pain, itching, or hypertrophic scarring.

See also

* Ballon cell nevus ; Balloon cell nevi are a cutaneous condition characterized histologically by large, pale, polyhedral balloon cells.

* Skin lesion; Most dermatoses present with skin lesions of more or less distinct characteristics. Macroscopically, these original lesions are known as the “primary lesion”, and identification of such lesions is “…the most important aspect of dermatologic examination.” However, these lesions may continue to develop or be modified by regression or trauma, producing “secondary lesions”. Additionally, on the microscopic level, these lesions can also be characterized by a distinct set of vocabulary.

FAQ on Sunscreens and Sunburns

1. “How Much Sunscreen Should I Apply?”

The average user of sunscreen tends to use significantly less sunscreen than the amount required to achieve the SPF listed on the container.

2. “How Often Should I Apply Sunscreen When I’m Out In The Sun?’”

Many experts recommend that frequent application during sun exposure is required. However, a group of children were tested by spreading on 1 application of sunscreen to one side of their bodies, and four applications to the other.

They then spent 6 hours in the sun. One application provided the same level of protection as four applications, confirming the adequacy of a single daily application of a sunscreen in that situation.

3. “How Long Before Sun Exposure Should I Apply Sunscreen To My Skin?”

As molecules of sunscreen are present in their active state in the sunscreen, sunscreens work immediately upon application. The only reason for application early is to allow absorption into the skin so that the sunscreen is less likely to be washed off, should the person be entering the water. Even so, modern sunscreens are quite resistant to removal from the skin.

4. “Sun Protection Factor (SPF) - What Is It?”

SPF is the ratio of the minimal ultraviolet dose required to produce redness with and without a sunscreen. For example, if it took ½ hour for your skin to become sunburned without any sunscreen, then for a sunscreen that has a 15 SPF rating, you could stay in the sun for 15 times longer (or 7.5 hours) before you get sunburned. This is provided, of course, that you’ve applied the sunscreen properly so that you’re getting the prescribed protection.

5. “Reactions To Sunscreens?”

Sunscreens can be both an irritant and an allergen, though allergic reactions are rare. Irritant reactions, however, abound. One classic error in sunscreen application is to put a large amount of sunscreen on the forehead. Perspiration and gravity can cause the sunscreen to migrate down your forehead into your eyes, causing a stinging sensation. Some people attribute this to an allergic reaction and discontinue use. It’s also important to wash your hands after applying sunscreen, since rubbing your sunscreen covered finger near your eyes can induce an irritant reaction.

6. “Why Is It Important To Use Sunscreens During Childhood?”

It appears that a great deal of time can elapse between actual sun damage and the development of skin cancer or other skin problems like photoaging. Therefore, it is important to protect your skin from an early age when you are out in the sun.

7. “Sunscreens And The Elderly?”

Many elderly people can become quite obsessed by sun avoidance, and their quality of life can suffer. Sometimes, if they are diagnosed with an actinic keratosis or basal cell carcinoma, they can become anxious and almost leap from shadow to shadow. However, few of them are likely to develop new skin cancers from present sun exposure. As long as they are prudent about avoiding excessive sun exposure and protecting their skin to prevent sunburn, they can continue to enjoy time outdoors.

8. “Can Sunscreens Prevent Cancer?”

There is clear evidence that sunscreens are helpful in preventing actinic keratoses, which are warty lesions that can occur on sun-exposed skin of the face or hands. Research has shown that these lesions can develop into a cancer called squamous cell carcinoma, and that this is linked to a cumulative exposure to the sun.

However, there is surprisingly little evidence that sunscreens have much effect in preventing another kind of skin cancer called basal cell carcinoma, or for malignant melanoma. For malignant melanoma and for basal cell carcinoma, the character and timing, that is, the type of sunlight and your age at the time of the exposure to the sun appears to be more important than the cumulative dose.

Adapted from an article by David I. McLean, MD, and Richard Gallagher, MA.

Skincare for dry, wrinkled or sun-damaged skin

Many of us, women especially, can relate to the phrase, “I just don’t have the time.” Conversely, if you grew up in any generation or location that frowned upon wearing makeup or using ‘beauty products’ as ‘unnatural’, you might have recently had second thoughts as those lines began to show a little too much, or those dark spots were just getting darker.

You have lived long enough to know “beauty isn’t everything,” but the truth is, when it starts to fade, boy, does it sure seem more important!
Regardless of the circumstance that finally brought you to shock the last time you looked in the mirror, the good news is; there are always second chances when it comes to taking care of your skin.

The older you are, the more important it is to get started with a quality skin care regimen.

Three simple steps can aid your skin back the face you knew yesterday. You might have heard this before, but here it is again…just in case you need a refresher.

1. Cleanse - but gently. Too many professional skin care products strip your facial skin of the natural elements it needs to keep your skin soft and supple. Using a mild cleanser with a very light, delicate scent that won’t leave your face feeling tight and dry. For damaged, wrinkled skin, a moisturizing cleanser or cream cleanser is best.

2. Exfoliate - Many exfoliating products using sand or walnut shells can be too harsh to use daily - try to find a gentle exfoliating product – a natural clay or organic oatmeal. Natural skin care products tend to be less irritating and will not only exfoliate the grime and pollution of the day from your delicate facial skin, they also moisturize, soften, and increase your body’s collagen and antioxidant production.

3. Moisturize - Use a dry skin care anti aging lotion each morning after cleansing. Excellent high quality moisturizers not only replace vital moisture in your face but leave it soft and smooth. Additional moisture will also supplement the antioxidants your skin needs to produce to stay looking healthy and young. If you use an SPF of in your moisturizer or foundation, it will also help protect your face from sun damage throughout the day.

One more thing…

The goal of your skin care routine is to address wrinkles, dark spots and dryness with products that deliver lighting, moisturizing and anti-wrinkle ingredients.
It’s not enough to get a facial to keep your skin clear and beautiful. You need to have a great home skin-care routine. It never hurts, to get a professional facial to deep cleanse your skin at least four times a year, as the seasons change. Every 4-6 weeks is ideal. But please, throw away the grocery-store soap and use quality skin care products that are right for your skin type. Also, if it still has to be said, wear sunscreen, even on cloudy days and in the winter. Use a good quality, high-SPF sunscreen. Sun damage is the single most important cause of premature aging. Last, if you have a tendency to engage in skin-damaging habits like smoking, excessive drinking, and tanning booths, please try to reduce or eliminate these habits altogether.

Remember, you want your skin to reflect and shine the beauty that we know you already are on the inside. Make all those years of wisdom and experience show on the outside as well.