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J Drugs Dermatol 2018 Jul;17(7):810-812

Introduction: Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies. Read More

Acta Dermatovenerol Croat 2018 Jun;26(2):183-185

Ružica Jurakić Tončić, MD, Department of Dermatovenereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Šalata 4, 10000 Zagreb, Croatia;

Dear Editor, There are few literature data about nevi in patients with a history of toxic epidermal necrolysis (TEN) and little recommendations for follow-up and risks of melanoma (MM). Eruptive melanocytic nevi (EMN) is a rare phenomenon that has been associated with bullous disorders, immunosuppression, and immunodeficiency, but in some cases can occur without precipitating factors (1). The etiology is largely unknown, but there is evidence that immunosuppression might play a crucial role in nevogenesis, probably due to the inability of the immune system to inhibit melanocytic (MC) proliferation (2,3). Read More

Acta Derm Venereol 2018 Jun;98(6):556-562

Dermatology Department, Gregorio Marañon General University Hospital and Clinica Dermatologica Internacional, Madrid, Spain.

The aim of this case-case study was to determine the differences between dysplastic and common naevus-associated melanomas (NAM) and de novo melanomas. A total of 1,021 prospectively collected patients with invasive cutaneous melanoma from an oncology referral centre were included in the study. Of these, 75. Read More

Ann R Coll Surg Engl 2018 Apr 15;100(4):330-337. Epub 2018 Mar 15.

University of Queensland, School of Medicine , Brisbane, Queensland , Australia.

Objective There remains confusion between Langer's lines and wrinkle lines with respect to the optimal orientation of elliptical excisions on the trunk. This study sought to determine the directions of wound closure that would result in least wound tension after skin lesion excisions. Materials and methods Some 1181 consecutive skin lesion excisions were investigated (age range 13-95 years, median 64 years) using a tensiometer to determine directions of least wound tension. Read More

Open Access Maced J Med Sci 2018 Jan 24;6(1):1-5. Epub 2017 Dec 24.

Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR-Sofia), General Skobelev 79, 1606 Sofia, Bulgaria.

Globalisation, scientific and technical progress are the basis of numerous innovative therapies for oncologic and non-oncologic diseases. It is another matter how much and by whom they are desired, and whether they have to be applied. When and how often? Innovative approaches should go towards simplification, universal distribution and application while at the same time analysis between the potential initial investment and the achieved final result should be made. Read More

Clin Exp Dermatol 2018 Jul 16;43(5):566-572. Epub 2018 Feb 16.

Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: High naevus count (HNC) (≥ 50 naevi) and presence of dysplastic naevi (DN) are risk factors for malignant melanoma (MM); however, MMs also occur in patients with low naevus count (LNC) (< 50 naevi) and in patients without DN. Little is known about differences between MMs in these groups.

Aim: To characterize the clinicopathological differences between MMs in patients with HNC and those in patients with LNC, with or without biopsy-proven DN. Read More

J Am Acad Dermatol 2018 Aug 4;79(2):367-369. Epub 2018 Jan 4.

Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

J Am Acad Dermatol 2018 05 11;78(5):913-919. Epub 2017 Nov 11.

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address:

Background: Shiny white streaks (SWSs) are best visualized with polarized dermoscopy and correlate with dermal fibroplasia histopathologically. SWSs have been described at higher frequencies in melanomas than in benign nevi.

Objective: We assessed the diagnostic value of different patterns of SWSs and their histologic correlate in melanocytic lesions. Read More

Pathology 2018 Jan 10;50(1):16-23. Epub 2017 Nov 10.

Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia; Melanoma Institute of Australia, The University of Sydney, North Sydney, Australia; Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

A stepwise progression from melanocytic precursors to cutaneous melanoma is a well-established model, based on decades of careful observation and morphological analysis. The steps identified are benign melanocytic naevus, dysplastic naevus, 'radial growth phase' melanoma (including melanoma in situ) and 'vertical growth phase' melanoma (also termed tumourigenic melanoma). Recent genomic data have refined the understanding of the steps of melanoma development and their relationship to one another. Read More

Australas J Dermatol 2017 Nov 2;58(4):304-307. Epub 2017 Nov 2.

South East Dermatology, Brisbane, Queensland, Australia.

Background/objectives: The management of dysplastic naevi based on histopathological grading is a contentious issue. Comprehensive management guidelines are lacking and the approach taken varies between clinicians. The authors sought to understand how Australian dermatologists approach the management of biopsy-proven dysplastic naevi, and the impact of grading of dysplasia upon this management. Read More

J Am Acad Dermatol 2017 11;77(5):e147

Department of Dermatology, Baylor College of Medicine, Houston, Texas; Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas. Electronic address:

J Am Acad Dermatol 2017 11;77(5):e145-e146

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Florida Center for Dermatology, PA, Saint Augustine, Florida. Electronic address:

Practitioner 2017 01;261(1800):23-7

More than 200 hereditary cancer susceptibility syndromes have been described, and it is thought that they account for 5-10% of all cancers. Many have dermatological manifestations (usually lesions, occasionally rashes) which frequently precede other systemic pathology. Dermatological signs are usually non-specific and often trivial in appearance, making their significance easy to overlook and a clinical diagnosis challenging. Read More

J Am Acad Dermatol 2017 Dec 2;77(6):1096-1099. Epub 2017 Oct 2.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. Electronic address:

Background: Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen.

Objective: To evaluate the clinical and histopathologic outcomes of in toto biopsy of DN using a predetermined margin of normal skin. Read More

J Dtsch Dermatol Ges 2017 Oct;15(10):999-1016

Department of Dermatology and Allergology, Augsburg Medical Center, Augsburg, Germany.

In addition to dermoscopy, there are other imaging and biophysical methods for the noninvasive diagnosis of skin lesions. Confocal laser microscopy allows for high-resolution imaging of the epidermis and upper dermis. It is particularly suitable in the differential diagnosis of melanocytic lesions. Read More

JAMA Dermatol 2017 11;153(11):1122-1129

Service de Dermatologie Centre Hospitalier, Lyon Sud, France.

Importance: Genetic testing for melanoma-prone mutation in France, a country with low to moderate incidence of melanoma, is proposed in cases with 2 invasive cutaneous melanomas and/or related cancers in the same patient, or in first- or second-degree relatives (rule of 2). In preclinical studies, these rules led to disclosure of mutation(s) in more than 10% of these families, the threshold widely accepted to justify genetic testing for cancers.

Objective: To reconsider these criteria in a general population testing of patients. Read More

J Am Acad Dermatol 2017 Nov 29;77(5):938-945.e4. Epub 2017 Aug 29.

Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy; Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy. Electronic address:

The reported prevalence of nevus-associated melanoma varies substantially. We performed a systematic review and meta-analysis to determine the incidence and prevalence of this disease; we also performed subanalyses considering age, tumor thickness, and nevus-type classification. In 38 observational cohort and case-control studies, 29. Read More

J Am Acad Dermatol 2017 09;77(3):e85

Department of Dermatology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas. Electronic address:

Biomed Res Int 2017 26;2017:6803756. Epub 2017 Feb 26.

Chair of Pathomorphology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16, 31-351 Kraków, Poland.

Dendritic cells could be involved in immune surveillance of highly immunogenic tumors such as melanoma. Their role in the progression melanocytic nevi to melanoma is however a matter of controversy. The number of dendritic cells within epidermis, in peritumoral zone, and within the lesion was counted on slides immunohistochemically stained for CD1a, CD1c, DC-LAMP, and DC-SIGN in 21 of dysplastic nevi, 27 in situ melanomas, and 21 invasive melanomas. Read More

Acta Derm Venereol 2017 Jun;97(6):720-723

Department of Dermatology, Hospital Clinic, 08012 Barcelona, Spain.

Li-Fraumeni syndrome (LFS) is a rare autosomal dominant disorder caused by a mutation in the p53 gene. Melanoma is considered to be a rare, controversial component of LFS. The aim of this study is to describe the utility of systematic screening for melanoma in patients with LFS and atypical mole syndrome. Read More

J Dermatol 2017 Jun 13;44(6):681-689. Epub 2017 Feb 13.

Department of Dermatology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain.

Digital dermoscopy (DD) follow up is a useful strategy for monitoring patients at high risk of melanoma. Reflectance confocal microscopy (RCM) is a valuable second-level examination after dermoscopy for the evaluation of difficult to diagnose lesions. The aim of this study was to assess the value of RCM in routine DD monitoring of patients at high risk of melanoma. Read More

Melanoma Res 2017 06;27(3):274-276

aDermatologic Unit, Department of Medical Sciences, University of Turin, Turin bSkin Cancer Unit cPathology Unit dBreast Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia eDepartment of Anesthesiology, Surgery and Emergency fDermatology Unit, Second University of Naples, Italy gFirst Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Capsular naevi (CNs) in lymph nodes (LNs) are relatively common, occurring in 3-22% of patients who undergo LN surgery for melanoma. Naevus count is one of the principal risk factors for melanoma, as well as a prognostic factor in melanoma patients. However, little is known about the occurrence of CN in melanoma patients on the basis of their naevus count. Read More

JAMA Dermatol 2016 12;152(12):1408

Ned Tijdschr Geneeskd 2016;160:D216

LUMC, afd. Dermatologie, Leiden.

Dysplastic (atypical) naevi have long been subject to discussion with regard to their nature; even their existence has been doubted. Recently, the atypical naevus has been formally identified by molecular genetic characteristics as an intermediate lesion between banal naevi and melanoma. However, the atypical naevus, as long as it is stable and asymptomatic, is regarded as a benign lesion that does not warrant excision. Read More

J Invest Dermatol 2017 04 24;137(4):905-909. Epub 2016 Nov 24.

Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address:

A well-defined risk factor and precursor for cutaneous melanoma is the dysplastic nevus. These benign tumors represent clonal hyperproliferation of melanocytes that are in a senescent-like state, but with occasional malignant transformation events. To portray the mutational repertoire of dysplastic nevi in patients with the dysplastic nevus syndrome and to determine the discriminatory profiles of melanocytic nevi (including dysplastic nevi) from melanoma, we sequenced exomes of melanocytic nevi including dysplastic nevi (n = 19), followed by a targeted gene panel (785 genes) characterization of melanocytic nevi (n = 46) and primary melanomas (n = 42). Read More

J Am Acad Dermatol 2017 Feb 9;76(2):244-249. Epub 2016 Nov 9.

Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address:

Background: Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited.

Objective: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. Read More

G Ital Dermatol Venereol 2016 Dec;151(6):728-730

Department of Dermatology, Bagcilar Research and Training Hospital, Istanbul, Turkey -

Support Care Cancer 2016 12 27;24(12):4849-4859. Epub 2016 Jul 27.

Centre for Cancer Research, The University of Sydney at The Westmead Institute for Medical Research and Melanoma Institute Australia, Sydney, NSW, 2145, Australia.

Purpose: People with melanoma often report pervasive fears about cancer recurrence, unmet information needs, and difficulties accessing psychological care. Interventions addressing the supportive care needs of people with melanoma are rare, and needs are often overlooked. The study evaluated a newly developed, evidence-based, psycho-educational resource for people with melanoma. Read More

Exp Dermatol 2017 07 19;26(7):615-618. Epub 2016 Dec 19.

Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.

We developed an automated approach for generating quantitative image analysis metrics (imaging biomarkers) that are then analysed with a set of 13 machine learning algorithms to generate an overall risk score that is called a Q-score. These methods were applied to a set of 120 "difficult" dermoscopy images of dysplastic nevi and melanomas that were subsequently excised/classified. This approach yielded 98% sensitivity and 36% specificity for melanoma detection, approaching sensitivity/specificity of expert lesion evaluation. Read More

Am J Dermatopathol 2017 Jan;39(1):49-52

*Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; †Ohio State University Comprehensive Cancer Center, Columbus, OH; and ‡NYC Dermatology and Cosmetic Center, New York, NY.

Epithelial sheath neuroma is a rarely recognized but established entity in the medical literature. First described in 2000 by Requena et al, there have only been 7 published cases to date, mostly in female patients and presenting as symptomatic solitary lesions on the back without a known history of trauma. In 2006, Beer et al described and reviewed a dozen cases in which epithelial sheath neuroma-like features were seen in the advent of a surgical procedure, which was termed "re-excision perineural invasion" and attributed to possible eccrine duct implantation during surgery. Read More

Br J Dermatol 2017 Sep 12;177(3):854-857. Epub 2017 Jul 12.

Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria.

Whether or not pregnancy favours the occurrence and growth of melanoma is a source of controversy in the literature. Several case reports have shown dramatic courses of diseases in pregnancy. We present a case of a 36-year-old woman with multiple naevi with one melanoma detected in 2009 in the first trimester and a second primary melanoma in 2010 in the third trimester of her pregnancy. Read More

J Am Acad Dermatol 2016 Dec 21;75(6):1171-1175. Epub 2016 Sep 21.

Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. Electronic address:

Background: For even seasoned practitioners, early melanomas can be difficult to distinguish from melanocytic nevi. Although serial digital dermoscopy is considered by many to be the gold standard for monitoring patients at high risk, poor compliance can seriously alter efficacy. In 2014, a concerning compliance rate of 25% was reported from a single, private clinic. Read More

J Invest Dermatol 2016 10;136(10):1933-1935

Wellman Center for Photomedicine and Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Mitsui et al. approach the problem of differentiating dysplastic nevi from common melanocytic nevi through a molecular lens. Whereas most of the literature on this topic shines the spotlight toward melanocytes, the focus of this paper is shifted to the tumor microenvironment. Read More

J Am Acad Dermatol 2016 10;75(4):e159

Department of Dermatology/Wellman Center for Photomedicine, Massachusetts General Hospital, Boston; Melanoma Genetics Program/MGH Cancer Center, Massachusetts General Hospital, Boston. Electronic address:

J Am Acad Dermatol 2016 10;75(4):e157

Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address:

Cancer Res 2016 10 16;76(19):5602-5604. Epub 2016 Sep 16.

Department of Dermatology, Keck USC School of Medicine and the Hoag-USC Advanced Skin Cancer Program, Los Angeles, California.

In this issue of Cancer Research, Almassalha and colleagues have proposed a new concept of the development of malignancy, that of the greater genomic landscape. They propose a stressor-related exploration of intracellular genomic sites as a response mechanism. This process can express sites with beneficial or deleterious effects, among them those that promote cell proliferation. Read More

JAMA Dermatol 2016 12;152(12):1327-1334

Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California2Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California.

Importance: Controversy persists regarding the appropriate management of incompletely excised, biopsy-proven, mild and moderate dysplastic nevi (DN).

Objective: To determine long-term risk of associated melanoma in biopsied mild or moderate DN with positive histologic margins that were clinically observed vs reexcised with negative margins.

Design, Setting, And Participants: Retrospective cohort study of mixed referral and community patients from an academic pigmented lesion clinic and dermatology clinics of the affiliated Veteran Affairs medical center with biopsy-confirmed DN with positive histologic margins diagnosed from May 15, 1991, to July 8, 2015, and followed up through May 30, 2016. Read More

PLoS One 2016 3;11(8):e0160146. Epub 2016 Aug 3.

Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.

Background: The similar genetic background of a pair of twins, and the similar environmental impacts to which they are exposed allow an exact and objective investigation of various constitutional and environmental factors in naevus development. As far as we are aware, this is the first published survey that simultaneously examines cutaneous and ocular pigmented lesions in an appreciable sample of identical and non-identical twins.

Methods: 172 pairs of twins of Caucasian origin were included in this study. Read More

J Invest Dermatol 2016 12 22;136(12):2453-2461. Epub 2016 Jul 22.

Department of Dermatology and Venereology, University Hospital Centre (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland. Electronic address:

Differentiation of proliferative nodules in giant congenital nevi from melanoma arising within such nevi is an important diagnostic challenge. DNA methylation is a well-established epigenetic modification already observed in the earliest stages of carcinogenesis, which increases during melanoma progression. The ten-eleven translocation enzymes catalyze the oxidation of 5-methylcytosine to 5-hydroxymethylcytosine (5-hmC), which has recently been reported as an epigenetic hallmark associated with tumor aggressiveness and poor prognosis in a wide variety of cancers. Read More

J Am Acad Dermatol 2016 Aug;75(2):e55-6

Department of Dermatology at Instituto Valenciano de Oncología, Valencia, Spain.

Vojnosanit Pregl 2016 May;73(5):449-57

Background/aim: Melanoma is the most aggresive malignant tumor of the skin. Contradictory data was published on vascular endothelial growth factor (VGEF) in tumor samples and its role in skin melanoma progression and prognosis. The aim of this study was to investigate the significance of VEGF expression as a prognostic parameter in melanoma. Read More

J Invest Dermatol 2016 10 1;136(10):2030-2040. Epub 2016 Jul 1.

Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA. Electronic address:

Dysplastic nevi (DNs), also known as Clark's nevi or atypical moles, are distinguished from common melanocytic nevi by variegation in pigmentation and clinical appearance, as well as differences in tissue patterning. However, cellular and molecular differences between DNs and common melanocytic nevi are not completely understood. Using cDNA microarray, quantitative RT-PCR, and immunohistochemistry, we molecularly characterized DNs and analyzed the difference between DNs and common melanocytic nevi. Read More

Roum Arch Microbiol Immunol 2015 Jul-Dec;74(3-4):105-11

Unlabelled: The authors' interest was focused on prolactin status in patients with melanocytic lesions and on changes induced by interferon treatment in melanoma patients.

Material And Method: The study lasted 5 years and included 128 melanoma patients, 48 dysplastic nevi patients and 48 healthy volunteers. Sixty melanoma cases were selected after surgical removal of tumor and divided into 2 groups: 30 patients with 10 MUmp(-1) interferon alpha2b treatment, three times a week, one year and 30 patients without interferon treatment. Read More

J Invest Dermatol 2016 09 21;136(9):1858-1865. Epub 2016 May 21.

Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. Electronic address:

Genital melanomas (GM) are the second most common cancer of the female external genitalia and may be confused with atypical genital nevi (AGN), which exhibit atypical histological features but have benign behavior. In this study, we compared the clinical, histological, and molecular features of 19 GM and 25 AGN. We described chromosomal copy number aberrations and the mutational status of 50 oncogenes and tumor suppressor genes in both groups. Read More

Semin Oncol 2016 06 23;43(3):347-52. Epub 2016 Feb 23.

Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC. Electronic address:

Genitourinary cancers are associated with a range of cutaneous syndromes, which can reflect direct metastatic spread, non-metastatic manifestations of malignancy or the consequences of treatment. More than 220,000 new cases of prostate cancer occur each year in the United States, and thus the associations with cutaneous involvement are quite well documented-rare metastatic spread, vasculitic and hemorrhagic syndromes. Cancers of the bladder and kidney may be associated with direct cutaneous metastases, vasculitic syndromes, hereditary leiomyomatosis, and other familial syndromes. Read More

Acta Dermatovenerol Croat 2016 Apr;24(1):73-7

Ewelina Bogumiła Zuba, MD, Medical University of Poznan, 49 Przybyszewskiego St, 60-355 Poznan, Poland;

Dear Editor, Ultraviolet (UV) radiation is a well-known physical hazard responsible for photoaging, photoallergic, and phototoxic reactions as well as carcinogenesis, including life-threatening melanomas (1,2). Overexposure to both natural and artificial UV radiation is a public health concern. 30% of cancers diagnosed worldwide are skin cancers. Read More

J Am Acad Dermatol 2016 May;74(5):1026-8

Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas.

Pathology 2016 Feb 16;48(2):147-54. Epub 2016 Jan 16.

Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States. Electronic address:

Tumours progress to fully malignant neoplasms through stages of development in a stepwise process. A carcinogenic stimulus such as UV light typically results in a large number of lesions, most of which are benign. Most such lesions will remain stable or regress, while a few will develop cytological and architectural atypia, placing them in a morphologically 'intermediate' category between wholly benign and fully malignant. Read More

Georgian Med News 2016 Feb(251):58-64

1Department "Medicinal Information and Non-interventional studies", Bulgarian Drug Agency, Sofia, Bulgaria; 2"Onkoderma"- Ambulatory Clinic for Dermatology and Skin Surgery, Sofia, Bulgaria; 3Department of General and Clinical Pathology, Medical Faculty, "Saint Kliment Ohridski University"; 4Dermatology Department, University Hospital of Coimbra, Praceta Mota Pinto, Portugal; 5Department of General and Clinical pathology, Medical University of Plovdiv, Bulgaria; 6Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.

We describe a rare case of a 28 year-old male patient presenting with pruritus and increased sensitivity of the prepuce accompanied by erythematous confluent papules, unilateral nevus flammeus (NF) along almost the whole length of the right lower limb and two dysplastic nevi (DN), one located on the mid back and the other on the medial border of the right fifth toe, the latter coinciding with the NF. A biopsy of the prepuce revealed lichen sclerosus et atrophicus (LSA). Mental health assessment revealed anxiety disorder and predisposition to panic attacks. Read More