"Melanocytic nevus", or is it?

Richa Pradeep Shindore, Prachi V Gole, Sunanda A Mahajan

 Department of Dermatology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Prachi V Gole
Department of Dermatology, Seth GSMC and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
India

A 40-year-old woman presented with an asymptomatic, well-defined, hyperpigmented, velvety plaque on the right palm [Figure - 1]. She gave a history of an electrical burn at the same site 10 years back for which split-thickness skin grafting was done. The donor site of the graft was right upper arm. The recipient site developed wound contracture, gradual thickening and darkening over time that mimicked melanocytic nevus or epidermal nevus. Unlike epidermal nevus, the lesion was confined only to the grafted skin, melanotic in color, non-blaschkoid and velvety in texture. Dermoscopy showed cerebriform pattern on low power [Figure - 2]a and plugs with microscales on high power [Figure - 2]b. This pattern was similar to acanthosis nigricans, but the sulci were straighter in this lesion. As against this, a benign acral melanocytic nevi would have shown patterns such as parallel furrow, lattice-like, fibrillar, globular, homogenous, reticular or transition. Thus, the diagnosis of melanocytic and epidermal nevus was eliminated. Histopathology showed orthohyperkeratosis, hyperpigmentation of basal layer with thickened bundles of vertical array of collagen in the papillary dermis. These changes were similar to lichen simplex chronicus. We concluded that this was an adaptation of donor skin to the site of the recipient skin leading to lichenification. Secondary contracture and graft hyperpigmentation are known complications of split-thickness skin grafts, especially on sites where graft cannot be fixed to the underlying rigid structure.

Figure 1: Well-defined, regular 4 cm × 2 cm lichenified velvety plaque on right palm

Figure 2

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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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