TITLE:
Nevus changed by recurrent Herpes simplex infection: Reflectance confocal microscopy
AUTHORS:
Marco Palla, Fabrizio Ayala, Gerardo Botti, Paolo Antonio Ascierto
KEYWORDS:
Confocal Microscopy; Melanoma; Naevi; Herpes Simplex Virus
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.2,
February
8,
2014
ABSTRACT: During a screening
program, a 24-year-old woman presented an itchy nodule above the upper lip, 5 ×
5 mm in size with irregular pigmentation, which had enlarged over the previous
three weeks. Personal clinical history revealed a recurrent Herpes virus infection. Dermoscopy
showed light brown irregular pigmentation, milia-like cysts and an atypical
vascular pattern. Reflectance confocal microscopy revealed architectural,
cytologic and vascular features suggestive of melanoma. A Tzanck test revealed
multinucleated keratinocytes with the typical nuclei infected by Herpes virus. Our case shows that
dermoscopy alone, despite its sensitivity and specificity, may not provide
adequate diagnostic accuracy on which to base a surgical decision.
Epiluminescence criteria should be considered together with a clinical evaluation
of the lesion and the patient’s clinical history. Reflectance-mode confocal
microscopy confirmed the difficulty of presurgical diagnosis in this case,
which highlights the importance of traditional cytological analysis in order to
avoid unnecessary surgical treatment.