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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 1  |  Page : 127--128

Neurocutaneous melanosis: Authors’ reply

S Karande, MV Kulkarni 
 Division of Pediatric Neurology, Department of Pediatrics, L.T.M. Medical College and L.T.M.G. Hospital, Sion, Mumbai - 400022, India

Correspondence Address:
S Karande
Division of Pediatric Neurology, Department of Pediatrics, L.T.M. Medical College and L.T.M.G. Hospital, Sion, Mumbai - 400022
India




How to cite this article:
Karande S, Kulkarni M V. Neurocutaneous melanosis: Authors’ reply.Neurol India 2004;52:127-128


How to cite this URL:
Karande S, Kulkarni M V. Neurocutaneous melanosis: Authors’ reply. Neurol India [serial online] 2004 [cited 2021 Sep 21 ];52:127-128
Available from: https://www.neurologyindia.com/text.asp?2004/52/1/127/6727


Full Text

Sir,

We thank the author(s) of the letter for taking interest in our article “Multiple giant congenital melanocytic nevi with central nervous system melanosis: a case report”.[1] We would like to reply to the three points raised as follows. Firstly, the diagnosis of neurocutaneous melanosis in our patient is 'definite' and is based on guidelines mentioned in 'recent literature'.[2],[3] The diagnosis of multiple giant congenital melanocytic nevi (GCMN) is straightforward, a spot diagnosis, and doesn't require a skin biopsy. On examining our patient, the same clinical diagnosis of “multiple GCMN” was made by a senior dermatologist and plastic surgeon in our institute. Although the neonate was neurologically normal, the presence of GCMN on scalp and dorsal spine prompted us to recommend a MRI brain study to screen for central nervous system (CNS) melanosis and operable presymptomatic non-melanocytic anomalies of the CNS.[2] Eventually, MRI in our patient could be done at six weeks of age, as the parents took time to arrange money for this investigation. The diagnosis of CNS melanosis was made in our patient because of the presence of highly characteristic melanin deposits in the MRI study.[3] This is the only method to diagnose CNS melanosis in a living patient.[3] Secondly, in our patient there were no clinical indicators suggestive of a developing cutaneous melanoma, viz. changes in colour, size, shape, rapid growth rate, proliferative nodules or ulceration, in any of the GCMN. Hence doing a skin biopsy to rule out a developing cutaneous melanoma was not indicated. We would like to mention that malignant transformation within GCMNs is exceptionally rare in the neonate and has been reported in only three neonates.[4] This recent review has stated that even if clinical indicators of cutaneous melanoma are present, careful histological evaluation may eventually reveal the lesion to be benign.[4] Also, the melanin deposits detected in our patient's MRI did not reveal any perilesional edema or necrosis or enhancement with gadolinium contrast; ruling out malignant degeneration.[3] Thirdly, the presence of melanin deposits in our patient's amygdala and thalami is not 'strange'. A recent report has stated that the most common area of involvement in their case series was the amygdala; detected in eight out of 10 MRIs.[5] Also presence of melanin deposits in thalami in cases of neurocutaneous melanosis is common.[2]

References

1Ahuja SR, Karande S, Kulkarni MV. Multiple giant congenital melanocytic nevi with central nervous system melanosis. Neurol India 2003;51:541-3.
2Kinsler VA, Aylett SE, Coley SC, Chong WK, Atherton DJ. Central nervous system imaging and congenital melanocytic naevi. Arch Dis Child 2001;84:152-5.
3Barkovich AJ, Frieden IJ, Williams ML. MR of neurocutaneous melanosis. AJNR Am J Neuroradiol 1994;15:859-67.
4Leech SN, Bell H, Leonard N, Jones SL, Geurin D, McKee PH, et al. Neonatal giant congenital nevi with proliferative nodules: a clinicopathologic study and literature review of neonatal melanoma. Arch Dermatol 2004;140:83-8.
5Foster RD, Williams ML, Barkovich AJ, Hoffman WY, Mathes SJ, Frieden IJ. Giant congenital melanocytic nevi: the significance of neurocutaneous melanosis in neurologically asymptomatic children. Plast Reconstr Surg 2001;107:933-41.