McClain Colt M, Kantrow Sara M, Abraham Jerrold L, Price Joey, Parker Eva R, Robbins Jason B
*Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN; †Pathology Associates of St Thomas, Nashville, TN; ‡Department of Pathology, SUNY Upstate Medical University, Syracuse, NY; §Cumberland Skin Dermatology, Lebanon, TN; ¶Franklin Dermatology Group, Franklin, TN; and ‖Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN.
Am J Dermatopathol. 2013 Oct;35(7):e115-8. doi: 10.1097/DAD.0b013e318284e37b.
We report 2 cases of patients who presented with blue macules clinically suspicious for blue nevi. One patient had no documented history of trauma or silver exposure, and the other reported exposure to silver over 30 years ago. Microscopic examination revealed a dermal population of brown-black globules predominantly adhering to collagen fibers. In both cases, no melanocytic proliferation was identified by immunohistochemistry. Analysis of the skin biopsies with scanning electron microscopy and energy dispersive x-ray spectroscopy demonstrated the presence of silver and selenium. These findings were diagnostic of localized cutaneous argyria. Our case reports highlight the importance of including localized cutaneous argyria in the differential diagnosis of pigmented lesions.
我们报告了2例临床上表现为蓝色斑疹、怀疑为蓝痣的患者。1例患者无创伤或接触银的记录史，另1例报告30多年前接触过银。显微镜检查显示真皮层有一群棕黑色小球，主要附着于胶原纤维。在这两个病例中，免疫组化均未发现黑素细胞增殖。通过扫描电子显微镜和能量色散X射线光谱对皮肤活检标本进行分析，证实存在银和硒。这些发现可诊断为局限性皮肤银质沉着症。我们的病例报告强调了在色素沉着性病变的鉴别诊断中纳入局限性皮肤银质沉着症的重要性。
