Isbary G, Coras-Stepanek B, Dyall-Smith D, Guther S, Tillmann A, Stolz W
Department of Dermatology, Allergology and Environmental Medicine, Hospital Munich Schwabing, Munich, Germany.
J Eur Acad Dermatol Venereol. 2014 Sep;28(9):1251-4. doi: 10.1111/jdv.12225. Epub 2013 Aug 6.
Pigmented lesions on the nipple and areola concern patients and physicians as melanoma and pigmented mammary Paget's disease must be considered in the differential diagnoses. There have been only six case reports of melanosis of the nipple and areola in the medical literature yet five cases presented to our department in a 26-month period.
Five women aged between 26 and 34 years presented with pigmentation of the areola and/or nipple. Two patients were pregnant and one also had vitiligo. All lesions were solitary, eccentrically located with a sharp but irregular contour, and homogeneous pigmentation. Dermoscopy was performed and reassuring features included light to dark brown cobblestone pigmentation with ring-like structures and reticulation. Blue-white veil and irregular centred black dots were not seen. Histology confirmed melanosis of the nipple and areola.
Melanosis of the nipple and areola is probably significantly underreported in the medical literature and, based on our experience, is likely to be the most common cause of pigmentation at this site. Considering this, benign condition on clinical and dermoscopic features should lead to biopsy rather than excision to confirm the diagnosis. Further reports of the dermoscopic features will help to define this condition further.
乳头和乳晕上的色素沉着病变引起患者和医生的关注，因为在鉴别诊断中必须考虑黑色素瘤和色素性乳腺佩吉特病。医学文献中仅有6例乳头和乳晕黑变病的病例报告，但在26个月内有5例患者前来我院就诊。
5名年龄在26至34岁之间的女性出现乳晕和/或乳头色素沉着。2名患者怀孕，1名患者同时患有白癜风。所有病变均为单发，位于偏心位置，轮廓清晰但不规则，色素沉着均匀。进行了皮肤镜检查， reassuring特征包括浅棕色至深棕色鹅卵石样色素沉着伴环状结构和网状结构。未见蓝白色薄纱和不规则的中心黑点。组织学证实为乳头和乳晕黑变病。
乳头和乳晕黑变病在医学文献中的报道可能明显不足，根据我们的经验，它可能是该部位色素沉着最常见的原因。考虑到这一点，基于临床和皮肤镜特征的良性病变应进行活检而非切除以确诊。进一步报道皮肤镜特征将有助于进一步明确这种情况。
