Martínez-Ortega Jesús Iván, Franco González Samantha, Fernández-Reyna Ilse
Dermatology, Jalisco Dermatology Institute, Zapopan, MEX.
Internal Medicine, National Medical Center 21st Century, Mexico City, MEX.
Cureus. 2024 Jul 26;16(7):e65453. doi: 10.7759/cureus.65453. eCollection 2024 Jul.
Facial melanoses (FM) present complex diagnostic and therapeutic challenges, particularly in the setting of dermal melanocytoses (DM). We present a case that illustrates these challenges as it does not fit within existing classification frameworks. Initially considered as Ota nevus, characterized by blue or dark pigmentation and scleral involvement, histopathological findings suggested acquired bilateral nevus of Ota-like macules (ABNOM). While ABNOM, more common in Asians, rarely affects the sclera or children, recent studies indicate that it may be underdiagnosed in these groups. Differential diagnosis ruled out other FM causes due to mucosal involvement. Correct classification is essential for epidemiological accuracy and treatment decisions, especially given varying responses to Q-switched laser therapy and melanoma risks associated with Ota nevus and ABNOM. While the pathogenesis remains unclear, a two-hit model involving shared melanoma mutations in melanocytes has been proposed and warrants further molecular study.
面部色素沉着症（FM）带来了复杂的诊断和治疗挑战，尤其是在皮肤黑素细胞增多症（DM）的情况下。我们展示了一个病例，该病例说明了这些挑战，因为它不符合现有的分类框架。最初被认为是太田痣，其特征为蓝色或深色色素沉着以及巩膜受累，组织病理学结果提示获得性双侧太田痣样斑（ABNOM）。虽然ABNOM在亚洲人中更为常见，很少影响巩膜或儿童，但最近的研究表明，在这些人群中它可能未得到充分诊断。鉴别诊断排除了因黏膜受累导致的其他FM病因。正确分类对于流行病学准确性和治疗决策至关重要，特别是考虑到调Q激光治疗的不同反应以及与太田痣和ABNOM相关的黑色素瘤风险。虽然发病机制尚不清楚，但已提出一种涉及黑素细胞中共享黑色素瘤突变的双打击模型，值得进一步进行分子研究。
