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Kissing nevus of the penis.
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PMID:  22148023     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Kissing or divided nevi are similar in shape to congenital melanocytic nevi located on an adjacent part of the body that are separated during embryogenesis. Kissing nevi of the upper and lower eyelids have been reported infrequently since the first report in 1908. Kissing nevi of the penis are very rare, with only 12 cases being reported until now, and this is the first case report in the Korean dermatological literature. A previously healthy 27-year-old man presented with asymptomatic black colored patches, which were detected 10 years ago, on the glans penis and the prepuce with growth in size. We report here a case of kissing nevus of the penis, which showed an obvious mirror-image symmetry relative to the coronal sulcus.
Authors:
Sook Jung Yun; Hyun Seung Wi; Jee-Bum Lee; Seong-Jin Kim; Young Ho Won; Seung-Chul Lee
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Publication Detail:
Type:  Journal Article     Date:  2011-11-03
Journal Detail:
Title:  Annals of dermatology     Volume:  23     ISSN:  2005-3894     ISO Abbreviation:  Ann Dermatol     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-07     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8916577     Medline TA:  Ann Dermatol     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  512-4     Citation Subset:  -    
Affiliation:
Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
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Journal Information
Journal ID (nlm-ta): Ann Dermatol
Journal ID (publisher-id): AD
ISSN: 1013-9087
ISSN: 2005-3894
Publisher: Korean Dermatological Association; The Korean Society for Investigative Dermatology
Article Information
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Copyright © 2011 Korean Dermatological Association; The Korean Society for Investigative Dermatology
open-access:
Received Day: 12 Month: 8 Year: 2010
Revision Received Day: 08 Month: 12 Year: 2010
Accepted Day: 08 Month: 12 Year: 2010
Print publication date: Month: 11 Year: 2011
Electronic publication date: Day: 03 Month: 11 Year: 2011
Volume: 23 Issue: 4
First Page: 512 Last Page: 514
ID: 3229949
PubMed Id: 22148023
DOI: 10.5021/ad.2011.23.4.512

Kissing Nevus of the Penis
Sook Jung Yun, M.D.A1
Hyun Seung Wi, M.D.A1
Jee-Bum Lee, M.D.A1
Seong-Jin Kim, M.D.A1
Young Ho Won, M.D.A1
Seung-Chul Lee, M.D.A1
Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Correspondence: Corresponding author: Seung-Chul Lee, M.D., Department of Dermatology, Chonnam National University Medical School, 671 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-220-6682, Fax: 82-62-222-4058, schul@chonnam.ac.kr

INTRODUCTION

Kissing nevi are a rare clinical variation of congenital melanocytic nevi that are located on adjacent sites of the body at which division occurs during embryogenesis. Since the first case report by Von Micheal in 1908, a few kissing nevi have been reported located on the upper and the lower eyelids1-3. A kissing nevus appears to be a single lesion when the lids are closed. These lesions are very rare on the penis, with only 12 cases being reported to date in the English literature, and only one case reported a kissing nevus of the eyelids in the Korean dermatological literature4-12. We report the first case of a patient with a kissing nevus located on the penis in the Korean dermatological literature.


CASE REPORT

In January 2010, a 27-year-old man presented with asymptomatic black colored patches on his penis that were detected 10 years ago when a circumcision was performed. On physical examination, 2.0×1.5 cm and 1.5×1.3 cm-sized black colored patches were located on the prepuce and the lateral glans penis, respectively (Fig. 1). These lesions did not affect the coronal sulcus but were seen on each side of it. The lesions overlapped each other when the prepuce was retracted. His past and family histories were non contributory. Laboratory tests were within normal limits. A skin biopsy was performed on both patches. Histopathological findings showed nests of nevus cells in the dermal-epidermal junction and in the upper dermis (Fig. 2). Immunohistochemical stains revealed a partial positive for HMB45 and a strong positive for melan A (Fig. 2). The black patches were diagnosed as compound melanocytic nevus. We recommended that he be treated with an Nd:YAG laser, but he refused further treatment.


DISCUSSION

In this report, we experienced a rare kissing nevus of the penis. Kissing nevi are two adjacent brownish to black pigmented lesions that split along with division of the body during embryogenesis. Kissing nevi of the eyelids were first described by Von Micheal in 1908, and the name was first used by Fuchs13 in 1919. Since then, at least 45 additional cases have been reported1-12,14-17. Other locations and types of kissing nevi have been reported less frequently than that of the eyelids: nevus spilus of the eyelids15, a divided mast cell nevus16, epidermal nevi of the finger17, and divided nevi of the penis4-11.

The borders that would be united into one and the mirror-image symmetric features are related to its embryologic mechanism. The eyelids start to form at weeks 5~6 of gestation and fuse at weeks 8 to 9 of gestation, then divide again at week 24 of gestation14. A kissing nevus of the eyelids may originate between weeks 8~24 of gestation. During the fused state, melanoblasts are present at the borderline between the upper and lower eyelids. Subsequently, cellular division continues, and one nevus becomes two lesions that were located on adjacent sites.

Kissing nevi of the penis are extremely rare. The first case was reported by Desruelles et al.4 in 1998, and only 12 cases of kissing nevi of the penis have been described4-11(Table 1). The same mechanisms can be applied to these lesions. Two invaginations appear in the digital edge of the penis from gestational week 11~14. The epithelial glandular placode forms the glandular urethra and the epithelial preputial placode divides and forms the glans and the prepuce4. Desruelles et al.4 hypothesized that melanoblasts and melanocytes migrate to the lesion before separation of the glans from the prepuce at 12 weeks. He thought that after separation each nevus may develop independently. In contrast, Kono et al.6 suggested that melanoblasts start to migrate just after completion of the invagination of the preputial epithelial placode.

Usually, almost all kissing nevi lesions of the penis are benign melanocytic nevi, except one case reported by Egberts et al.8 in 2007. Although that patient had no family history and was just 30-years-old when melanoma was detected, his lesions grew rapidly and atypical pigmentation was an unusual clinical feature.

Malignant melanoma of the penis is rare, accounting for <2% of primary penile malignancies. Most cases of malignant melanoma of the penis occur in patients in their sixth and seventh decades18. So, when choosing a therapeutic option for a kissing nevus of the penis, the focus should be on esthetic and functional outcome. Surgical excision and reconstruction by skin grafting using remnant foreskin have been recently performed and showed favorable outcomes10. However, in cases in which nevi are large, as these lesions, surgical excision may cause a scar and deformity of the glans penis. Mandal et al.19 treated congenital nevocellular nevi with a laser and showed satisfactory esthetic results. In our patient, we concluded that laser treatment was the best method to treat his lesion without complications. But, he denied any further treatment and chose observation.

We report here a rare case of kissing nevus of the penis that showed an obvious mirror-image symmetry relative to the coronal sulcus.


References
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2. Harrison R,Okun M. Divided nevus. A clue to the intrauterine development of melanocytic neviArch DermatolYear: 19608223523614400047
3. Hamming N. Anatomy and embryology of the eyelids: a review with special reference to the development of divided neviPediatr DermatolYear: 1983151586387662
4. Desruelles F,Lacour JP,Mantoux F,Ortonne JP. Divided nevus of the penis: an unusual locationArch DermatolYear: 19981348798809681361
5. Choi GS,Won DH,Lee SJ,Lee JH,Kim YG. Divided naevus on the penisBr J DermatolYear: 20001431126112711069553
6. Kono T,Nozaki M,Kikuchi Y,Erçöçen AR,Hayashi N,Chan HH,et al. Divided naevus of the penis: a hypothesis on the embryological mechanism of its developmentActa Derm VenereolYear: 20038315515612735657
7. Phan PT,Francis N,Madden N,Bunker CB. Kissing naevus of the penisClin Exp DermatolYear: 20042947147215347326
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11. Zhou C,Xu H,Zang D,Du J,Zhang J. Divided nevus of the penisEur J DermatolYear: 20102052752820551005
12. Sagong C,Ahn YS,Yu HJ,Kim JS. Congenital divided nevus of the eyelidKorean J DermatolYear: 200745864866
13. Fuchs A. Ueber geteilte naevi der augenliderKlin Monatsbl AugenheikdYear: 191963678683
14. Guerra-Tapia A,Isarría MJ. Periocular vitiligo with onset around a congenital divided nevus of the eyelidPediatr DermatolYear: 20052242742916190993
15. Sato S,Kato H,Hidano A. Divided nevus spilus and divided form of spotted grouped pigmented nevusJ Cutan PatholYear: 19796507512521542
16. Niizawa M,Masahashi T,Maie O,Takahashi S. A case of solitary mastocytoma suggesting a divided form of mast cell nevusJ DermatolYear: 1989164024042600279
17. Hayashi N,Soma Y. A case of epidermal nevi showing a divided form on the fingersJ Am Acad DermatolYear: 1993292812828335757
18. Demitsu T,Nagato H,Nishimaki K,Okada O,Kubota T,Yoneda K,et al. Melanoma in situ of the penisJ Am Acad DermatolYear: 20004238638810640941
19. Mandal A,Al-Nakib K,Quaba AA. Treatment of small congenital nevocellular naevi using a combination of ultrapulse carbon dioxide laser and Q-switched frequency-doubled Nd-YAG laserAesthetic Plast SurgYear: 20063060661017009134

Article Categories:
  • Case Report

Keywords: Nevus, Pigmented.

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