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Eruptive Acral Nevi Secondary to Treatment With Chemotherapy

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1 Credit CME

A 4-year-old boy undergoing maintenance chemotherapy for acute lymphoblastic leukemia presented with a new eruption of junctional nevi on the dorsum of both feet (Figure). The lesions were brought to the dermatologist’s attention by the patient’s parent during a follow-up for eczematous dermatitis. At the time of presentation, the patient’s chemotherapy regimen followed the Children's Oncology Group protocol AALL0932, comprising mercaptopurine, methotrexate, vincristine, dexamethasone, and trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis jirovecii pneumonia. Differential diagnoses included eruptive nevi and genodermatoses associated with melanocytic nevi, including Noonan syndrome, Carney complex, and familial atypical multiple mole-melanoma syndrome.1 Physical examination revealed scant melanocytic nevi outside the new eruptions and was otherwise noncontributory. The patient had even skin pigmentation, normal facies, and age-appropriate cognition. Dermoscopy results revealed small, evenly pigmented globules typical of eruptive nevi. Due to the patient’s age and the benign appearance of the nevi using a dermatoscope, histologic examination was not conducted. Given the appearance of the lesions, the patient’s history of immunosuppression, and the lack of findings suggestive of an underlying genetic syndrome, this presentation was considered most in keeping with eruptive nevi.

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Article Information

Corresponding Author: Catherine J. Stewart, MSc, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada (catherine.stewart@ucalgary.ca).

Published Online: May 17, 2023. doi:10.1001/jamadermatol.2022.6543

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s mother for granting permission to publish this information.

References
1.
Ramseier  JY , Perkins  SH .  Genodermatoses associated with melanocytic nevi.   Clin Dermatol. 2022;40(4):339-354. doi:10.1016/j.clindermatol.2022.02.007PubMedGoogle ScholarCrossref
2.
Burian  EA , Jemec  GBE .  Eruptive melanocytic nevi: a review.   Am J Clin Dermatol. 2019;20(5):669-682. doi:10.1007/s40257-019-00444-8PubMedGoogle ScholarCrossref
3.
O’Connor  C , Ryan  C , Murphy  L-A .  Eruptive acral lentiginosis following chemotherapy for acute lymphoblastic leukemia: a case series.   Clin Case Rep. 2021;9(10):e05015. doi:10.1002/ccr3.5015PubMedGoogle ScholarCrossref
4.
Reutter  JC , Long  EM , Morrell  DS , Thomas  NE , Groben  PA .  Eruptive post-chemotherapy in situ melanomas and dysplastic nevi.   Pediatr Dermatol. 2007;24(2):135-137. doi:10.1111/j.1525-1470.2007.00359.xPubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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