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Realizada ex&#233;rese com hip&#243;tese de carcinoma basocelular&#44; espiradenoma e hidradenoma&#46; Ao exame anatomopatol&#243;gico&#44; foi identificada neoplasia d&#233;rmica de c&#233;lulas basaloides de aspecto mon&#243;tono&#44; sem conex&#227;o com a epiderme&#44; dispostas em blocos coesos&#44; com &#225;reas c&#237;sticas&#44; forma&#231;&#227;o de ocasional pali&#231;ada perif&#233;rica e m&#250;ltiplos focos de pigmenta&#231;&#227;o &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Os blocos de c&#233;lulas epiteliais estavam envoltos por estroma fibroso hipercelular exibindo numerosas c&#233;lulas em fuso sem atipias&#46; Foi identificado artefato em fenda entre o estroma neopl&#225;sico e a derme adjacente&#46; N&#227;o foi observada calcifica&#231;&#227;o&#44; ulcera&#231;&#227;o e&#47;ou cistos c&#243;rneos&#46; Para quantifica&#231;&#227;o dos melan&#243;citos e diferencia&#231;&#227;o de um tricoblastoma pigmentado&#44; foi realizado o estudo imuno&#8208;histoqu&#237;mico &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41; utilizando contra colora&#231;&#227;o com magenta para evitar influ&#234;ncia do pigmento de melanina na interpreta&#231;&#227;o das l&#226;minas&#46; A neoplasia foi positiva para coquetel de citoceratina &#40;clone&#58; AE1&#47;AE3&#41;&#44; e a positividade para Melan&#8208;A &#40;clone A103&#41; destacou a presen&#231;a de numerosos melan&#243;citos intratumorais&#46; Realizada tamb&#233;m marca&#231;&#227;o para Ki&#8208;67&#44; que evidenciou positividade esparsa em c&#233;lulas predominantemente na periferia do tumor&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Trata&#8208;se do sexto caso descrito dessa neoplasia na literatura vigente&#46; Ao analisar os dados cl&#237;nicos dos casos previamente descritos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#44; observa&#8208;se localiza&#231;&#227;o preferencial no couro cabeludo&#44; m&#233;dia de idade de 45 anos&#44; maior frequ&#234;ncia entre mulheres e rara associa&#231;&#227;o com nevo seb&#225;ceo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Descrita pela primeira vez em 2002<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> como variante distinta do tricoblastoma&#44; o melanotricoblastoma ainda permanece como entidade pouco conhecida entre dermatologistas e patologistas&#59; o carcinoma basocelular &#40;CBC&#41; pigmentado &#233; seu principal diagn&#243;stico diferencial&#46; Destaca&#8208;se que essa diferencia&#231;&#227;o se torna importante em virtude do progn&#243;stico e do seguimento&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Estudos em dermatoscopia<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> demonstraram que&#44; ao contr&#225;rio do CBC&#44; 87&#37; dos TB s&#227;o les&#245;es sim&#233;tricas&#44; com &#225;rea azul&#8208;acinzentada homog&#234;nea &#250;nica &#40;em contraste com os m&#250;ltiplos ninhos ovoides do CBC&#41;&#46; Sessenta e um por cento dos TB podem ter telangiectasias arboriformes&#44; e 69&#44;6&#37; podem ter estruturas brancas &#40;cris&#225;lides inclusas&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Em rela&#231;&#227;o &#224; histopatologia&#44; ambas s&#227;o neoplasias de c&#233;lulas basaloides as quais podem apresentar variados padr&#245;es arquiteturais&#58; grandes blocos s&#243;lidos com &#225;reas c&#237;sticas&#44; micron&#243;dulos&#44; padr&#227;o adenoide&#8208;c&#237;stico&#44; em cord&#245;es etc&#46; No entanto&#44; os tricoblastomas n&#227;o apresentam conex&#227;o com a epiderme&#44; exibem estroma hipercelular caracter&#237;stico e artefato em fenda entre o estroma neopl&#225;sico e a derme adjacente&#46; J&#225; o CBC geralmente apresenta conex&#227;o com a epiderme ou epit&#233;lio folicular&#44; estroma com alguma diferencia&#231;&#227;o mixoide e artefato em fenda entre os blocos epiteliais da neoplasia e a derme&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Um estudo avaliou a express&#227;o dos genes <span class="elsevierStyleItalic">BRAF</span>&#44; <span class="elsevierStyleItalic">NRAS</span>&#44; <span class="elsevierStyleItalic">KRAS</span> e <span class="elsevierStyleItalic">HRAS</span>&#44; e observou muta&#231;&#227;o do <span class="elsevierStyleItalic">HRAS</span> tanto em um nevo seb&#225;ceo quanto no TB originado dele&#44; indicando poss&#237;vel origem em comum&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> H&#225; casos relatados de m&#250;ltiplas les&#245;es derivadas do nevo seb&#225;ceo&#44; como a <span class="elsevierStyleItalic">syringocystadenoma papilliferum</span>&#44; tricoblastoma&#44; adenoma tubular ap&#243;crino&#44; sebaceoma&#44; tumor de infund&#237;bulo folicular e epitelioma com diferencia&#231;&#227;o seb&#225;cea&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> No entanto&#44; a neoplasia deste relato &#233; ainda mais incomum&#44; e sua diferen&#231;a consiste na prolifera&#231;&#227;o melanoc&#237;tica intratumoral e n&#227;o apenas a presen&#231;a de pigmento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">H&#225; um caso relatado na literatura de melanoma associado a melanotricoblastoma&#44; intitulado tricoblastomelanoma&#44; de uma paciente de 62 anos com les&#227;o de crescimento lento desde a inf&#226;ncia&#44; medindo 8<span class="elsevierStyleHsp" style=""></span>cm&#44; com linfonodos axilares associados&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> A presen&#231;a de uma c&#225;psula fibrosa sugeriu degenera&#231;&#227;o da les&#227;o para melanoma posterior ao surgimento do TB&#44; e a paciente&#44; ap&#243;s ex&#233;rese ampla&#44; apresentava dois anos de seguimento sem progress&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Nesse caso&#44; foi observada a muta&#231;&#227;o NRAS&#44; rara muta&#231;&#227;o presente em melanomas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nosso caso se encaixa naqueles citados anteriormente na literatura&#44; de crescimento lento no couro cabeludo&#44; em mulher de 59 anos de idade&#46; No entanto&#44; n&#227;o se associou a nevo seb&#225;ceo nem ceratose seborreica&#44; como descritos anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;7&#8211;10</span></a> Pela nossa revis&#227;o&#44; trata&#8208;se do sexto caso relatado&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Permanece em discuss&#227;o se o melanotricoblastoma seria uma variante ou um sin&#244;nimo de tricoblastoma pigmentado&#44; uma vez que apenas ap&#243;s o advento da imuno&#8208;histoqu&#237;mica foi poss&#237;vel identificar a presen&#231;a e quantificar os melan&#243;citos nos blocos tumorais&#46; O melanotricoblastoma destaca a forte associa&#231;&#227;o das c&#233;lulas epiteliais e melanoc&#237;ticas presente na estrutura do fol&#237;culo piloso&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A intera&#231;&#227;o entre queratin&#243;citos e melan&#243;citos no surgimento das les&#245;es neopl&#225;sicas ainda &#233; campo pouco explorado e pouco conhecido&#44; e a presen&#231;a de les&#245;es com mistura desses componentes indica haver import&#226;ncia em se conhecer melhor essa rela&#231;&#227;o&#44; at&#233; mesmo num contexto fisiopatol&#243;gico&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Juliana Polizel Ocanha&#8208;Xavier&#58; Conceito&#44; investiga&#231;&#227;o&#44; seguimento e ex&#233;rese cir&#250;rgica&#44; escrita &#8211; original&#44; revis&#227;o e edi&#231;&#227;o&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Jos&#233; C&#226;ndido Caldeira Xavier&#8208;J&#250;nior&#58; Investiga&#231;&#227;o&#44; an&#225;lise histopatol&#243;gica&#44; escrita &#8211; revis&#227;o e edi&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflito de interesses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Refer&#234;ncia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">G&#234;nero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade &#40;em anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tamanho &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Les&#227;o associada a nevo seb&#225;ceo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Kanitakis et al&#46;&#44; 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Kim et al&#46;&#44; 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dorso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Hung et al&#46;&#44; 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quist e DiMaio&#44; 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mizuta et al&#46;&#44; 2021&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Perna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Presente caso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8 cm&nbsp;\t\t\t\t\t\t\n
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Cartas ‐ Dermatopatologia
Melanotricoblastoma: sexto relato de caso na literatura
Juliana Polizel Ocanha‐Xaviera,b,
Corresponding author
jpocanha@gmail.com

Autor para correspondência.
, José Cândido Caldeira Xavier‐Júniorb,c,d
a Departamento de Dermatologia, Clínica Privada, Araçatuba, SP, Brasil
b Departamento de Patologia, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brasil
c Departamento de Patologia, Faculdade de Medicina, Centro Universitário Católico Salesiano Auxilium, Araçatuba, SP, Brasil
d Departamento de Dermatopatologia, Instituto de Patologia de Araçatuba, Araçatuba, SP, Brasil
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3</a>&#41; utilizando contra colora&#231;&#227;o com magenta para evitar influ&#234;ncia do pigmento de melanina na interpreta&#231;&#227;o das l&#226;minas&#46; A neoplasia foi positiva para coquetel de citoceratina &#40;clone&#58; AE1&#47;AE3&#41;&#44; e a positividade para Melan&#8208;A &#40;clone A103&#41; destacou a presen&#231;a de numerosos melan&#243;citos intratumorais&#46; Realizada tamb&#233;m marca&#231;&#227;o para Ki&#8208;67&#44; que evidenciou positividade esparsa em c&#233;lulas predominantemente na periferia do tumor&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Trata&#8208;se do sexto caso descrito dessa neoplasia na literatura vigente&#46; Ao analisar os dados cl&#237;nicos dos casos previamente descritos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#44; observa&#8208;se localiza&#231;&#227;o preferencial no couro cabeludo&#44; m&#233;dia de idade de 45 anos&#44; maior frequ&#234;ncia entre mulheres e rara associa&#231;&#227;o com nevo seb&#225;ceo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Descrita pela primeira vez em 2002<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> como variante distinta do tricoblastoma&#44; o melanotricoblastoma ainda permanece como entidade pouco conhecida entre dermatologistas e patologistas&#59; o carcinoma basocelular &#40;CBC&#41; pigmentado &#233; seu principal diagn&#243;stico diferencial&#46; Destaca&#8208;se que essa diferencia&#231;&#227;o se torna importante em virtude do progn&#243;stico e do seguimento&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Estudos em dermatoscopia<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> demonstraram que&#44; ao contr&#225;rio do CBC&#44; 87&#37; dos TB s&#227;o les&#245;es sim&#233;tricas&#44; com &#225;rea azul&#8208;acinzentada homog&#234;nea &#250;nica &#40;em contraste com os m&#250;ltiplos ninhos ovoides do CBC&#41;&#46; Sessenta e um por cento dos TB podem ter telangiectasias arboriformes&#44; e 69&#44;6&#37; podem ter estruturas brancas &#40;cris&#225;lides inclusas&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Em rela&#231;&#227;o &#224; histopatologia&#44; ambas s&#227;o neoplasias de c&#233;lulas basaloides as quais podem apresentar variados padr&#245;es arquiteturais&#58; grandes blocos s&#243;lidos com &#225;reas c&#237;sticas&#44; micron&#243;dulos&#44; padr&#227;o adenoide&#8208;c&#237;stico&#44; em cord&#245;es etc&#46; No entanto&#44; os tricoblastomas n&#227;o apresentam conex&#227;o com a epiderme&#44; exibem estroma hipercelular caracter&#237;stico e artefato em fenda entre o estroma neopl&#225;sico e a derme adjacente&#46; J&#225; o CBC geralmente apresenta conex&#227;o com a epiderme ou epit&#233;lio folicular&#44; estroma com alguma diferencia&#231;&#227;o mixoide e artefato em fenda entre os blocos epiteliais da neoplasia e a derme&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Um estudo avaliou a express&#227;o dos genes <span class="elsevierStyleItalic">BRAF</span>&#44; <span class="elsevierStyleItalic">NRAS</span>&#44; <span class="elsevierStyleItalic">KRAS</span> e <span class="elsevierStyleItalic">HRAS</span>&#44; e observou muta&#231;&#227;o do <span class="elsevierStyleItalic">HRAS</span> tanto em um nevo seb&#225;ceo quanto no TB originado dele&#44; indicando poss&#237;vel origem em comum&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> H&#225; casos relatados de m&#250;ltiplas les&#245;es derivadas do nevo seb&#225;ceo&#44; como a <span class="elsevierStyleItalic">syringocystadenoma papilliferum</span>&#44; tricoblastoma&#44; adenoma tubular ap&#243;crino&#44; sebaceoma&#44; tumor de infund&#237;bulo folicular e epitelioma com diferencia&#231;&#227;o seb&#225;cea&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> No entanto&#44; a neoplasia deste relato &#233; ainda mais incomum&#44; e sua diferen&#231;a consiste na prolifera&#231;&#227;o melanoc&#237;tica intratumoral e n&#227;o apenas a presen&#231;a de pigmento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">H&#225; um caso relatado na literatura de melanoma associado a melanotricoblastoma&#44; intitulado tricoblastomelanoma&#44; de uma paciente de 62 anos com les&#227;o de crescimento lento desde a inf&#226;ncia&#44; medindo 8<span class="elsevierStyleHsp" style=""></span>cm&#44; com linfonodos axilares associados&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> A presen&#231;a de uma c&#225;psula fibrosa sugeriu degenera&#231;&#227;o da les&#227;o para melanoma posterior ao surgimento do TB&#44; e a paciente&#44; ap&#243;s ex&#233;rese ampla&#44; apresentava dois anos de seguimento sem progress&#227;o da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Nesse caso&#44; foi observada a muta&#231;&#227;o NRAS&#44; rara muta&#231;&#227;o presente em melanomas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nosso caso se encaixa naqueles citados anteriormente na literatura&#44; de crescimento lento no couro cabeludo&#44; em mulher de 59 anos de idade&#46; No entanto&#44; n&#227;o se associou a nevo seb&#225;ceo nem ceratose seborreica&#44; como descritos anteriormente&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;7&#8211;10</span></a> Pela nossa revis&#227;o&#44; trata&#8208;se do sexto caso relatado&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Permanece em discuss&#227;o se o melanotricoblastoma seria uma variante ou um sin&#244;nimo de tricoblastoma pigmentado&#44; uma vez que apenas ap&#243;s o advento da imuno&#8208;histoqu&#237;mica foi poss&#237;vel identificar a presen&#231;a e quantificar os melan&#243;citos nos blocos tumorais&#46; O melanotricoblastoma destaca a forte associa&#231;&#227;o das c&#233;lulas epiteliais e melanoc&#237;ticas presente na estrutura do fol&#237;culo piloso&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A intera&#231;&#227;o entre queratin&#243;citos e melan&#243;citos no surgimento das les&#245;es neopl&#225;sicas ainda &#233; campo pouco explorado e pouco conhecido&#44; e a presen&#231;a de les&#245;es com mistura desses componentes indica haver import&#226;ncia em se conhecer melhor essa rela&#231;&#227;o&#44; at&#233; mesmo num contexto fisiopatol&#243;gico&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Juliana Polizel Ocanha&#8208;Xavier&#58; Conceito&#44; investiga&#231;&#227;o&#44; seguimento e ex&#233;rese cir&#250;rgica&#44; escrita &#8211; original&#44; revis&#227;o e edi&#231;&#227;o&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Jos&#233; C&#226;ndido Caldeira Xavier&#8208;J&#250;nior&#58; Investiga&#231;&#227;o&#44; an&#225;lise histopatol&#243;gica&#44; escrita &#8211; revis&#227;o e edi&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflito de interesses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Refer&#234;ncia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">G&#234;nero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade &#40;em anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localiza&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tamanho &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Les&#227;o associada a nevo seb&#225;ceo&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Kanitakis et al&#46;&#44; 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Kim et al&#46;&#44; 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Dorso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hung et al&#46;&#44; 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Quist e DiMaio&#44; 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mizuta et al&#46;&#44; 2021&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Perna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Presente caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Couro cabeludo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o&nbsp;\t\t\t\t\t\t\n
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ISSN: 26662752
Original language: Portuguese
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